1. Delaware’s Health Insurance Marketplace: Update on Activity Delaware Health Care Commission, April 10, 2014 Secretary Rita Landgraf, Department of Health and Social Services

2. Agenda Marketplace enrollment update Special Enrollment Periods Medicaid update Stories from the ground Consumer Assistance update Media and Outreach update Plan Management update Important reminders 2

3. Enrollment Update

4. Marketplace and Medicaid Enrollment Update As of March 31, 2014, 14,746 Delawareans have enrolled in health care coverage through expanded Medicaid and the Marketplace since October 1, 2013 4

5. Marketplace and Medicaid Enrollment Update Enrollment for the 6-Month Period: October 1, 2013 through March 31, 2014* Total Number of Enrollees Increase from previous month Marketplace*11,33562% Medicaid3,41157% Total14,74661% *This number represents Delawareans who have selected a Marketplace plan, either through Healthcare.gov or through direct enrollment with an issuer (with or without the first premium payment having been received directly by the Insurance Company.) 5

6. Marketplace Enrollment

7. Marketplace Enrollment Update Marketplace Plan Selection by Metal Level — Silver plans account for 57% of the plan selections in the Delaware Marketplace. Metal level distribution (rounded to the nearest whole number): Bronze = 15% Silver = 57% Gold = 19% Platinum = 7% Catastrophic = 1% Marketplace Plans: Financial Assistance — More than three-quarters (79%) of the Delawareans who have selected a Marketplace plan will be receiving Federal financial assistance in paying their premiums. This includes people who qualify for an advance premium tax credit (APTC), with or without a cost-sharing reduction (CSR). Paid Premiums* — 63% of those who selected plans by March 31 st had paid their first month’s premium. *Reminder—those who enrolled between March 16 and March 31 st have until April 30 th to pay their first month’s premium for coverage to go into effect on May 1 st. 7

8. Marketplace Enrollment Update: Comparison by Age Enrollees% Enrolled Age Groups 0 -171,24711% 18 – 257867% 26 – 341,69115% 35 – 441,79916% 45 – 542,49122% 55 – 643,28529% 65+36<1% Total11,335100% 8

9. Marketplace Enrollment Update: Comparison by County Enrollees% Enrolled County Kent1,42713% New Castle7,05962% Sussex2,84825% Total11,334100% 9 *Data received from the issuer only included county identification for 11,334 enrollees.

10. Marketplace Enrollment Update: Comparison by Gender Enrollees% Enrolled Gender Male5,06945% Female6,26655% Total11,335100% 10

11. Marketplace Enrollment Update: Metal Level Comparisons by Age 11 Delaware Marketplace Enrollment 0-1718-2526-3435-4445-5455-6465+ Bronze1551102482543945649 Silver6004389481,0561,5111,92924 Gold3451412663264446281 Platinum133611321631421642 Catastrophic143697 N/A Total1,2477861,6911,7992,4913,28536

12. Marketplace Enrollment Update: Metal Level Comparisons by Gender and County 12 Delaware Marketplace Enrollment New CastleKentSussex Bronze1,126209399 Silver3,9968381,672 Gold1,268291591 Platinum56767163 Catastrophic1022223 Total7,0591,4272,848 Delaware Marketplace Enrollment MaleFemale Bronze812922 Silver2,7923,714 Gold9981,153 Platinum379418 Catastrophic8859 Total5,0696,266

13. Marketplace Enrollment Update: The “Young Invincibles” 13 Age Group% of Total Enrollment % Uninsured 1 0-17 11% 18.56% 18-25 7% 19.07% 26-34 15% 20.75% 35-44 16% 17.89% 45-54 22% 13.32% 55-64 29% 10.41% 1 Derived from a 2 year average of 2012 and 2013 Current Population Survey (CPS) data. *Note: Insurance company enrollment information does not indicate if enrollees were previously uninsured 22% of Marketplace enrollees are in the “Young Invincible” age group (ages 18-34). The national average of enrollments for this critical age group is 25% as of March 1 st. 56% of Young Invincibles enrolled through the Marketplace have chosen a Silver QHP

14. Trend of Marketplace Enrollments 14

15. Special Enrollment Periods

16. “In Line” Enrollees Delawareans who started but were unable to complete their enrollment by March 31 will have until 11:59 p.m. on April 15 to complete enrollment Coverage will be effective May 1 Consumers that complete enrollment will not have to pay the individual shared responsibility payment (tax penalty) for the month(s) that they were without coverage Consumers can enroll at Healthcare.gov or by calling the Federal help center (1-800-318-2596) and attesting that they tried to start the process before April 1 16

