Health Insurance Exchange Marketplace Opens Tomorrow

Consumers  and Small Business Owners can sign up for health plans for the first time, renew or change their plans for 2015 on HealthCare.gov [or https://www.nevadahealthlink.com/ in Nevada]; more plans are available this year

HealthcareInsuranceStarting tomorrow, consumers can sign up for 2015 health insurance plans through HealthCare.gov, the call center, or in-person assistance. With more issuers offering coverage through the Health Insurance Marketplace this year, the consumers will find more options for themselves and their families.

“When Open Enrollment begins tomorrow, consumers who are renewing their coverage or signing up for the first time will have an opportunity to obtain quality health coverage at a price they can afford,” said Health and Human Services Secretary Sylvia M. Burwell. “Whether consumers visit the simpler, faster and more intuitive HealthCare.gov or contact the call center, they’re going to find more choices and competitive prices.”

The Health Insurance Marketplace is a simpler way to purchase health insurance for Americans and their families. Consumers can go online to find and compare options, see if they qualify for lower costs, and select coverage that best meets their needs and budget. About 85 percent of those who signed up last year through the Marketplace received financial assistance. Coverage begins as early as January 1, 2015 for people enrolling by December 15, 2014. Tomorrow, the Centers for Medicare & Medicaid Services (CMS) is launching an education and outreach campaign in communities nationwide to drive both the uninsured and current enrollees to enroll in coverage or renew their coverage. Enrollment events will take place in local communities including in public libraries, churches, festivals, sports events, and community meetings.

“Tomorrow marks the beginning of an intense open enrollment and public education campaign for the Marketplace,” said CMS Administrator Marilyn Tavenner. “We want consumers to visit the Marketplace, compare their options, see if they qualify for lower costs, and reenroll or get new coverage that best meets their needs and budget.”

CMS has worked to improve the consumer experience by making the application process easier. A window shopping tool allows consumers to answer a few simple questions, such as location and family size, in order to compare plans and get an estimate on how much financial assistance they may qualify for, without needing a log-in or submitting an application.

For most consumers who are renewing coverage, up to 90 percent of their application will be pre-filled based on last year’s application. And a new streamlined application reduces the number of screens to 16 with fewer clicks to navigate through the questions for most consumers signing up for the first time. Last year, consumers went through 76 screens to sign up for coverage. This year, along with a simpler, faster application, consumers can shop and enroll on a smartphone, tablet, computer, or by calling the call center or with in-person assistance.

Tomorrow, Secretary Burwell will participate in an enrollment event at the Evergreen Health Center in Manassas, Virginia with local consumers and Certified Application Counselors who are helping consumers enroll.

Open Enrollment for the Health Insurance Marketplace begins tomorrow, Nov. 15, 2014, and runs through Feb. 15, 2015. Consumers should visit HealthCare.gov to review and compare health plan options and find out if they are eligible for financial assistance, which can help pay monthly premiums and reduce out-of-pocket costs when receiving services. All consumers shopping for health insurance coverage for 2015— even those who currently have coverage through the Marketplace — should enroll or re-enroll between November 15 and December 15 in order to have coverage effective on Jan. 1, 2015.

A number of different resources are available to help consumers find Marketplace coverage. They can get more information through HealthCare.gov or CuidadoDeSalud.gov. Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.

The Marketplace includes a Small Business Health Option Program (SHOP), designed to give small businesses new health insurance options and a simpler way to cover their employees. The SHOP is available to small employers with 50 or fewer full-time equivalent employees. Starting tomorrow, November 15, 2014, the SHOP Marketplace will allow qualifying employers to find, compare, purchase, and enroll in 2015 SHOP health and dental coverage entirely online through HealthCare.gov. Employees will be able to view offers of insurance from their employer and enroll online through HealthCare.gov. Small businesses and their employees can get help from the toll-free SHOP Marketplace call center at 1-800-706-7893 or for TTY, call 711. The hours are Monday through Friday, 9 a.m. to 7 p.m. EST.

