1. Health Insurance Marketplace Survey of the 2019 Virginia QHP Options
12/17/2013
Health Insurance Marketplace Survey of the 2019 Virginia QHP Options
Deepak Madala
Enroll Virginia Program Manager
Virginia Poverty Law Center
October 28, 2018

2. Virginia Health Insurance Marketplace
12/17/2013
Virginia Health Insurance Marketplace
6 Plan Options
Loss of Innovation Health, United Healthcare, and Aetna Health
Anthem Smaller Service Area

3. Virginia Health Insurance Marketplace
12/17/2013
Virginia Health Insurance Marketplace
Statewide coverage, Every County and City has at least 1 option
Anthem Returned to Most of Virginia

4. Premiums and Projected Membership
Avg Rate Change from 2018 to 2019
Avg 2019 Per Member Per Month Rates
2019 Projected Covered Lives
CareFirst BlueChoice
14.5%
$809.21
5,135
Cigna
11.0%
$584.00
73,597
CareFirst PPO
45.1% $
3.101
Anthem HealthKeepers
2.5%
$730.73
94,000
Kaiser Permanente
33.8%
$641.44
54,232
Optima
-7.2%
$761.06
59,973
Piedmont
11.94%
$858.80
17,786
Virginia Premier
N/A
$575.92
3,506
Source: Virginia Bureau of Insurance, 2019 ACA Rate Filing Data available at

5. 2019 Rate Increase Drivers No Mandate in 2019
12/17/2013
2019 Rate Increase Drivers
No Mandate in 2019
Increase in Medical Costs
Short-Term and Association Health Plans
Non-Payment of Cost-Sharing Reduction Reimbursement
Decrease in Outreach and Enrollment Funding
However – Medicaid Expansion reduces rates.

6. Cost Sharing Reductions (CSRs)
Special protections for those with income under 250% FPL
Limits on Out-Of-Pocket Costs: Deductibles, Co-Pays, and Co-insurance
Only applies if Silver Plan is purchased
Increases Actuarial Value of Silver Plan to:
94% AV (income 100%-150% FPL)
87% AV (income 150%-200% FPL)
73% AV (income 200%-250% FPL)
Insurance companies provide these subsidies to reduce out-of-pocket costs for deductibles and co-pays for low-income people.
If you qualify for a CSR, you’ll still get the subsidies because insurers are required to provide them whether they get reimbursed by the government or not. Insurers would compensate for that reduced revenue by raising premiums for So the people who would suffer the most are those with higher incomes, who don’t qualify for premium tax credits or CSRs. They would feel the pain of big rate hikes most.

7. Cost Sharing Reductions (CSRs)
12/17/2013
Cost Sharing Reductions (CSRs)
Insurers are required to provide CSRs whether they get reimbursed by the government or not
Insurers have compensated for loss of CSR reimbursement by raising premiums for 2018
People affected the most are those who don’t qualify for premium tax credits
The Virginia Bureau of Insurance has confirmed that all of the exchange insurers have added the cost of CSR to their silver plans.
Adding the cost of CSR to silver plan premiums protects most enrollees, as premium subsidies are based on the cost of the second-lowest-cost silver plan, and will thus grow to keep pace with the cost of silver coverage.

8. How Much Will Coverage Cost?
Premium Cost is based on sliding-fee scale for people with income below 400% FPL:
Premium Tax Credit picks up difference between required contribution and premium for second lowest cost silver plan.
Income
Percent of income required to pay toward premiums
Up to 133% of poverty
2.01%
% of poverty %
% of poverty %
% of poverty %
% of poverty %
% of poverty
9.56%

9. Premium Tax Credit Example
Heather is 32-year old single female Annual Income of $18,090/year (150% FPL) Maximum Contribution 4% Income = $724/yr Cost of 2nd lowest Silver Plan $4,000 ($333.33/mo.) Subtract Contribution - $724 ($ 60.33/mo.) Annual Federal Tax Credit $3,276 ($273.00/mo.)
Heather can pay as little as $60.33 per month
Tax Credit of $3,276 can go straight to Health Plan

10. Premium Tax Credits Increase if Rates Increase
Annual Income of $18,090/year (150% FPL) Maximum Contribution 4% Income = $724/yr
Cost of 2nd Lowest Cost Silver Plan
Maximum Contribution for Heather
Annual Federal Tax Credit
$4,000 ($333.33/mo.)
$724 ($60.33/mo.)
$3,276 ($273.00/mo.)
$6,000 ($500.00/mo.)
$5,276 ($439.67/mo.)

