planning ahead for open enrollment: what’s new for 2020 · 1. engage, enroll, and retain clients...
TRANSCRIPT
Planning ahead for Open Enrollment whatrsquos new for 2020
Access Care and Engagement (ACE) TA Center July 16 2019
How to Ask a Question Attendees are in listen-only mode If you have a question use the chat
box at the lower-left of your screen to chat with the presenter
You may also email questions to acetacenterjsicom after the webinar
Can You Hear Us The audio is being shared via your computer speakersheadset
If you canrsquot hear the audio make sure your computer audio is turned on
If yoursquore still having problems please contact the host using the chat box You may also call in using the number and passcode below to hear
Call-in number 800-289-0462 Passcode 822831
ACE TA Center
The Access Care and Engagement (ACE) Technical Assistance (TA) Center supports Ryan White HIVAIDS Program (RWHAP) health care service providers to 1 Engage enroll and retain clients in health coverage
2 Communicate with clients about how to stay enrolled and use health coverage
3 Build organizational health insurance literacy thereby improving clientsrsquo capacity to use the health care system
ACE TA Center
Target Audiences RWHAP staff including case managers
RWHAP leaders and managers
RWHAP clients
Navigators and other in-person assisters that help enroll RWHAP clients
targethivorgace
Todayrsquos presenters
MIRA
DORI
LIESL
ALICIA
Session overview
Whatrsquos new for 2020
Planning ahead for Open Enrollment (OE) Account Tune-Ups
Questions and answers
Audience poll
Have you been on an ACE TA Center webinar before Yes
No
Standard Open Enrollment timelinefor 2020 plans
Whatrsquos new for 2020 Considerations for Ryan White HIVAIDS Program Recipients and Staff
What are co-pay accumulators
Policies adopted by some insurance companies that no longer count the value of a manufacturerrsquos co-pay card towards an enrolleersquos deductible or out-of-pocket maximum
Individuals would be required to pay full deductible themselves after the value of the co-pay card is used
Can result in unexpected high pharmacy costs for clients
Co-pay accumulator policies
Issuers and PBMs may refuse to apply manufacturer coupons to plan deductible and annual out-of-pocket maximums Centers for Medicare and Medicaid
Services (CMS) recently ruled co-pay coupons must count towards deductible and out-of-pocket maximum when used for brand name drugs that have no generic equivalent
Individual Mandate
The federal individual mandate requires most people to have health insurance or pay a penalty For 2019 the individual mandate will remain in
place however the federal tax penalty for not having coverage is reduced to $0
DC New Jersey and Massachusetts have state-level individual mandates which include a financial penalty Vermont individual mandate goes into effect in
2020
Additional considerations Health plan enrollment and purchasing options
2020 Plan Landscape
Silver loading is a practice whereby insurers increase premiums on silver-level plans to offset the loss of cost sharing reduction (CSR) payments Also has the affect of increasing advance premium
tax credits (APTCs) Silver-loading continues to be permissible under
federal law APTCs will shield many low-income consumers from
premium increases Significant increase in out-of-pocket maximums $8150 (self-only) $16300 (family)
Short-term limited duration insurance (STLDI)
STLDI traditionally provides coverage for a short period of time but federal regulations now allow contracts of up to 364 days
Do not renew automatically
Do not have to comply with Marketplace rules Not required to provide Essential Health Benefits
including prescription coverage
Can deny coverage for pre-existing conditions
Can impose lifetime and annual limits
Expansion of STLDI
Recent study found Brokers and insurers report increased enrollment in
STLDI in 2019 High rates of consumer confusion about coverage
limitations lack of Marketplace protections cost implications
States may limit plan duration set coverage standards or otherwise take action to limit availability and prevalence of sub-par plans
Bottom line Consumers will need assistance to find plans that meet their care and treatment needs Study conducted by Kleimann Communications Group ldquoTesting Consumer Understanding of a Short-term Health Insurance Planrdquo
Enrollment and consumer assistance changes
Expansion of non-Marketplace enrollment assistance More leniency for web-brokers and issuers to promote
non-Marketplace-compliant products during enrollment appointment
Agents and brokers may use unlicensed application assisters
Changes to Navigator program functions Removes mandatory Navigator functions including
post-enrollment support (appeals reconciliation using coverage) and tax referrals
Reduces requirements for Navigators to ensure physical and other accessibility for people with a full range of disabilities
Enrollment and consumer assistance changes cont
Changes to Navigator training standards Reduces Navigator program training standards Reduces requirement that Navigators provide
information in a culturally competent manner
Bottom line Consumers may need extra support from RWHAP recipients both during and after enrollment
Medicare Part D rule
Department of Human and Health Services (HHS) will continue to require that Medicare Part D plans cover HIV treatments Step therapy and prior authorization are not