17. Complex Cases Delawareans with certain complex cases will also be allowed additional time to complete the Marketplace enrollment process. This may include consumers: Awaiting Medicaid eligibility results That received incorrect subsidy determinationsor calculations at Healthcare.gov That encountered problems verifying an eligible immigration status Delawareans with complex cases will have 60 days from the date their issue is resolved in which to apply for and select a Marketplace plan 17

18. Qualifying Life Events Individuals who started their applications April 1 or later will be unable to purchase coverage until the next open enrollment unless they qualify for a special enrollment period because of a life change, including: Getting married Birth or adoption of a child Moving to Delaware Losing other coverage 18

19. Medicaid Newly Eligible Enrollment

20. Medicaid (Newly Eligible) Enrollment Update: Comparison by Age Enrollees% Enrolled Age Groups 19 – 2560017.6% 26 – 3484624.8% 35 – 4472721.3% 45 – 5469820.5% 55 – 6454015.8% Total3,411100% 20

21. Medicaid (Newly Eligible) Enrollment Update: Comparison by County Enrollees% Enrolled County Kent71220.9% Sussex95728.1% New Castle1,74251.1% Total3,411100% 21

22. Medicaid (Newly Eligible) Enrollment Update: Comparison by Gender Enrollees% Enrolled Gender Male1,12132.9% Female2,29067.1% Total3,411100% 22

23. Stories from the Ground 23 A husband and wife who enrolled in Bear said they were excited and amazed that they could afford coverage. They will pay $80 a month. A 61-year-old man from Frankford is paying $212 a month after a tax credit, with a deductible of $1,100. His coverage started April 1, the day after his Medicaid coverage ended. After starting her application weeks before, a Dover woman was able to enroll March 24 with the help of a Marketplace Guide. She will pay $132 after her tax credit.

24. Stories from the Ground 24 A woman, who applied Dec. 10 via the federal marketplace and was assessed as eligible for Medicaid, reached out about the status of her case. She was determined eligible for Medicaid, effective Jan. 1, and was notified of her eligibility. Her phone number, transferred from the FFM, was one digit off. A Marketplace Guide assisted a 34-year-old Dover woman. After a tax credit, she will pay $97 a month, is glad to avoid the penalty, and grateful for the guide’s assistance “because she had a lot of issues with the application.” A family of three from Wilmington walked into enrollment blitz. The mom has coverage through her job, but can’t add her husband or daughter. The dad was eligible for a tax credit and will pay $189 a month for his marketplace plan. The daughter was eligible to apply for CHIP. The Rev. Dr. Donald Morton of New Castle, who enrolled Dec. 24, revealed that doctors had diagnosed him with prostate cancer. After 20 years without coverage, he is grateful to have health insurance now.

25. Consumer Assistance Update

26. Marketplace Guide Activities to Date As of April 8, 2014: 1,107 completed enrollments 2,086 completed applications 2,155 outreach activities conducted 1,363 referrals to Medicaid 26

27. Guide Support Remains Available Guides will continue to provide enrollment assistance for consumers that qualify for a special enrollment period and those that are still completing enrollments started on or before March 31. Delawareans that attempted to enroll prior to March 31 still have time, but must complete enrollment by April 15. List of Guide assistance locations and contact information is available at www.ChooseHealthDE.comwww.ChooseHealthDE.com 27

28. Outreach Strategy for Next Open Enrollment Work to prepare for the next open enrollment has begun Refocusing our outreach efforts on known uninsured including identified internal audiences and through community partners Assessing best locations for Guide support and placement Focusing on special populations, including Hispanic/Latino Employees of small businesses Refining our resource needs to best accomplish this strategy 28

29. Continued Presence Choose Health Delaware will maintain a community and limited media presence throughout the non-open enrollment period ChooseHealthDE.com will continue to be a resource for updates on the Health Insurance Marketplace, including Special Enrollment Periods and preparations for the next open enrollment Developing partnerships and engaging stakeholders will be a focus for the non-open enrollment period as we work toward integration and long-term sustainability Providers including mental health, FQHCs Agents/Brokers CACs and other enrollers 29

30. Next steps for the newly insured Go to Healthcare.gov and ChooseHealthDE.com for official resources and FAQs, including how to use insurance coverage Connect to primary care and establish a provider relationship 30

31. Media and Outreach Update

32. 2014 Traffic to ChooseHealthDE.com January 1-April 6, 2014 Visits: 60,652 Pageviews: 245,782 Pages/Visit: 4.05 Avg. Visit Duration: 2:02 Media 32

