Health Care Reform Today
General Manager, Individual and Family Plans
July 31, 2013
The final leg of the race is here as we approach the October 1st launch of the new Health Insurance Marketplaces...
Some Points Worth Noting About The New Health Insurance Marketplaces
The final leg of the race is here as we approach the October 1 launch of the new Health Insurance Marketplaces–the government-run online insurance warehouses, formally known as Exchanges–is quickly approaching. The buzz is building as employers and consumers alike seek answers to the numerous questions around how the state-run and federally-facilitated Marketplaces will work, available coverage, eligibility for premium tax credits and subsidies, to name a few.
With so many questions you may be asking yourself – where do I begin? What do I need to know? Here are some important facts and milestones I am often asked about as we prepare for this changing marketplace.
First, polls continue to show that many Americans know very little about the Marketplaces and how to use them. The timing is right for an all-out marketing and PR blitz to raise awareness. As a result, the Department of Health and Human Services’ (HHS) recently re-launched www.healthcare.gov – with new educational materials and videos. HHS and the states are also using social media, digital advertising, TV and radio to get the word out about the Marketplace.
In addition, states running their own marketplaces (e.g., CO and CT) and HHS are setting up customer call centers and launching aggressive marketing campaigns aimed at familiarizing Americans with their state specific Marketplace options. State-run Marketplaces may have their own rules and regulations in addition to the benefit and coverage provisions mandated by the Patient Protection and Affordable Care Act (PPACA). As a result, plans may vary from one Marketplace to another; this could affect the costs of the Marketplace plans, as different coverage requirements can increase or decrease rates. We have already seen a number of these campaign tactics in the market today, but expect the buzz to only get louder as we get closer to and move into the open enrollment period.
The initial open enrollment for individual and family Marketplace plans is scheduled to run from October 1, 2013 through March 31, 2014 for the 2014 plan year. However, consumers will also have opportunities to buy coverage 60 days after a “qualifying event”, such as marriage, birth or the loss of minimum essential coverage. We anticipate enrollment will grow with each passing month as consumers better understand their options and how to enroll.
Comprehensive training is expected to start in September for government-funded “navigators,” private brokers and agents. They will all play a critical role in helping individuals understand and buy insurance through the Marketplaces. As brokers and agents look for future opportunities to expand/grow their practices they may look to get certified in Marketplaces they want to “play” in to support enrollment.
Part of the process for enrolling in a Marketplace plan involves determining eligibility for a Federal Premium Tax Credit. Eligibility is based on the individual’s income and status in an employer plan. If eligible, the individual receives a subsidy, which is calculated on household income; the subsidy is paid directly to the insurance plan by the U.S. Treasury. The remaining balance (the dollar difference between the subsidy amount and the total premium charged for the plan) is paid by the individual or family.
According to the Employee Notice of Coverage Options rule, most employers need to notify all full- and part- time employees about the Marketplace by October 1. This notice gives employees information about their employer-sponsored health coverage, or not – information needed while enrolling in a Marketplace plan. Notice templates are posted on the Department of Labor website and on InformedOnReform.com.
These are just highlights of what we expect from this new insurance arena. I would encourage you to regularly reference our comprehensive Health Care Reform resource InformedOnReform.com to learn more and stay informed with the latest facts and updates. In addition, we recently hosted a web meeting on the Marketplace, which offers an overview of Marketplace developments and where Cigna will participate in 2014. Take care and I look forward to seeing you at the finish line as we sprint toward October 1.
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