permitted for coverage of HIV treatments Protected class protections remain intact
Medicare Advantage plans may use step therapy for Part B drugs May impact access to long-acting injectable
antiretrovirals (ARVs) expected to be available in the future
Step therapy = starting patients on less expensive treatment requiring treatment failure before a recommended regimen can be covered
Other changes
New Special Enrollment Period (SEP) foroff-Exchange enrollees whose incomesdrop within APTC range Protections against discrimination by
requiring issuers to justify reductions incoverage of medication assisted treatmentused for substance use disorder (SUD)treatment
Review HRSAHAB policy on insurance purchase
RWHAP recipients may assist eligible low-incomeclients with insurance premiums and cost sharing if1) The insurance plan includes at least one drug in each
class of core antiretroviral therapeutics from the HHSClinical Guidelines for the Treatment of HIVAIDS
2) The cost of paying for the health care coverage(premiums and cost sharing) is cost-effective in theaggregate compared to Paying for the full cost for medications and other
appropriate HIV outpatientambulatory healthservices (RWHAP Part A RWHAP Part B RWHAPPart C and RWHAP Part D) Paying for the full cost for medications (RWHAP
ADAP)
Review HRSA HAB PCN 18-01
Planning ahead Open Enrollment for 2020
Planning ahead
Open Enrollment begins on November 1 It lasts only 45 days
July ndash August Assess resources conduct training and build partnerships
Assess staff workload
Evaluate staff capacity and assess the impact of OE-related workload changes Consider workload impact of all tasks (ie
routine tasks and preparing for open enrollment) Develop work plan to accomplish open
enrollment preparation and enrollment activities
Develop a scheduling plan for staff and clients Determine staff availability for enrollment
appointments Ensure enrollment assistance is available
during non-traditional work hours
Conduct training and build enrollment staff capacity
Train staff on health insurance enrollment basics Focus on specific plan considerations for
PLWH
Consider getting staff trained as Certified Application Counselors (CACs)
Provide health insurance literacy training
Train staff to conduct lsquoAccount Tune-upsrsquo for all insurance-eligible clients
Train staff as Certified Application Counselors
Certified Application Counselors are trained individuals able to help consumers seeking health coverage options through the Marketplace
Free training from CMS available to individuals in states that use healthcaregov platform
Organizations should encourage all staff to be trained and certified as CACs
Use the ACE TA Center
Ask new staff to sign up for the ACE TA Center email list
Participate in the ACE TA Center webinars
Build enrollment partnerships
If needed identify and establish partnerships with Navigators Certified Application Counselors and other enrollment assisters Assisters may be found at partner organizations
or within your health system
Train your program staff to refer clients to these partners before and during open enrollment
Make sure partners are aware of RWHAP including role of ADAP in health coverage
targethivorgassisters
Video How Assisters Can Help People with HIV Get Affordable Coverage
targethivorglibraryresources-enrollment-assisters
July ndash October Conduct Account Tune-Ups
to
Client engagement and preparation
to
Start now Use ADAP re-certification or scheduled medical visits to Incorporate conversations about health
coverage and enrollment Schedule and conduct account-tune ups Schedule enrollment appointments
Identify and engage clients who do not have a scheduled visit before November 1
What is an account tune-up to
A pre-enrollment appointment to 1 Check client paperwork accounts and
payments 2 Review finances 3 Confirm enrollment in relevant
RWHAP insurance assistance including ADAP
4 Help clients prepare for their enrollment appointment
Account tune-ups 1 Check paperwork accounts amp payments
to
Help clients organize insurance and Marketplace paperwork
Help clients update their Marketplace account details If needed help clients
set up a Marketplace account
Review insurance documents and identify any outstanding payments or credits
Account tune-ups 2 Review finances
to
Ensure that clients who received Advance Premium Tax Credits (APTCs) have filed their federal taxes so that they remain eligible for this financial assistance
Estimate client income and report any changes to the Marketplace to avoid under- or over-payments
Account tune-ups 3 Confirm RWHAPADAP enrollment
to
Confirm eligibility and enrollment in ADAP or other RWHAP-supported premium and cost-sharing assistance If the clientrsquos certification is due within the
open enrollment period re-certify early
Account tune-ups 4 Help clients prepare for enrollment
to
Help clients identify their coverage priorities including HIV medications and preferred providers Dedicate time to educate clients on the
importance of health coverage and answer questions
Account Tune-ups in action
According to the 2019 ACE TA Center Needs Assessment findings organizations are conducting many key components of account tune-ups
Among direct service providers who engaged in any account tune-up activities 69 contact clients and schedule enrollment