To sign up for individual and family coverage, visit: https://www.healthcare.gov/apply-and-enroll/

To sign up for small business coverage, visit: https://www.healthcare.gov/small-businesses/

For more information about Health Insurance Marketplaces, visit: www.healthcare.gov/marketplace


Note: All HHS press releases, fact sheets and other news materials are available at http://www.hhs.gov/news.

Nearly 2.2 million Americans selected plans in the Health Insurance Marketplace from October through December

Thirty percent of those who selected plans were under age 35

Nearly 2.2 million people have selected plans from the state and federal marketplaces by Dec. 28, 2013 (the end of third reporting period for open enrollment), Health and Human Services Secretary Kathleen Sebelius announced today.

A new HHS report provides the first demographic information about enrollees. December alone accounted for nearly 1.8 million enrollees in state and federal marketplaces. Enrollment in the federal Marketplace in December was seven-fold greater than the combined total for October and November – and eight-fold greater for young adults ages 18 to 34.

“Americans are finding quality affordable coverage in the Marketplace, and best of all, because coverage began on New Year’s Day, the promise and hope of the Affordable Care Act is now a reality,” Secretary Sebelius said. “Our outreach efforts have ramped up, so whether it’s through public service announcements, events, our champions or other means, we are doing all we can to find, inform and enroll those who can benefit from the Marketplace.  There is still plenty of time for you and your family to sign up in a private plan of your choice, so visit HealthCare.gov to learn more and sign up now.”

Key findings from today’s report include:

  • Nearly 2.2 million (2,153,421) people selected Marketplace plans from Oct. 1 through Dec. 28, 2013
  • These signups in the state and federal marketplaces represent a nearly five-fold increase from October-November, including nearly 1.8 million (1,788,739) people who selected a plan in December (compared with the previous two-month cumulative total of 364,682 through Nov. 30, 2013).
  • Of the almost 2.2. million:
    • 54 percent are female and 46 percent are male;
    • 30 percent are age 34 and under;
    • 24 percent are between the ages of 18 and 34, and;
    • 60 percent selected a Silver plan, while 20 percent selected a Bronze plan; and
    • 79 percent selected a plan with Financial Assistance.

Today’s report also details state-by-state information where available.  In some cases, only partial datasets were available for state marketplaces.

The report features cumulative data for the three-month period because some people apply, shop, and select a plan across monthly reporting periods.  Enrollment is measured as those who selected a plan.

To read the report visit:  http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

To hear stories of Americans enrolling in the Marketplace visit:  http://www.hhs.gov/healthcare/facts/mystory/index.html

Daniel’s Story: Finding Affordable Coverage for $70 a Month

By Salim Zymet, Digital Advisor, Department of Health and Human Services

Enrolling just a day after the Health Insurance Marketplace opened, Daniel, a 22 year old from Orlando, Florida, is one of the millions of Americans eligible for affordable health coverage through the Health Insurance Marketplace.

Daniel says he’s “thrilled” to get coverage at the price he got it, and is relieved to be covered:

“I already had health insurance, but I just wanted to see if I could do a little bit better on the marketplace, and I did. I was able to pick a much higher quality plan, and because of my income as a student, I’ll only pay about 70 bucks a month for health insurance.”

To compare plans in your area, weigh your options, and get enrolled for coverage beginning January 1st, apply on HealthCare.gov by December 15th.

There are 4 basic ways consumers can apply for and enroll in Marketplace coverage: 

  1. Online at HealthCare.gov;
  2. Over the phone by calling the 24/7 customer service center (1-800-318-2596, TTY 1-855-889-4325);
  3. Working with a trained person in your local community (Find Local Help); or by
  4. Submitting a paper application through the call center or downloading a copy at marketplace.cms.gov.

Holding Insurance Companies Accountable for High Premium Increases

— by Kathleen Sebelius, Secretary of Health and Human Services

The Affordable Care Act (ACA) prohibits some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.  It provides families and individuals with new protections against discriminatory rates due to pre-existing conditions, holds insurance companies accountable for how they spend your premium dollars, and prevents insurance companies from raising your insurance premium rates without accountability or transparency.

