Open Enrollment: Tools for Success: Here are some essential tools for marketing and selling our 2020 qualified health plans in the individual market to existing members and new prospects.

Plan Information:

Get links to 2020 Plan Comparison Charts, Summaries of Benefits and Coverage and Benefit Highlights in this new flier PDF.

Renewal Packets:

Active members of retail plans should be receiving their renewal packets for 2020. Here are the details PDF, including links to sample packets.

Retention Call Center:

Your clients can access a special retention call center for producer sold business PDF to help renewing members through open enrollment. When your clients use the call center, you remain the producer of record.

Retail Producer Portal:

The portal allows you to complete and submit enrollment applications for your clients. Control the entire sales cycle from quote to effectuation. For details, see our guide PDF.

Agency Alert Re: Marketplace Registration:

Writing producers must be registered with the Marketplace before helping clients enroll in Marketplace policies. See our Agency Alert for details PDF.

SMALL GROUP (1-50)

2020 No Contribution/No Participation Option Period Starts Nov. 1

If your new ACA/small group (1-50 employees) wants to elect the No Contribution/No Participation Option,

follow these directions and deadlines.

 

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Marketplace 2020 Plan Information Now Available: On October 25, 2019, CMS launched updates to window shopping (the “See plans & prices” page on HealthCare.gov) that allows consumers and their agents and brokers to preview 2020 plans and prices before Open Enrollment begins. As in previous years, window shopping lets consumers browse plans without logging in, creating an account, or filling out the official application.

Starting November 1, consumers can log in to HealthCare.gov and CuidadodeSalud.gov or call 1-800-318-2596 to fill out an application and enroll in a 2020 Marketplace health plan. Agents and brokers may also work with direct enrollment partners to enroll consumers in Marketplace plans for plan year 2020.

For more information, see these additional plan data resources released today:

2020 Health Insurance Exchange Premium Landscape Issue Brief

To view the Department of Health & Human Services 2020 Health Insurance Exchange Premium Landscape Issue Brief, visit: https://www.cms.gov/CCIIO/Resources/Data-Resources/QHP-Choice-Premiums.html

2020 Plan Landscape Data

For more information on 2020 individual and family health plans available in the Federal Health Insurance Exchange, visit: https://www.healthcare.gov/health-and-dental-plan-datasets-for-researchers-and-issuers/

2020 Health Insurance Exchange Public Use Files

To see the 2020 Health Insurance Exchange Public Use Files, visit:

https://www.cms.gov/cciio/resources/data-resources/marketplace-puf.html

2020 Quality Rating System Public Use Files

To see the Plan Year 2020 Quality Rating System Public Use Files, visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.html

2020 Issuer Participation County Map

To see the 2020 Issuer Participation County Map, visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Health-Insurance-Exchange-Coverage-Maps.html

To learn more about new quality rating information, the streamlined HealthCare.gov application, and other key updates and enhancements for the 2020 Open Enrollment, follow this link: https://www.cms.gov/newsroom/fact-sheets/federal-health-insurance-exchange-2020-open-enrollment

 

Applies to: Small Groups: (1-50 employees) / Deadline: December 16, 2019: From Nov.1 through Dec.15, 2019, small groups purchasing ACA/Metallic plans may opt to waive participation and contribution requirements.

The No Contribution/No Participation Option is available to new groups:

* Applying for coverage during the annual open enrollment period

* Sold during the open enrollment periods for Jan.1 and Jan.15, 2020, effective dates

Submission dates and deadlines:

If your new ACA/small group wants to elect the No Contribution/No Participation Option, please submit the small group enrollment with all required documentation via the ACA Small Group Enrollment tool between Nov. 1 and Dec.16, 2019.

* The group must sign the enrollment paperwork by Dec.15, 2019, and we must receive the enrollment by Dec.16, 2019.

* If we receive the enrollment after Dec.16, standard small group participation and contribution levels will apply.

 

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FEDERAL POVERTY LEVEL (FPL): A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.

The 2019 federal poverty level (FPL) income numbers below are used to calculate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). 2018 numbers are slightly lower, and are used to calculate savings on Marketplace insurance plans for 2019.

  • $12,490 for individuals
  • $16,910 for a family of 2
  • $21,330 for a family of 3
  • $25,750 for a family of 4
  • $30,170 for a family of 5
  • $34,590 for a family of 6
  • $39,010 for a family of 7
  • $43,430 for a family of 8

 

How federal poverty levels are used to determine eligibility for reduced-cost health coverage.

  • Income between 100undefined FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
  • Income below 138undefined FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.
  • Income below 100undefined FPL, you probably won’t qualify for savings on a Marketplace health insurance plan or for income-based Medicaid.

