Transcript Kaitlyn Kenney Presentation - Alliance for Health Reform

Presentation to:
Alliance for Health Reform
Congressional Briefing
Kaitlyn Kenney
Director, Policy & Research
Health Connector
May 24, 2010
Role of the Health Connector
• The Massachusetts “Exchange”
– Established as part of MA Health Care Reform
in 2006
• Responsibilities:
– Administration of two programs:
• Commonwealth Care for subsidy-eligible adults (< 300% FPL)
• Commonwealth Choice for unsubsidized non-group &
small-group insurance
– Young Adult Plans (YAPs) offered through this program
– Policy development:
• Affordability Schedule
• Minimum Creditable Coverage (MCC) regulations
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Young Adult Plan Development
• DOI and Health Connector developed
regulations to define YAP benefits
– Coverage includes: inpatient and outpatient
hospital services, physician services for
physical and mental illness, emergency
services, and all MA mandated benefits
– Offered both with and without prescription
drug coverage
– May include annual benefit max of no less
than $50,000
• YAPs sold to individuals ages 18 – 26 solely
through the Health Connector
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YAPs vs. Catastrophic Plan
Massachusetts
YAPs
PPACA
Catastrophic Plan
Eligibility:
•Age
18 – 26
Under 30 years old, OR, if access to
affordable coverage is not available*
•If access to ESI?
No
Yes, if coverage is not affordable
•First Dollar Coverage
Yes, for some services
Yes, only for 3 primary care visits
•Annual limits
Allowed, and most include
No
•Deductibles
$250 or $2,000
Equal to Out-of-Pocket Maximum for
HSA-qualified HDHPs ($5,950 ind in
2010)
•Out-of-Pocket Maximum
$5,000
Same as above ($5,950 ind. in 2010)
•Prescription Drug Coverage
Not required
Required
Benefit Design:
*This could have an impact on the demographics and risk profile of this population, which in turn could impact
premium prices.
Commonwealth Choice:
Shopping Experience
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Commonwealth Choice:
Shopping Experience (con’t)
Step 1: Select Family Size
Step 3: Provide demographic info and select coverage
start date
Step 2: Determine whether eligible for
subsidized plan
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Commonwealth Choice:
Shopping Experience (con’t)
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Commonwealth Choice:
Shopping Experience (con’t)
Step 5: Select High or Low and With or Without prescription drug coverage
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YAP Enrollment
• YAP subscribers represent about 25% of
total non-group enrollment (~4,700 subscribers)
• About 80% of those eligible for a YAP
enroll in a YAP
– About 67% of individuals choosing a YAP
select a plan with prescription drug
coverage
• MA extended dependent coverage, but
expansion under PPACA may impact YAP
take-up
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