11. Silver Plan Options for People w/o APTCs
12/17/2013
Silver Plan Options for People w/o APTCs
If an insurer sells the same plan ON and OFF the Marketplace then both will have same cost and as a result both will include the cost of CSRs
But OFF exchange plan doesn’t qualify for APTC
Some Issuers in Virginia have created slightly different OFF exchange only plans that do not have the cost of CSRs added
Cigna, Anthem, Piedmont, and Virginia Premier do not have OFF exchange plans
CareFirst, Kaiser Permanente, and Optima all have OFF exchange silver plans that are different from their ON exchange plans. These silver plans do not include the cost of CSRs
KP VA Silver 2500/30/Dental Off $462.98
KP VA Silver 2500/30/Dental On/Off $562.14

12. 12/17/2013
Anthem HealthKeepers
Premiums for an Adult Individual Age 40 in Roanoke, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Bronze
Anthem HealthKeepers Bronze X 6500
HMO
$439.87
Anthem HealthKeepers Bronze X 5250
$448.77
Anthem HealthKeepers Bronze X 5900
$460.74
Anthem HealthKeepers Bronze X 4900 for HSA
$465.43
Anthem HealthKeepers Bronze X 5700 Online Plus
$467.26
Gold
Anthem HealthKeepers Gold X 1350
$569.87
Silver
Anthem HealthKeepers Silver X 6100
$570.09
Anthem HealthKeepers Silver X 1800
$623.31
bronze and gold plans will be especially valuable in 2018 for enrollees who get premium subsidies, as the larger premium subsidies (based on the dramatically higher prices for silver plans) can be applied to plans at any metal level, despite the fact that premiums at the other metal levels don’t include the added cost to cover CSR

13. CareFirst Premiums for an Adult Individual Age 40 in Alexandria, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Gold
HealthyBlue HMO Gold $1,750
HMO
$750.51
Silver
BlueChoice HMO Silver $3,000
$801.57
HealthyBlue PPO Gold $1,750
PPO
$1,166.85
BluePreferred Silver $3,000
$1,210.27

14. Cigna Premiums for an Adult Individual Age 40 in Sterling, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Bronze
Cigna Connect 7000
EPO
$403.82
Cigna Connect 6750
$416.52
Silver
Cigna Connect 6500
$507.85
Gold
Cigna Connect 1500
$520.17
Cigna Connect 4500
$521.91

15. 12/17/2013
Kaiser Permanente
Premiums for an Adult Individual Age 40 in Fredericksburg, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Bronze
KP VA Bronze 5500/50/Dental
HMO
$517.40
Gold
KP VA Gold 1500/20/Dental
$611.16
KP VA Gold 1000/20/Dental
$626.07
Silver
KP VA Silver 6000/35/Dental
$638.47
KP VA Gold 0/20/Dental
$643.97
KP VA Silver 3200/20%/HSA/Dental
$674.87
KP VA Silver 2500/30/Dental
$718.42
Platinum
KP VA Platinum 0/5/Dental
$744.33
KP VA Silver 2500/30/Dental Off $462.98
KP VA Silver 2500/30/Dental On/Off $562.14

16. Silver Premiums Higher than Most Gold Plans
12/17/2013
Silver Premiums Higher than Most Gold Plans
Premiums for an Adult Individual Age 40 in Fredericksburg, VA
KP VA Standard Silver 6000/35/Dental
KP VA Gold 1500/20/Dental
Monthly Premium
$638.47
$611.16
Deductible
$6,000
$1,500
Out-of-Pocket Maximum
$7,900
$6,850
Primary Doctor
$35
$20
Specialist
$55
$40
Tier 2 Brand Drugs
$60
$30
KP VA Silver 6000/35/Dental Off $ (1.278 age factor for 40 year old) Geo is 1.0 $525.85
KP VA Silver 6000/35/Dental On/Off $499.59

