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Access Health Connecticut Access Health Connecticut Health Plan Benefits & Qualifications Advisory Committee (HPBQ AC) Meeting February 21, 2019 Agenda • Call to Order and Introductions • Public Comment • Votes: Meeting Minutes (January 31, 2019) • Follow-Ups from Prior Meeting • AHCT Consumers & Buying Patterns • Wakely Consulting Presentation: 2020 Standardized Plan Designs • AHCT QHP/SADP Certification Requirements & Submission: Plan Year 2020 Timeline • Certification Requirements: Discussion Topics – Recap of 2019 Plan Year – Carrier Submittals for Consideration for 2020 Plan Year • Future Items for Discussion • Action Items • Upcoming Meeting Schedule 2 Public Comment 3 Votes: Review and Approval of Minutes: January 31, 2019 HPBQ AC Special Meeting 4 AHCT Vision and Mission AHCT Vision AHCT Mission • The CT Health Exchange supports • To increase the number of insured health reform efforts at the state and residents, improve health care national level that provide CT quality, lower costs and reduce health residents with better health, and an disparities through an innovative, enhanced and more coordinated competitive marketplace that health care experience at a empowers consumers to choose the reasonable, predictable cost. health plan and provider that give them the best value. 5 AHCT Values in Action 6 Follow-Ups from Prior Meeting Action Item Status AHCT Consumers & Buying Patterns Included in this presentation Standardized Plan Designs FOR 2020: Options for Consideration Included in this presentation Value-Based Insurance Design (VBID) Approach in Other State Exchanges Summary for Discussion 2018 Standardized Plans: Impact of Mental Health Parity Testing Refer to Appendix (Slide 34) Connecticut General Statute: Mammography Ultrasound Cost Sharing Refer to Appendix (Slide 35) Actuarial Value Calculator (AVC): AHCT Initial Results of Compliance Refer to Appendix (Slides 36-37) Review for 2019 Standardized Plans 7 AHCT Consumers & Buying Patterns Open Questions From Prior HPBQ AC Meeting • How have customer product preferences shifted? • How does APTC eligibility play a role in product selection? • How does CSR eligibility play a role in product selection? • Which plans are most popular and how has that changed? • How are repeat customer preferences changing? 8 AHCT Consumers & Buying Patterns: Metal Tier Product Preferences – 6 Year Overview Annual End of OE Proportion of Enrollment by Metal Tier* OE 1 OE 2 OE 3 OE 4 OE 5 OE 6 Catastrophic 2.2% 2.2% 1.8% 1.8% 1.5% 1.7% Platinum tier plans Bronze 16.2% 22.4% 23.3% 25.3% 35.1% 44.2% were only offered to Silver 63.4% 59.5% 61.5% 63.9% 55.6% 48.5% the on-exchange Gold 18.1% 15.1% 12.1% 9.1% 7.8% 5.5% individual market during 2015 and 2016. Platinum N/A .9% 1.4% N/A N/A N/A *Percent totals may not sum to 100% due to rounding. 9 AHCT Plan Enrollment (Subsidized) by Metal Level: Plan Years 2017 through 2019 2017 Plan Year: Subsidized % Enrollment by Metal 2018 Plan Year: Subsidized % Enrollment by Metal 2019 Plan Year: Subsidized % Enrollment by Metal Level Level Level Catastrophic Bronze Silver Gold Catastrophic Bronze Silver Gold Catastrophic Bronze Silver Gold Percent Enrollment by Metal Level Metal Level 2017 2018 2019 Catastrophic 0.4% 0.3% 0.4% Bronze 18.4% 23.2% 32.5% Silver 74.8% 70.1% 63.1% Gold 6.5% 6.4% 4.0% 10 Data for Individual AHCT plans as of end of open enrollment for plan year AHCT Plan Enrollment (Unsubsidized) by Metal Level: Plan Years 2017 through 2019 2017 Plan Year: Unsubsidized % Enrollment by 2018 Plan Year: Unsubsidized % Enrollment by 2019 Plan Year: Unsubsidized % Enrollment by Metal Level Metal Level Metal Level Catastrophic Bronze Silver Gold Catastrophic Bronze Silver Gold Catastrophic Bronze Silver Gold Percent Enrollment by Metal Level Metal Level 2017 2018 2019 Catastrophic 6.1% 4.8% 5.0% Bronze 47.7% 67.8% 72.7% Silver 28.6% 15.7% 13.0% Gold 17.6% 11.7% 9.2% 11 Data for Individual AHCT plans as of end of open enrollment for plan year AHCT Consumers & Buying Patterns: Plan Selection by Enrollees Eligible for CSRs Proportion of CSR Eligible Enrollment By Plan Metal, CSR Tier, & Year 2017 2017 2018 2018 2019 2019 Metal 94% CSR 87% CSR 73% CSR Total 94% CSR 87% CSR 73% CSR Total 94% CSR 87% CSR 73% CSR Total Catastrophic 0.1% 0.1% 0.3% 0.1% 0.1% 0.1% 0.3% 0.2% 0.1% 0.0% 0.2% 0.1% Bronze 2.7% 10.1% 22.8% 11.7% 3.6% 11.2% 27.2% 14.2% 4.6% 13.8% 37.5% 19.3% Silver 95.7% 87.3% 69.3% 84.4% 94.6% 86.5% 64.6% 81.8% 