For more than a decade before the ACA health insurance premiums had risen rapidly, straining the pocketbooks of American families and businesses.  Oftentimes, insurance companies were able to raise rates without explanation to consumers or public justification of their actions.

One of the provisions of the ACA is that insurance companies must now reveal the percentage of premium dollars they actually spend on health care and how much they spend on administration (e.g., salaries and marketing. Prior to ACA, this type of information was a closely held secret and insurance companies pocketed a good percentage of your premium dollars. With ACA in place, that’s no longer the case. If an insurance company spends less than 80% of premiums on medical care and quality (or less than 85% in the large employer, large group market), it must rebate the portion of premium dollars that exceeded this limit. This 80/20 rule is commonly known as the Medical Loss Ratio (MLR) rule

Chart showing the percent of rate filings that requested increases of 10 percent or more. 2009: 72%, 2010: 75%, 2011: 51%, 2012: 34%, 2013: 14% Rate Review in Action
The ACA brought an unprecedented level of scrutiny and transparency to health insurance rate increases by requiring insurance companies in every state to publicly justify their actions if they want to raise rates by 10% or more.  Insurance companies are required to provide easy to understand information to their customers about their reasons for significant rate increases, and any unreasonable rate increases are posted online.

And it’s working.  A new report released today shows that the health care law is helping to moderate premium hikes.  Since this rule was implemented, the number of requests for insurance premium increases of 10% or more has dropped dramatically, from 75% to 14%.  The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggest that this slowdown in rate increases has continued into 2013.

Moreover, when an insurer does decide to increase rates, consumers are seeing lower rate increases than what the insurers initially requested.  In the review of rate requests for 10% or more, over 50% resulted in customers receiving either a lower rate increase than requested or no increase at all.

States have received $250 million in Health Insurance Rate Review Grants to help strengthen and improve their rate review processes thanks to the Affordable Care Act.  Of the 44 states that received rate review grants, 40 have reported enhancements to their rate review websites.  These website enhancements include searchable rate filings, new public comment options, live streaming of rate hearings, and plain language explanations of rate review and rate filings.

The Effective Rate Review program is one of many in the health care law aimed at protecting consumers.  The rate review program works in conjunction with the 80/20 rule, which requires insurance companies to generally spend 80% of premiums on health care or provide rebates to their customers. Insurance companies that did not meet the 80/20 rule have provided nearly 13 million Americans with more than $1.1 billion in rebates. Americans receiving the rebate will benefit from an average rebate of $151 per household.

Additionally, today we issued a final rule that implements five key consumer protections from the Affordable Care Act, including protection against denial of health coverage because of a pre-existing condition.  This rule makes the health insurance market work better for individuals, families and small businesses, and it also increases the transparency brought to rate increases by directing insurance companies in every state to file all of their rate increase requests.

For more information about the Affordable Care Act, visit http://www.healthcare.gov/index.html.

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Your Insurance Company & Costs of Coverage

The Affordable Care Act includes features that promote transparency and hold insurers accountable for how they spend your premium dollars and rate increases. “Medical Loss Ratio” and “Rate Review” are two features of the health care law that are in place and making a difference for consumers.

  • Medical Loss Ratio: Insurers must, in general, spend 80% or 85% of the premium dollars they take in on health care costs and health care improvement activities. If they do not, they must provide refunds to policy holders. Learn more about Medical Loss Ratio.
  • Rate Review: Health insurance companies must tell consumers when they want to increase insurance rates for individual or small group policies by an average of 10% or more. Learn more about Rate Reviews.

Use this search tool at healthcare.gov to find a basic profile of your insurance company or information about Medical Loss Ratio (MLR) and Rate Reviews. To get started, select your state, enter the name of your insurance company, or enter the company’s NAIC Number (consumers can find the NAIC Number on their policy document, from their state Department of Insurance website or by contacting their insurer). Then select Overview, MLR, or Rate Reviews and click the Search button. You can also use the Rate Review tool further down the page to find rate increases where you live. Note: Not all states currently have rate reviews to report.