“Income” above refers to “modified adjusted gross income” (MAGI). For most people, it’s the same or very similar to “adjusted gross income” (AGI). MAGI isn’t a number on your tax return.

Read More at: https://www.healthcare.gov/glossary/federal-poverty-level-fpl/

2020 COVERAGE FOR LAWFULLY PRESENT IMMIGRANTS: Lawfully present immigrants are eligible for coverage through the Health Insurance Marketplace.

The term “lawfully present” includes immigrants who have: “Qualified non-citizen” immigration status without a waiting period (see details below) Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking) Valid non-immigrant visas Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals) See a full list of immigration statuses eligible for Marketplace coverage.

Lawfully present immigrants and Marketplace savings

If you’re a lawfully present immigrant, you can buy private health insurance on the Marketplace. You may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income.

If your annual income is 400undefined federal poverty level: If you’re not otherwise eligible for Medicaid you’ll be eligible for premium tax credits and other savings on Marketplace insurance, if you meet all other eligibility requirements.

Immigrants and Medicaid & CHIP

Immigrants who are “qualified non-citizens” are generally eligible for coverage through Medicaid and the Children’s Health Insurance Program (CHIP), if they meet their state’s income and residency rules.

In order to get Medicaid and CHIP coverage, many qualified non-citizens (such as many LPRs or green card holders) have a 5-year waiting period. This means they must wait 5 years after receiving “qualified” immigration status before they can get Medicaid and CHIP coverage. There are exceptions. For example, refugees, asylees, or LPRs who used to be refugees or asylees don’t have to wait 5 years.

The term “qualified non-citizen” includes:

* Lawful Permanent Residents (LPR/Green Card Holder)

* Asylees

* Refugees

* Cuban/Haitian entrants

* Paroled into the U.S. for at least one year

* Conditional entrant granted before 1980

* Battered non-citizens, spouses, children, or parents

* Victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa

* Granted withholding of deportation

* Member of a federally recognized Indian tribe or American Indian born in Canada

Medicaid & CHIP Coverage for Lawfully Residing Children and Pregnant Women

States have the option to remove the 5-year waiting period and cover lawfully residing children and/or pregnant women in Medicaid or CHIP. A child or pregnant woman is “lawfully residing” if they’re “lawfully present” and otherwise eligible for Medicaid or CHIP in the state. Learn how someone is defined as lawfully present.

Twenty-nine states, plus the District of Columbia and the Commonwealth of the Northern Mariana Islands, have chosen to provide Medicaid coverage to lawfully residing children and/or pregnant women without a 5-year waiting period. Twenty-one of these states also cover lawfully residing children or pregnant women in CHIP. Find out if your state has this option in place.

Getting emergency care

Medicaid provides payment for treatment of an emergency medical condition for people who meet all Medicaid eligibility criteria in the state (such as income and state residency), but don’t have an eligible immigration status.

Medicaid, CHIP, and “public charge” status

Applying for Medicaid or CHIP, or getting savings for health insurance costs in the Marketplace, doesn’t make someone a “public charge.” This means it won’t affect their chances of becoming a Lawful Permanent Resident or U.S. citizen.There’s one exception. People receiving long-term care in an institution at government expense may face barriers getting a green card.

Read More at: https://www.healthcare.gov/immigrants/lawfully-present-immigrants/

It withdrew from the market at the end of 2016, after two other insurers dropped out of the individual marketplace.

Health care startup Oscar Health sold insurance in Dallas-Fort Worth for 2016, only to lose money and drop out of the market a year later.

Now, the New York-based insurer is returning to North Texas to sell individual and family health plans on the exchange created by the Affordable Care Act.

In an interview, Oscar CEO Mario Schlosser said the company negotiated more cost-competitive contracts with local providers, so it can attract customers and keep the company on the path to profitability.

Oscar’s return to the Dallas area signals that it has the confidence to grow, even as lawmakers and presidential candidates debate changes that could shake up the health care market. It also indicates the startup is serious about competing in Texas, which has the highest uninsured rate in the country. The company has 260,000 members across the U.S., with about 1 in 4 living in Texas. It sells insurance in Austin, San Antonio and El Paso. It’ll tack on two extra Texas metro areas in 2020: Dallas-Fort Worth and Houston.

Oscar is expanding to 12 new markets and six states in 2020, its largest expansion since it was founded in 2012. It will be in 15 states and 26 markets, and will start selling Medicare Advantage in Houston and New York City.

It isn’t the only insurer in growth mode. Thirteen companies that compete in the individual marketplace are entering at least one new state in 2020 and none have announced they’re exiting a state, said Rachel Fehr, a research assistant who studies health reform and private insurance for the Kaiser Family Foundation. She said the companies have remained profitable despite policy changes — such as the repeal of a mandate that required most Americans to buy insurance or pay a fine.

