CMS Updates May 28, 2014

CMS UpdatesMay 28, 2014

Final ASPE Report: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollment.pdf

Report Highlights:• Number of Eligible Persons who have Selected a Plan through

the SBMs and FFM: 8 million • An additional 5 million may have purchased off-Marketplace

• Number of Persons who have had a Medicaid/CHIP Determination or Assessment through the Marketplaces: 6.7 million (does not include individuals applying through State Medicaid/CHIP agencies.)

• 20 percent of the persons who have selected a Marketplace plan have selected a Bronze plan / 65 percent selected a Silver plan

• 85 percent of the persons who have selected a Marketplace plan have selected a Marketplace Plan with Financial Assistance.

• 46% Male/ 54% Female

Marketplace Enrollment Summary

Marketplace Enrollment Summary

States with Highest Marketplace Enrollment:• California (1,405,102, SBM)• Florida (983,775, FFM)• Texas (733,757, FFM)• New York (370,451, SBM )• North Carolina (357,584, SBM)

• 15 SBMs enrolled 2,573,585 • 36 FFMs enrolled 5,446,178

Key policies include: Standardizing Notices to Improve Consumer Education and

Choices Strengthening the Prescription Drug Exceptions Process Implementing Quality Standards Providing Additional Options for SHOP in 2015 Strengthening Standards for Navigators and Other Assisters Clarifies Premium Stabilization Policies

Source: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/marketstandards-5-16-2014.html

Exchange and Insurance Market Standards for 2015 and Beyond

5/28/2014CMS Updates to the Cover Arizona Coalition

Special Enrollment Periods

New Fact Sheets Posted to Marketplace.gov• SEP for People with COBRA:

http://marketplace.cms.gov/help-us/sep-for-consumers-with-cobra.pdf

• SEP People with Individual Market Plans coming up for renewal outside of the open enrollment period: http://marketplace.cms.gov/help-us/sep-up-for-renewal.pdf

• SEP and Hardship Exemption for AmeriCorps Members: http://marketplace.cms.gov/help-us/5-6-14-americorp-sepfinal.pdf

• Hardship Exemption for Consumers Who Obtained Coverage Outside the Marketplace That is Effective May 1, 2014: http://marketplace.cms.gov/help-us/2014-5-6-hardship-exemptionoep.pdf

• Assisting Young Adults Enrolling in the Marketplace Outside Open Enrollment: http://marketplace.cms.gov/help-us/assisting-young-adults.pdf

5/28/2014CMS Updates to the Cover Arizona Coalition

People with COBRA May not have been adequately informed of the

available options Can disenroll from COBRA and enroll into a

Marketplace plan One time SEP

Call the Marketplace call center Select a plan by July 1, 2014

Refer to publication: http://marketplace.cms.gov/help-us/sep-for-consumers-with-cobra.pdf

Special Enrollment Periods

5/28/2014CMS Updates to the Cover Arizona Coalition

Non-Renewing Individual Market plans (non QHP plans)

Consumers choosing not to renew Report up to 60 days before the renewal date Must select a plan within 60 days after the

renewal date Apply online

Refer to publication: http://marketplace.cms.gov/help-us/sep-up-for-renewal.pdf

Special Enrollment Periods

5/28/2014CMS Updates to the Cover Arizona Coalition

AmeriCorps/VISTA/National Civilian Corps Members Members and their dependents with no coverage or

coverage not considered minimum essential coverage eligible to enroll when they experience the following

triggering events: on the date they begin their service terms; and on the date they lose any coverage after their service term

ends have 60 days to select a plan

Refer to publication: http://marketplace.cms.gov/help-us/5-6-14-americorp-sepfinal.pdf

5/28/2014CMS Updates to the Cover Arizona Coalition

Special Enrollment Periods

Young adults maybe eligible for a SEP when he/she graduates and lose coverage, otherwise leave college age off their parent’s plan when he/she turn 26

Refer to:http://marketplace.cms.gov/help-us/assisting-young-adults.pdf

SEPS for young adults who lose health insurance

Losing employer-sponsored coverage- ongoing SEP Two options – choose only one

Get an individual Marketplace plan 60 days to enroll from the date the existing coverage

ends apply online or call the Marketplace call center

Get COBRA coverage generally, will not be able get a Marketplace plan

outside of the open enrollment period Refer to publication: http://

marketplace.cms.gov/help-us/assisting-consumers-losing-coverage.pdf

Consumers who are losing employer sponsored coverage

5/28/2014CMS Updates to the Cover Arizona Coalition

Extended coverage for children who - Aged out to foster care, and Had previously received Medicaid

Former foster children will remain eligible for full scope Medicaid until they turn 26

Refer to: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html and http://www.azahcccs.gov/applicants/categories/children.aspx

Extended coverage for former foster children

5/28/2014CMS Updates to the Cover Arizona Coalition

Hardship Exemptions and Tips

Source: https://www.healthcare.gov/exemptions/

Ensure the applicant completes all questions for every adult in the tax household and any dependent child who also needs the exemption

Encourage consumers to submit any supporting documents requested on the application

Missing information may delay processing Originals (other than the application itself) should

not be sent. Applicants should keep a copy of completed application and all documents sent to the Marketplace, along with proof od mailing.

5/28/2014CMS Updates to the Cover Arizona Coalition

Hardship Exemptions

Source: https://www.healthcare.gov/exemptions/ 1. You were homeless.2. You were evicted in the past 6 months or were facing

eviction or foreclosure.3. You received a shut-off notice from a utility company.4. You recently experienced domestic violence.5. You recently experienced the death of a close family

member.6. You experienced a fire, flood, or other natural or

human-caused disaster that caused substantial damage to your property.

5/28/2014CMS Updates to the Cover Arizona Coalition

Hardship Exemptions

7. You filed for bankruptcy in the last 6 months.8. You had medical expenses you couldn’t pay in

the last 24 months.9. You experienced unexpected increases in

necessary expenses due to caring for an ill, disabled, or aging family member.

10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.

5/28/2014CMS Updates to the Cover Arizona Coalition

11. Appeals decision found the individual eligible for enrollment in a QHP for time period when he or she wasn’t enrolled in a QHP.

12. Doesn’t qualify for Medicaid solely based on a state’s decision not to expand Medicaid eligibility.

13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.

14. You experienced another hardship in obtaining health insurance. Used for situations which don’t fit in other hardship categories, OR may be used for specific scenarios described in CMS guidance (ex: new guidance for AmeriCorps, VISTA, and NCCC members).

Hardship Exemptions

5/28/2014CMS Updates to the Cover Arizona Coalition

Uniform Glossary

A consumer resource to help people understand some of the most common but confusing jargon used in health insurance.  

Source: http://www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf

5/28/2014CMS Updates to the Cover Arizona Coalition

Purpose: Allows consumers to make “apples-to-apples”

comparisons when looking at different plans.

What it is: An easy-to-understand summary about a health plan’s benefits and coverage. All individual and group health plans must use the

same standard form to help compare plans and provide it to consumers prior to enrollment, at renewal, and anytime upon request, for example.

Summary of Benefits & Coverage

Consumers have the right to get an SBC when shopping for, enrolling in, or renewing coverage.

The SBC is available for every plan in the Marketplace. Consumers will find a Web link to it on each plan page when they enroll through HC.gov.

Consumers also have a right to receive an SBC from their insurance company or group health plan upon request at any time.

Consumers may be able to request an SBC in Spanish, Chinese, Tagalog, or Navajo.

Summary of Benefits & Coverage