Leader staff writer
St. Vincent Medical Center-North in Sherwood recently hosted a seminar about the Affordable Care Act and the state’s private option approach to it ahead of open enrollment, which starts Nov. 15.
Zane Chrisman, plan management and attorney specialist for the Arkansas Insurance Department’s Arkansas Health Connector Division, led the seminar that was co-sponsored by Sam’s Club.
A dozen people attended the first of what the hospital hopes will become an ongoing series on health-related topics.
Chrisman described what the Insurance Department expects to see in 2015.
A revision to the state’s Medicaid expansion waiver, which allowed for the private option, proposes a healthcare independence accounts program.
Chrisman kicked off her presentation by saying, “We’ve had a very busy couple of years…We often described it at the department as trying to put the wings on while flying the plane. ”
The Insurance Department began working to comply with the Affordable Care Act when the president signed it in 2010, and she was hired in 2012, Chrisman noted.
The department is staying busy, but the workflow is beginning to slow down, Chrisman said.
She said the Affordable Care Act was necessary because more than 550,000 Arkansans were uninsured before it was implemented.
Arkansas is ranked No. 1 in the country for increasing its rate of insured people, Chrisman added.
She also said, precipitating the Affordable Care Act, premiums had doubled in the last 10 years with many spending more than 10 percent of their incomes on healthcare.
Arkansas had the sixth-highest uninsured rate for ages 19-64 — 26 percent — in 2010. That 26 percent dropped to 18 percent in 2013, Chrisman noted.
The state also has the second-highest number of people who earn below 400 percent of the federal poverty level. That number is 75 percent.
And Arkansas is ranked 49th in health nationwide because it has high rates of obesity, smoking and chronic disease, Chrisman said.
Chrisman said two changes are proposed for next year, adding that businesses that are required to provide coverage (those with 50 or more full-time equivalent employees) would receive notices in two months of what their plans might look like next year.
The first, she continued, is that those who fall within 50 and 100 percent of the federal poverty level will be placed on the 94 percent actuarial value plans that those between 100 and 138 percent of that level were on this year.
An actuarial value is the portion of healthcare costs that an insurance company pays, Chrisman said. With a 94 percent plan, the remaining 6 percent is the out-of-pocket expense charged to the insured person.
Second, Chrisman said, those between 50 and 138 percent of the federal poverty level will be asked to make income-based contributions to healthcare independence accounts. If they don’t, Medicaid will not cover co-pays, co-deductibles and co-insurance costs.
Chrisman said the Department of Health and Human Services, through a third-party vendor, would track the money in those accounts and be able to turn on and off cards that insured people can use to pay medical expenses.
She was not sure when in 2015 those changes would be implemented as the waiver is being processed.
Open enrollment for 2015 Affordable Care Act plans ends on Feb. 15.
But individuals and families qualify for a 60-day special enrollment period following certain life events that include moving to another state, marriage, divorce, the birth of a child, changes to income or loss of other health coverage.
Job-based plans require that a 30-day special enrollment period be granted, according to www.healthcare.gov.
Another change for next year is that employers with 100 or more employees must cover at least 75 percent of their employees starting Jan. 1. In 2016, that will go up to 95 percent.
The private option, Chris-man explained, allows eligible Arkansans to purchase plans from private insurance companies through a competitive marketplace.
It preserved the personal responsibility component lawmakers wanted, she noted. The Private option also meant better plans than those offered through the traditional Medicaid program and doctors being paid more, she said.
The private option allows employers to place individuals who qualified for Medicaid on their group plans with Medicaid paying the premiums, she continued.
Chrisman said private option-eligible individuals are childless adults ages 19-65 with incomes below 138 percent of the federal poverty level, parents ages 19-65 with incomes between 17 percent and 138 percent of that level, people who aren’t on Medicare, people who aren’t disabled and people who have not been determined to be more effectively covered by a standard Medicaid plan (such as those confined to long-term care facilities).
She said the marketplace allows individuals, families and employers to shop for high quality and affordable private plans. It also helps eligible individuals receive tax credits and cost-sharing reductions, Chrisman noted.
She said people who qualify for the tax credits have household incomes between 138 and 400 percent of the federal poverty level, are enrolled in a marketplace plan, are lawfully present and not incarcerated and are not eligible for other coverage.
Arkansas has bronze plans with 60 percent actuarial values, silver plans with 70 percent actuarial values and gold plans with 80 percent actuarial values, Chrisman said.
She noted that people who qualify for cost-sharing reductions are limited to silver plans, but the actuarial value is adjusted based on where they fall with the federal poverty level. Cost-sharing reductions are offered only to those who are at less than 250 percent of that level.
Chrisman said the benefits of using the marketplace are that every plan must have essential health benefits. Because of how Arkansas law is written and how the federal government’s Affordable Care Act website works, hearing aids and temporomandibular joint coverage will be added to some plans next year.
Chrisman said essential health benefits are ambulatory services, hospitalizations, emergency services, maternity and newborn care, mental health and substance use disorder treatment, prescription drugs, rehabilitative and habilitation services/devices, laboratory services, preventative, wellness and chronic disease management and pediatric services that include oral and vision care.
The qualified health plans on the marketplace for 2014 were through Arkansas Blue-Cross BlueShield, BlueCross BlueShield Multi-State plan, Celtic Insurance Company and QCA Health Plan Inc.
The standalone dental plans were through Arkansas BlueCross BlueShield, BEST Life and Health Insurance Co., Delta Dental of Arkansas and Dentegra Insurance Company.
Dentegra may not participate next year, Chrisman said. She said several of the others would return and additional providers have expressed interest in participating.
One benefit of the Affordable Care Act, Chrisman said, is that premiums can only be increased for age, geography, tobacco use and a change in the type of coverage.
And the premiums are limited based on income to being no more than 9.5 percent for people who fall between 350 and 400 percent on that federal poverty level scale.
Penalties for being uninsured start next year at $95 or 1 percent of adjusted gross income, whichever is greater, for each adult in the household, Chrisman added.
She also said companies with 50 or more full-time equivalent employees that don’t offer coverage with premiums no more than 9.5 percent of the employees’ incomes will have to pay a $3,000 penalty for each employee who qualifies for a tax-subsidized plan or $2,000 for each employee after the first 30, whichever is less.
She added that businesses would still be subject to those penalties if candidates who are campaigning against the Private option are elected and do away with it.
Chrisman said she doubted that would happen.
She also said, in response to a question, an employer’s coverage must be affordable for an individual. The coverage for a family may not be affordable, but that family can’t go to the marketplace and get a subsidy.
Chrisman said officials are working to close that loophole.
Until 2016, she continued, people can stay on grandfathered plans. Employers’ contributions or plan benefits must remain significantly unchanged for a plan remain grandfathered.