appointments 69 confirm andor re-certify eligibility for ADAP
or other RWHAP-supported premium and out-of-pocket assistance
Account Tune-ups in action
However certain components have not been fully implemented Among direct service providers who
engaged in any account tune-up activities 64 do not review client finances including
tax filing history to determine eligibility for Marketplace assistance
66 do not ensure client insurance payments are up-to-date
Audience poll
Did your organization conduct any account tune-up activities last year (check one) Yes - we did Conducted some activities
Conducted a few activities
No not last year
September ndash October Assess health plans and conduct client outreach
Health plan assessment and purchasing
For RWHAP recipients purchasing insurance Assess all plan options including off-
Marketplace plans Consider locating a third-party to do a
plan assessment once plan information becomes available Train subrecipient staff on plan options
as soon as they have been assessed
Tips for working with insurance companies
Develop working relationships with insurance companies
Receive assistance reviewing plans to identify which ones could be sponsored by RWHAP and ADAP
Set up process to make emergency premium payments via credit-card
How direct service programs can prepare
For RWHAP-funded direct service providers Check with ADAP andor other RWHAP
insurance purchasing programs on plan options available to clients
Train program staff on plan options as soon as they have been assessed
If no one is analyzing plans in your area use existing plan assessment tools and templates ACE Health Care Plan Selection Worksheet
Outreach and enrollment key messages for clients
Importance of health coverage RWHAP is not insurance Benefits of receiving enrollment assistance to find
and select a plan Explain importance of actively comparing and
enrolling into plans Avoid short term plans
When reviewing plans check for preferred HIV medications and providers
Availability of financial assistance Ensure no outstanding balance on current health
plan Remember Cheaper isnrsquot always better
Nov 1 ndash Dec 15 Open Enrollment
Enroll
Revisit staff schedule and ensure availability for enrollment appointments Including walk-ins
Be prepared to contact the Marketplace with enrollment questions or problems Have customer service phone number
handy
Continue promoting enrollment opportunities and scheduling appointments with clients
Audience poll
In what area(s) does your organization need to improve to prepare for OE 2020 (check all that apply) Staff training Assessing staff workload Enrollment partnerships Account tune-ups Enrollment appointments Plan assessment Other please specify
Preparing for Open Enrollment Lessonsfrom Louisiana
Alicia Cooke Health Insurance Program Coordinator Louisiana Office of Public Health
Overview Louisiana ADAP
The Louisiana Health Access Program (LA HAP) serves approximately 3500-3700 clients at any given time Uninsured clients full cost of medications
for treatment of HIV and HCV only
Insured clients premiums deductibles copays and coinsurance for health dental and vision plans
Client eligibility and insurance status is tracked via Ramsell database with robust data reporting ability
Insurance status of LAHAP Population
Insurance status of insurance-eligible LAHAP Population May 2019
Uninsured 10
Marketplace 35
Other Private 23
Medicare 32
Excludes justice-involved clients
Challenging our assumptions
Medicare and Marketplace enrollment face distinct challenges Do case managers have experience with both populations Is everyone clear on whatrsquos possiblenot possible during Medicare
OE Established enrollment partners may have undergone changes
since last OE Are the supervisors new Are they invested in the concept of
insurance Is the staff new Does your guidance assume context they donrsquot
have Not all clients know what services are offered by ADAP
Did they join the program in the last year before they were eligible to purchase insurance
Has a case manager connected with them about insurance recently
This isnrsquot our first rodeohellipbut it might be someone elsersquos
ADAP enrollment
Clients can
bull Submit their own application
bull Work with a case manager at a Ryan White HIVAIDS Program funded agency
bull Work with any other willing assister (nurse patient navigator etc)
Insurance enrollment
bull Enroll themselves through healthcaregov or directly through the insurer with or without case manager assistance
bull Contact a broker to enroll on their behalf (most clients choose this option)
No wrong door to enroll in ADAP coverage or health insurance
Overview ADAP amp Insurance Enrollment in LA
Current enrollment model
ADAP staff provide extensive technical assistance and process paperwork for payment but generally do not play an active role in enrollment itself
Most clients choose to work with a broker to facilitate enrollment Relationship took time to build and there was skepticism
and miscommunication in the beginning however never malicious intent
The reality of LArsquos insurance market being dominated by one carrier eliminates concern about brokers steering clients into certain plans over others
The LA broker model was implemented to help case managers feel less overwhelmed during OE
Agents and brokers 101
Agents
Agents may work for a single health insurance company
Brokers