17. Optima Premiums for an Adult Individual Age 40 in Norfolk, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Bronze
OptimaFit Bronze % Direct M
HMO
$443.48
OptimaFit Bronze % HSA Direct M
$478.79
Silver
OptimaFit Silver % Direct M
$601.63
Gold
OptimaFit Gold % Direct M
$610.31
OptimaFit Silver % Direct M
$663.65

18. Piedmont Premiums for an Adult Individual Age 40 in Lynchburg, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Bronze
Bronze Standard 6800
POS
$468.66
Bronze 7800
$471.94
Bronze HSA 5500
$504.79
Gold
Gold 1600/35/60
$606.84
Silver
Silver 6600/20%
$640.75
Silver 4500/40/25%
$651.80

19. Virginia Premier
Premiums for an Adult Individual Age 40 in Richmond, VA
Metal Level
Plan Marketing Name
Plan Type
Premium
Bronze
Preferred Bronze 6600
HMO
$379.00
Gold
Preferred Gold 1600
$499.02
Silver
Preferred Silver 6500
$503.95
Preferred Silver 4500
$518.61

20. Premium Rates Will Vary
Age
Geographic Region (12 regions in Virginia)
Metal Tier
Tobacco
Actual rates and plan details are available on

21. Maximum Out-of-Pocket in 2019
12/17/2013
Maximum Out-of-Pocket in 2019
Puts a cap on what the enrollee pays in cost-sharing charges each year
Only applies to in-network services
Out-of-Pocket limit is not the amount that an enrollee must spend each year
All people, regardless of whether they are in a family or individual health plan, will not have to pay more than the individual max for cost-sharing
2017
2018
2019
Individual Maximum
$7,150
$7,350
$7,900
Family Maximum
$14,300
$14,700
$15,800
The maximum out-of-pocket limit for self-only coverage is $7,150 (up from $6,850 in 2016). For coverage other than self-only (such as family coverage), the maximum out-of-pocket limit is $14,300 (up from $13,700 in 2016).

22. Tobacco Surcharge in Virginia
12/17/2013
Tobacco Surcharge in Virginia
Tobacco use is defined as
Using tobacco products an average of four times per week within no longer than the past six months
Religious or ceremonial uses of tobacco is excluded 
APTC does not apply to the tobacco surcharge
Tobacco users will need to pay for this additional cost.
Tobacco cessation services are included as an EHB with no cost sharing in all qualified health plans available on the marketplace

23. Tobacco Surcharge in Virginia
12/17/2013
Tobacco Surcharge in Virginia
Insurance Company
Tobacco Surcharge
Anthem HealthKeepers Blue Cross Blue Shield
0-30%
CareFirst BlueCross BlueShield 0%
Cigna
25%
Kaiser Permanente
20%
Optima Health
Piedmont
0-50%
Virginia Premier
15%
Tobacco use is defined as
Using tobacco products an average of four times per week within no longer than the past six months
Religious or ceremonial uses of tobacco is excluded 
APTC does not apply to the tobacco surcharge
Tobacco users will need to pay for this additional cost.
Tobacco cessation services are included as an EHB with no cost sharing in all qualified health plans available on the marketplace

24. Anthem Tobacco Surcharge
Age
Tobacco Factors
0-17 0%
18-24 5%
25-29
10%
30-39
15%
40-49
20%
50-59
25%
60+
30%

25. Piedmont Tobacco Surcharge
Age
Tobacco Factors
0-18 0%
19-24 5%
25-29
10%
30-34
15%
35-39
20%
40-44
25%
45-49
30%
50-54
40%
55+
50%

26. Plan Selection Checklist
12/17/2013
Plan Selection Checklist
Always consider all costs
Any services not subject to the deductible?
Check provider networks: many providers are now out-of-network
Check the prescription drug formulary and cost sharing requirements for the various drug tiers
Remind consumers to take advantage of no-cost sharing preventive services
Are there any exclusions or limitations on covered services?
premiums, deductibles, co-pays, and coinsurance vary quite a bit and can make a big difference in what people pay.

27. 12/17/2013
QUESTIONS?
Thank you!