“It’s definitely a stable market, despite uncertainty,” Fehr said.

In Dallas-Fort Worth, Oscar will offer about a dozen different insurance plans on the exchange for 2020. Oscar has signed contracts with Methodist Dallas and Medical City. It has deals with HCA Healthcare, the country’s largest hospital system and Medical City’s parent company, in other markets.

The last time Oscar was in the Dallas market, it partnered with Tenet Healthcare and Baylor Scott & White Healthcare System.

Oscar dropped out of the individual marketplace in the Dallas area at the end of 2016, after Aetna and Scott & White Health (a plan offered through the Dallas-based health care system) announced plans to withdraw from the marketplace. Oscar had between 7,000 and 8,000 members in the Dallas area in 2016.

Schlosser said the company had to make tough choices. At the time, he said, the company’s medical claims were about 20undefined of Oscar members’ visits to a new doctor, the company has been the source that has recommended that doctor, he said.

It has a feature that aims to get ahead of a common complaint, too. If customers are going to be billed more than $200 out-of-pocket for a claim, they get a message ahead of time that offers to answer questions.

Schlosser said Oscar and insurers on the exchange must pay attention to something that’s overlooked by many “sleepy incumbents”: customer service.

“If you hate your insurance company and you get it through your employer, you’re out of luck,” he said. “You can’t go to your employer and say, ‘Please, for the thousand people who are at this company with me, can you please change companies? I had a bad experience.’ That’s not going to happen. But in our market, you can vote with your feet.”

“In my view, that’s how all of health care should work and how all of health insurance companies should work,” he added.

BACK WITH A SPLASH

Oscar grew to $1.2 billion in annual revenue in 2018. Two years ago, it began offering Oscar for Business in select markets. The employer-based health coverage is available to companies with up to 100 employees in New York, New Jersey, Nashville and Los Angeles. It has 17,000 members covered through the plan.

Oscar will compete with other companies on Healthcare.gov in Dallas, Collin and Tarrant counties. Three companies — Blue Cross Blue Shield of Texas, Celtic Insurance and Molina Healthcare — participated in the exchange in Dallas and Collin counties in 2019. Two companies, Blue Cross and Celtic, competed on the exchange in Tarrant County in 2019. Open enrollment on Healthcare.gov begins Nov. 1.

Texas is a significant business opportunity for health insurance companies, but it’s a challenging one. Nearly 18 percent — or 5 million — of Texans did not have health insurance in 2018, according to U.S. Census Bureau data. That’s higher than any other state and double the national average of about 9%.

While some states have encouraged signups with outreach campaigns and other approaches, Texas has taken the other tack. It is one of 14 states that have not accepted funding to expand Medicaid. It set strict rules and required additional training for navigators, people who help in the community with health plan sign-ups. And Texas Attorney General Ken Paxton is leading a challenge of the ACA in court.

That means companies like Oscar have had to field their own ground game to persuade Texans to sign up for health insurance — especially those who are young, healthy and feel they can go without it.

Oscar has a Texas office in Dallas with about a dozen employees who work in sales, growth and clinical review, said Kyle Estep, market director for Oscar’s central region. It opened in 2015.

Estep said the company, originally known for catering to hipsters and freelancers, has a diverse customer base that includes lower-income families, middle-age professionals and grandparents.

In recent weeks, Schlosser visited with insurance brokers in Dallas. And Dallas residents will soon see the Oscar brand on billboards and ads on streaming services, such as Netflix.

“We’re going to really try to make a splash in Dallas and reintroduce ourselves to the market in a very convincing way,” he said.

If you are among the Californians who buy your own health insurance, a surprise may await you as the enrollment period for 2020 coverage opens this week.

Starting Jan. 1, California will become the first state to offer subsidies to middle-income people who make too much money to qualify for the federal tax credits that help consumers buy health coverage through Covered California, the state’s Affordable Care Act insurance exchange.

Many people in the middle class have struggled to afford health insurance, often shouldering the entire cost of premiums that can surpass $1,000 a month.

“The law is going to do what it is intended to do, which is to help out those people who didn’t qualify for any assistance when in reality they should have gotten something,” says Jonathan Edewards, president of Citrust Insurance Agency in Pasadena, Calif. “And those people really got hammered.”

Covered California estimates that nearly 1 million Californians could benefit from the new state money.

Also starting next year, state residents will be on the hook for a tax penalty if they are uninsured for more than three months, unless they qualify for one of several exemptions.

The penalty will mirror the federal one that was nullified — effective this year —by the 2017 federal tax reform law. In many cases, it will amount to $695 for a single adult and about $2,000 for a family of four. But for a lot of people, the financial hit could be substantially larger.

In California the deadline to enroll in coverage through Covered California or the open market is Jan. 31, but if you want the coverage to begin Jan. 1, you must sign up by Dec. 15.