33. Total Traffic to ChooseHealthDE.com When paid media and search media campaigns ran, traffic to ChooseHealthDE.com increased significantly. o In 2013, paid media and search drove 56% of all traffic to the site. o In 2014*, paid media and search drove 64% of all traffic to the site. *2014 includes January 1-April 6 33

34. Clicks from ChooseHealthDE.com to Healthcare.gov Between January 1-April 6, 2014, there were 7,822 clicks from ChooseHealthDE.com to Healthcare.gov. ChooseHealthDE.com Healthcare.gov 34

35. Bruno Mars Ticket Contest Promoted Post March 7- 9 Contest Registrations/New Fans Acquired: 75 35

36. Plan Management

37. Insurance rates: Small group vs. Individual Market There is a rate difference between small group and individual markets. The main reason is the transitional reinsurance program, which benefits only the individual market. The ACA established the transitional reinsurance program from 2014-2016 to stabilize individual market rates. Reinsurance fees are distributed to insurers to offset the costs of high-cost individuals, assuming that the individual market will disproportionately attract high- cost enrollees The reinsurance program phases out over three years, so as the transitional reinsurance program winds down and then is eliminated, the individual and small group premiums may start to come together. 37

38. Plan Management: Preparing for Plan Year 2015 May-Sept 2014 DOI reviews plans for compliance with federal and state laws and standards Areas for review include rates, benefit design, cost-sharing, network adequacy, among others October 2014 Federal government conducts final QHP reviews and certifies state- recommended plans DOI releases Premium Rate information November 2014 Federal government releases list of certified QHPs for Plan Year 2015 Open Enrollment begins November 15 th for Plan Year 2015 The DOI and Plan Management Team are already working with insurance companies and the federal government to prepare for the Second Open Enrollment Insurance companies are currently designing health plans to meet new or updated federal guidelines; developing premium rates and cost-share variations; and evaluating provider networks to ensure compliance with state and federal standards and regulations CMS is finalizing process guidelines and development of tools to support the QHP review. 38

39. Plan Management: Looking Ahead The Marketplace Program team will work with the HCC to review current state- specific QHP Standards and Essential Health Benefits (EHBs), and develop recommendations for changes for implementation in Coverage Year 2016 Proposed Schedule of Activities 39 StepActivityProposed Timeline 1 Review current QHP Standards and EHB benchmark to identify opportunities for modification/additions. April - July 2014 2 Submit list of recommended changes to EHB and QHP Standards to HCC for review and comment July –August 2014 3 Conduct Public Comment Period on proposed changes to QHP Standards and EHB Benchmark August - September 2014 4 Review stakeholder feedback on proposed changes and develop final recommendations for HCC review September - October 2014 5Review Final Recommendations with HCCOctober 2, 2014 6Solicit HCC decision (approval/denial) on recommended changesNovember 6, 2014 7Publish Delaware EHB benchmark and QHP Standards for Coverage Year 2016December 1, 2014

40. Important Reminders

41. Penalty If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. They also have to pay for all of their health care. For 2014, consumers will pay whichever of these amounts is higher: 1% of yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average yearly premium for a bronze plan. $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285. The fee increases every year. In 2015, it’s the higher of 2% of income or $325 per person. In 2016 and later years it’s the higher of 2.5% of income or $695 per person. For those uninsured for just part of the year, 1/12 of the yearly penalty applies to each month without insurance. Those uninsured for less than 3 months do not have a penalty. 41

42. Penalty Tax Year 2014 Tax Year 2015 Tax Year 2016 Beyond TY 2016 Income-based penalty 1% of household income above the filing threshold 2% of household income above the filing threshold 2.5% of household income above the filing threshold Minimum penalty amount $95/person$325/per person $695/person$695 + inflation adjustment/per person 42 For more information on the Individual Shared Responsibility Payment, go to: Healthcare.gov https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/ IRS http://www.irs.gov/uac/Newsroom/The-Individual-Shared-Responsibility-Payment-An-Overviewhttp://www.irs.gov/uac/Newsroom/The-Individual-Shared-Responsibility-Payment-An-Overview

43. Key Dates for Consumers DateMilestone April 15, 2014Deadline for those consumers “in-line” by March 31 st to complete their enrollment November 15, 2014-February 15, 2015Open enrollment for coverage in Plan Year 2015 43 Notes: Medicaid enrollment can occur at anytime. Employers may continue to enroll in SHOP on a rolling monthly basis. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.