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Wednesday, December 18, 2013

An Obamacare Overview - with data slides from Maine Commissioner Cioppa

I was assigned to be scribe when our Maine Insurance Commissioner Eric Cioppa spoke at the Rotary Club of Portland Maine.  Commissioner Cioppa gave an informative, fact filled talk about the Affordable Care Act, accompanied by power point data slides. (link included)

Take away message from the Commissioner is this - Medicare Beneficiaries are not impacted by Obamacare. 

Otherwise, beneficiaries are able to shop for affordabe plans based upon the co-pays a person or family can afford, rather than on what services are, or aren't, covered, without regard for pre-existing conditions. Nevertheless, enrollment of young and healthy enrollees are essential to create coverage providing affordable premiums.

Here’s a link to the Bureau of Insurance website where you can view/download Eric Cioppa's slides on the Affordable Care Act.


Rotary Club of Portland Friday December 6, 2013

Speaker Eric A. Cioppa Maine Superintendent of Insurance

Julie's notes published in the Windjammer Newsletter December 6, 2013:  Rotary President Jack Marr introduced Maine’s Superintendent of Insurance Eric A. Cioppa, who spoke about the Affordable Care Act (ACA) and Maine’s Health Insurance Market.

Mr. Cioppa said the ACA is complex legislation. Some provisions are already in effect. 

Since 2010, the ACA has lifted lifetime limits on coverage; children up to 19 years old are covered without exclusions for pre-existing conditions; children can receive coverage under their parents’ private insurance plans up to 26 years of age

Enrollment in the health insurance exchanges for individuals required to receive coverage in 2014, began October 1, 2013. The envollment period extends until March 31, 2014. Coverage starts as soon as January 1, 2014.

Medicare beneficiaries are not impacted by the Affordable Care Act.

Mr. Cioppa explained where the nation and Maine are at regarding the costs of providing health care. Cost of providing health care in the USA is nearly 20 percent of the Gross Domestic Product (GDP), but this isn’t an indicator of quality. For example, Japan has the world’s longest life expectancy but their expenditures on health care are lower than the USA. In 2009, Maine was number 5 in the nation reporting per capita health care costs. Less than half of Maine’s population receives health coverage through private insurance. Other coverage is provided by Medicare, Medicaid and the military. Additionally, 133,000 Maine people are uninsured.

The breadth of the ACA affects all aspects of private health insurance.Everyone must be covered in 2014 or be subject to a penalty fee.

Employers who provide coverage under the ACA law fall into two categories. Those with 50 or more employees are large groups; those with 49 and less are small groups.

Beginning in 2015, employers with 50 or more full time equivalent (FTE’s) employees must make coverage available to their full-time employees and their dependents. Coverage must be affordable, meaning the employees’ share of premiums cannot exceed 9.5 percent of their income (based on the cost of the employee’s coverage only and not the cost of family coverage). A full time employee is defined as one who works 30 hours or more a week averaged over one month. Failing to offer the minimum coverage involves a penalty at $2000 per year times the number of full-time employees, minus 30. Employers determined to offer unaffordable coverage also invokes a penalty. Nevertheless, penalties are less than the cost of providing coverage.

A Minimum Medical Loss Ration (MLR) requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement. It also requires them to issue rebates to enrollees if this percentage doesn’t meet minimum standards. MLR requires insurance companies to spend at least 80% of premium dollars on medical care for those who purchase individual plans; 80% for those enrolled in small group plans and 85 % for those in large group plans.

Preventive care is 100 percent covered.

Carriers for Maine’s Health Insurance Individual Marketplace are Anthem and Maine Community Health Option; small group market carriers are Anthem and Maine Community Health Options (MCHO); Large Group Market carriers are Anthem, Connecticut General, Harvard Group, Nationwide, Aetna Group and United Healthcare.

Individuals are mandated to obtain minimum coverage beginning January 1, 2014. Access to coverage is offered via a “no wrong door” or single entry concept. Individuals are eligible for Modified Adjusted Gross Income (MAGI) subsidy based on a calculation of their income developed by the Federal government. The calculation also determines an individual’s eligibility to participate in the Medicaid and Children’s Health Insurance (CHIP) programs. This determination qualifies an individual for Medicaid, CHIP, premium tax credits or cost-sharing reductions. Dependents are indelible for subsidies if they’re covered by an employer plan. Tax status determines subsidies for those who fall between zero and 400 percent of the Federal poverty level. Subsidies are zero for those who fall over 400 percent of Federal Poverty level. If a beneficiary underestimates their income, a rebate is issued; but if income exceeds 400 percent of poverty level, the entire subsidy must be repaid.

The only place where subsidies are available are through the insurance exchanges. Insurance rates are contingent on recruiting young and health people into the plans.

Another provision to keep premiums affordable is the implementation of a Cadillac Tax, imposed when health insurance benefits exceed a certain threshold. This provision was put in place as an incentive for employers to reduce overutilization of health care.

Insurers will offer “metal tier plans” at these actuarial values (AV)

a. Bronze 60 %

b. Silver 70 %

c. Gold 80 %

d. Platinum 90 %

e. Catastrophic plans are available if premiums exceed 8 percent of a family’s income.

Out of picket maximum expenses for co-pays and deductibles will not exceed $6,300 per year or double that amount for a family.



Individual and small group health plans will cover essential health benefits to include at least these 10 categories: (a) ambulatory care (b)emergency services (c) hospitalization (d) maternity and newborn care (e) mental health and substance use disorder services including behavioral health treatment (f) prescription drugs (g) rehabilitative and habilitative services and devices (h) laboratory services (i) preventative and wellness services and chronic disease management and (j) pediatric services including oral and visual care.

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