Some of the $429 million worth of state subsidies available in 2020 will go to low- and moderate-income people who earn between 200undefined of the federal poverty level, or roughly $25,000 to $50,000 for an individual and $51,500 to $103,000 for a family of four, based on 2019 figures. This group also qualifies for federal tax credits. The average household state subsidy in this category would be $15 a month, Covered California estimates.

The lion’s share will go to those whose incomes are between 400undefined of the poverty level — too high for federal aid but still low enough to make health care financially challenging. That’s between about $50,000 and $75,000 a year for an individual and $103,000 to $154,500 for a family of four. The average state assistance for this group will be about $170 a month, says Peter Lee, Covered California’s executive director.

Say, for example, you are a married couple in Sacramento, both 55 years old, with an annual income of $80,000. You would not have qualified for a federal tax credit this year and would have been responsible for the entire $1,654 monthly premium for a Blue Shield of California Silver 70 HMO, the second lowest level of coverage. In 2020, you would pay $995 per month after a $688 subsidy from the state — a savings of $659 a month, despite a 1.7% increase in the premium.

You could pocket those savings, or you could bump yourselves up to a higher level of coverage with lower deductibles and copays.

For a do-it-yourself estimate of what your financial assistance might be, go to the Covered California site (www.coveredca.com) and click on “Shop and Compare.” You will be asked to enter your ZIP code, the number and ages of people in your household, and your family income.

The tool will show you a list of health plans, how much you would pay per month for each and the subsidy amount, if any, labeled “monthly savings.” Hover on that, and you will see a breakdown of state vs. federal dollars.

But before you sign up, seek free help from an insurance agent or enrollment counselor, who can guide you through the complexities of the process. Find one in your area by visiting the Covered California website and clicking on the “Find Help” tab. You can also search for local insurance agents at the National Association of Health Underwriters website (www.nahu.org) under “Membership.”

A word of caution: Be careful estimating your income. If you end up making more than you guessed, you may have to pay back some or all of the financial aid.

That has been the case for the federal tax credits since the health insurance exchanges debuted in 2014.

“That’s caused a lot of stress. I have two people this year who owe about 20 grand,” says Larry Pon, a certified public accountant in Redwood City, Calif.

You may also have to pay back some or all of your state aid if your income exceeds your estimate, but the details of how much you will owe are being finalized.

On the flip side, if you make less than expected, you can retroactively claim the credit, whether state or federal, when you file your taxes — but only if you enrolled in a health plan through Covered California.

So if you don’t seem to qualify for financial aid but think your income might drop, or you’re just not sure, strongly consider signing up with Covered California — even with no initial subsidy — instead of buying a plan through the open market.

“I am putting anybody on Covered California if there is any potential for their income to fall,” says Tom Freker, a Huntington Beach, Calif.-based insurance agent.

Maribeth Shannon and her husband, residents of Napa, Calif., plan to switch to Covered California in 2020. They are paying $1,671 out of pocket each month for a Kaiser Permanente bronze HMO that they purchased outside the exchange, and they just learned it will rise to $1,834 in 2020. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanante.)

Shannon, 63, is retired. Her husband, also 63, is self-employed, and his income fluctuates. She thinks that by working less, he can reduce it enough next year to qualify for a state subsidy. He’s been wanting to cut back anyway, “and this has really given us the motivation to speed up his retirement plan,” she says.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

READY, SET, QUOTE!
2020 ACA Small Group (1-50) new business plans are now available for quoting.
The plan designs and rates for new groups can be found in Blue Access for Producers on the eSales Tools home page for Jan. 1, 2020, effective dates. If you have any questions, please contact your sales executive or general agent.

Review Helpful Changes to Small Group Paperwork Due Date and HMO Disclosure Form.If you need a few extra days to submit December renewals or want to reduce the number of required forms, we have you covered. Find out how we’re making the Q4 rush easier.

Group:

New This Fall: Producer Ancillary Bonus Program

Learn about the new, expanded producer bonus program for Blue Cross and Blue Shield of Texas (BCBSTX) ancillary products. These include life, disability, dental, vision, critical illness and accident insurance. Our new program PDF will provide you the ability to earn:

* Up to a 5undefined for persistence on existing case

Big picture:

The updated incentive program for 2020 business was designed with producer feedback to improve the dental program. It will align with and complement the Medical Package Pricing that rolled out for medical and ancillary in September. For questions, contact your BCBSTX representative.

Q4 Is Here; Get Your Mid-market Quotes Faster

Want to know how to get your 2020 quotes back quickly? See our mid-market quoting tips.

Contact our Enrollment Support Team at 1-866-590-9771 or support@enrollinsurance.com for more BCBS information.