94.4% 84.9% 57.7% 78.3% Gold 1.6% 2.5% 7.6% 3.8% 1.7% 2.1% 8.0% 3.9% 0.9% 1.3% 4.6% 2.3% Grand Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Most Popular CSR Eligible Plans By CSR Tier 2019 2019 # Plan Name 94% CSR 87% CSR 73% CSR Total 1 Choice Silver Alternative POS 7,196 9,712 4,870 21,778 2 Choice Silver Standard POS 2,447 3,466 2,155 8,068 3 Silver PPO Standard Pathway X 1,166 2,233 1,451 4,850 4 Choice Bronze Standard POS 220 1,213 3,016 4,449 12 AHCT Consumers & Buying Patterns: Top 5 most popular plans (Subsidized vs. Non-subsidized) SUBSIDIZED ENROLLEES 2017 2018 2019 2017 Top 5 Plans 2018 Top 5 Plans 2019 Top 5 Plans Enrollment Enrollment Enrollment Choice Silver Standard POS 42,130 Choice Silver Standard POS 40,285 Choice Silver Alternative POS 25,685 Silver PPO Standard Pathway X 12,499 Silver PPO Standard Pathway X 11,268 Choice Bronze Standard POS 11,851 Choice Bronze Standard POS HSA 6,856 Choice Bronze Standard POS HSA 6,782 Choice Silver Standard POS 11,324 Choice Silver Alternative POS 3,642 Choice Bronze Standard POS 5,172 Silver PPO Standard Pathway X 7,022 Choice Bronze Standard POS 2,995 Choice Gold Standard POS 3,726 Choice Bronze Standard POS HSA 4,978 UNSUBSIDIZED ENROLLES 2017 2018 2019 2017 Top 5 Plans 2018 Top 5 Plans 2019 Top 5 Plans Enrollment Enrollment Enrollment Choice Bronze Standard POS HSA 7,531 Choice Bronze Standard POS HSA 11,258 Choice Bronze Standard POS HSA 8,314 Choice Silver Standard POS 4,061 Choice Bronze Standard POS 2,839 Choice Bronze Standard POS 7,406 Passage Bronze Alternative PCP Choice Gold Standard POS 2,172 Bronze PPO Standard Pathway X 2,588 2,619 POS Silver PPO Standard Pathway X 1,980 Choice Silver Standard POS 2,521 Bronze PPO Standard Pathway X 2,464 Bronze PPO Standard Pathway X 1,766 Choice Gold Standard POS 2,198 Choice Gold Standard POS 1,981 Data for Individual AHCT plans as of end of open enrollment for plan year 2017: Subsidized: 85,258 + Unsubsidized: 26,284 = Total: 111,542 2018: Subsidized: 83,627 + Unsubsidized: 30,507 = Total: 114,134 13 2019: Subsidized: 78,654 + Unsubsidized: 32,412 = Total: 111,066 AHCT Plan Enrollment: Plan Purchasing History 2017 2018 2019 2017 2018 2019 2017 2018 2019 2,827 168 17 3,978 796 355 131 46 13 355 56 16 35 164 3 Gold: 700 545 Silver: 27,586 23,610 Bronze: 565 413 5,258 30,800 13,325 120 3,812 149 12 14 25 580 40 2,859 152 12,714 271 528 2,693 12,418 Percent 2017 Gold enrollees continuously Percent 2017 Silver enrollees continuously Percent 2017 Bronze enrollees continuously enrolled in Gold through 2019: 53.8% enrolled in Silver through 2019: 76.8% enrolled in Bronze through 2019: 93.2% Exhibit includes members in Gold, Silver & Bronze metal levels that have been covered via plans available through AHCT for 14 each of the plan years (2017, 2018 & 2019); Excludes members in a Catastrophic plan during any of these years Access Health CT 2020 Individual Market Standard Plan Designs True BUSINESS PowerPoint Presentation Template PRESENTED BY February 21, 2019 Julie Andrews, FSA, MAAA – Sr. Consulting Actuary Page 15 Agenda 2020 Plan Design Review • Summary of Plan AVCs • Carrier Feedback • Proposed Plan Designs • VBID Page 16 2020 Plan Design Review Page 17 Summary of 2020 AV Changes Silver Individual Market Gold Silver Coinsurance Bronze Bronze HSA Copay Permissible AV Range 76.0%-82.0% 66.0%-72.0% 66.0%-72.0% 56.0%-65.0% 1 56.0%-65.0% 1 2019 AV Range 80.% to 82.0% 70.1% to 71.9% 70.1% to 70.4% 64.0% to 64.6% 62.5% 2020 AV Range 82.2% to 82.8% 71.8% to 73.1% 70.8% to 71.4% 65.4% to 66.0% 63.7% 1 Bronze plan designs are eligible for new expanded "de minimis" range Individual Market - CSR Plan Variations: 73% AV CSR 87% AV CSR 94% AV CSR Silver Copay Permissible AV Range 72.0%-74.0% 2 86.0%-88.0% 93.0%-95.0% 2019 AV Range 72.3% to 73.9% 86.9% to 87.9% 93.9% to 94.7% 2020 AV Range 73.8% to 75.1% 88.1% to 88.6% 94.9% to 95.0% Individual Market - CSR Plan Variations: 73% AV CSR 87% AV CSR 94% AV CSR Silver Coinsurance Permissible AV Range 72.0%-74.0% 2 86.0%-88.0% 93.0%-95.0% 2019 AV Range 73.3% to 73.5% 87.3% to 87.5% 94.76% 2020 AV Range 73.8% to 74.5% 87.9% to 88.03% 95.01% 2 73.0% CSR Silver must be have a differential of 2.0%+ with Standard Silver Page 18 2020 Benefit Cost-Sharing Carrier Feedback • Acceptable to All: • Increase MOOP • Increase Emergency Room Copay – Can go as high as $500 suggested • Changes to OP Copay – Suggest that the inpatient copay should be 2x any OP copay.
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