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.

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HHS announces first guidance implementing Supreme Court’s decision on the Defense of Marriage Act

Today, the Department of Health and Human Services (HHS) issued a memo clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.  This is the first guidance issued by HHS in response to the recent Supreme Court ruling, which held section 3 of the Defense of Marriage Act unconstitutional.

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius.  “Today’s announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner.  “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”

Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in, among certain other skilled nursing facilities (SNFs), the SNF where their spouse resides (assuming that they have met the conditions for SNF coverage in the first place, and the SNF has agreed to the payment amounts and other terms that apply to a plan network SNF).  Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse.

Today’s guidance clarifies that this guarantee of coverage applies equally to all married couples.  The guidance specifically clarifies that this guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live.
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New Support for Consumer-driven Non-profit Health Plan in Nevada

— CMS awards loan to Hospitality Health Co-Op —

The Affordable Care Act creates a new type of nonprofit health insurer, called a Consumer Oriented and Operated Plan, or “CO-OP.”  CO-OPs are directed by their customers and designed to offer individuals and small businesses more affordable, consumer-friendly and high quality health insurance options. 

Starting January 1, 2014, CO-OPs, will be able to offer health plans through the new, competitive health care marketplaces in each state, called the Affordable Insurance Exchanges.  In addition to offering health plans through an Exchange, CO-OPs may also offer health plans outside of an Exchange.

CO-OP loans are only made to private, non-profit entities that demonstrate a high probability of financial viability. All CO-OPs receiving loans were selected by CMS on a competitive basis based on external independent review by a multi-disciplinary team. Only when CO-OPs meet or exceed developmental milestones are funds allowed to be incrementally drawn down.

The Centers for Medicare & Medicaid Services (CMS) recently awarded a loan to Hospitality Health CO-OP in Nevada to launch a new private non-profit, consumer-governed health insurance company, called a Consumer Operated and Oriented Plan (CO-OP).

Hospitality Health CO-OP
Service Area: Nevada
Award Amount: $65,925,396
Award Date: May 18, 2012

Hospitality Health CO-OP is sponsored by the Culinary Health Fund, its national parent Unite HERE Health, and the Health Services Coalition. Hospitality Health CO-OP will operate for everyone in the Exchanges and the individual and small group markets. Hospitality Health CO-OP plans to provide health insurance coverage statewide.

Created by the Affordable Care Act, the CO-OP Program encourages eligible groups to create new, innovative and consumer-responsive health insurance companies to increase competition in the individual and small business markets. 

“CO-OPs will promote competition and give consumers more health insurance choices,” said Marilyn Tavenner, CMS acting administrator.  “These new private non-profit insurers will be run by consumers and are designed to offer individuals and small businesses more affordable consumer-friendly and high quality health insurance plans.”

In addition to giving consumers more choices and improving competition in their states, as consumer-run insurers, CO-OPs will operate differently from traditional insurance companies.  More than half of the Board of Directors must be the customers or members of the CO-OP, and all directors must be elected by a majority vote of the members, improving accountability and transparency.  Under the Affordable Care Act, profits gained by a CO-OP must go directly back to their enrollees, to be used to lower premiums, expand benefits, or improve quality.

To ensure CO-OPs are truly new entities, the health care reform law prohibits any state-licensed health insurance company that existed on July 16, 2009, from qualifying for the CO-OP program.

CMS will closely monitor CO-OPs to ensure they are meeting program goals.  To ensure strong financial management, CO-OPs are required to submit quarterly financial statements, including cash flow and enrollment data, receive site visits and undergo annual external audits.  This monitoring is concurrent with the financial and operational oversight by state insurance regulators.  The CO-OPs are required to meet state and federal standards for qualified health plans to sell coverage through the Exchanges and the State’s Small Business Health Option Programs.

The CO-OP program offers low-interest loans to eligible nonprofit groups to help set up and maintain these issuers.  To date, a total of 12 non-profits offering coverage in 12 states have been awarded $982,472,104.

For more information on the CO-OP program and recent awardees, please visit http://www.healthcare.gov/news/factsheets/2012/02/coops02212012a.html. For more information on CO-OPs, including what federal loans are available, who can apply and licensing requirements, please visit:  http://cciio.cms.gov/resources/factsheets/coop_final_rule.html