Brokers may represent several companies
Must be licensed by state and have signed agreements to sell Marketplace plans
Often get payments (ldquocommissionsrdquo) from insurance companies for enrolling individuals in plans
May directly enroll consumers in Marketplace plans through their own platforms without visiting Marketplace website (ldquoenhanced direct enrollmentrdquo)
May market non-QHP options to consumers during enrollment appointment
Timeline for Open Enrollment Preparation
August Schedule OE19 debrief and OE20 planning meetings
Meet with broker to discuss ADAP priorities and policy clarifications
Meet with principal insurer to discuss payment mechanisms and deadlines holidays schedules points of contact and mailing address confirmation
September Prepare 3 separate mailings for Uninsured Privately
Insured and Medicare clients Mailings include When is Open Enrollment What action should you take to enroll What action should you take with ADAP Health Insurance ldquoPassportrdquo tool
Louisiana OE Flyer
Timeline for Open Enrollment Preparation cont
October Send recertification packets to clients whose ADAP eligibility will
expire in November or December Host webinar for Ryan White case managersproviders Topics
include National and state-level changes affecting Medicare Marketplace
Responsibilities toward ADAP
Technical assistance on running insurance status reports in Ramsell portal
Reminder to help clients gather financial information for enrollment appointments
November Targeted phone outreach begins
Week 1 amp 2 Using data for OE outreach
Task Identify all self-managed clients (those not enrolled in case management) by conducting outreach to Uninsured clients
Explain how ADAP wraps around insurance coverage How to enroll amp how to follow up with ADAP
Medicare clients Remind clients they can keep or change plan How to enroll amp what information to provide to ADAP
Privately insured clients Remind clients they can keep or change plan How to enroll amp what information to provide to ADAP
Week 3 amp 4 Using data for OE outreach
Task Identify all remaining uninsured clients by case management status amp agency
Which case management agencies have the lowest client enrollment rates
Follow-up with uninsured self-managed clients from last week Have you initiated action What problems have you encountered
Reach out to supervisors at case management agencies with low enrollment rates Assess buy-in from supervisors Offer client outreach assistance
Week 5 amp 6 Using data for OE outreach
Task Identify final priorities for outreach All remaining uninsured All remaining self-managed who have not yet taken
action Make follow-up calls to all previously contacted
clients Conduct check-in calls with all case
management agencies How is your workload Who are you having trouble reaching
Outreach to particular clients at case manager request
Guiding questions for selecting partners In what specific ways is client choice important in your
state What out-of-pocket costs do ADAP clients need to consider
LA ADAP pays all premiums and cost sharing amounts for prescriptions
How much choice is available on your state Marketplace LA Marketplace contains 3 company trade names but under single carrier
What does internet coverage and computer literacy look like in your state Is it realistic to expect your clients to access healthcaregov
LA 744 have home broadband internet connection (5th lowest in US)
How many clients do you serve overall How much time availability does your enrollment community have
for each client
Identifying your enrollment model
When might you consider utilizing a broker
What brokersagents can offer
Fast accurate high-volume enrollment
Longstanding relationships amp greater data-sharing capacity with insurers
Convenient and easy for client
Considerationstrade offs
Less time spent on discussion of individual client needs
Relationships may be limited to specific insurers
Lack of client engagement in enrollment process
Going off-Marketplace
Clients initially ineligible for premium tax credits can enroll directly through the insurer into an off-Marketplace plan
What brokersagents can offer Considerationstrade offs
Maximizing relationships with brokers Add brokers to mailing lists and invite them to
presentationswebinars
Frequently share program policies and guidance and be as transparent as possible
Seek their expertise when possible and necessary
Acknowledge shared successes
These actions can help promote familiarity with the RWHAP community its values and priorities and build mutual trust and accountability
Questions amp Follow-up
Alicia Cooke MPH
Health Insurance Program Coordinator Louisiana Office of Public Health STDHIV Program
Aliciacookelagov
504-568-5489
Next webinar Basics of Health Coverage Enrollment Strategies
careacttargetorgacewebinars
August 21 2-330PM ET For staff that are new to enrollment andor ACE TA Center
Questions
Thank you for joining us
Please complete the evaluation
targethivorgace Sign up for our mailing list download tools and resources and morehellip
Contact Us acetacenterjsicom
- Structure Bookmarks
-
- Figure
- Planning ahead for Open Enrollment whatrsquos new for 2020
-
- Planning ahead for Open Enrollment whatrsquos new for 2020
- Access Care and Engagement (ACE) TA Center July 16 2019
-
- Access Care and Engagement (ACE) TA Center July 16 2019
- Figure
- How to Ask a Question
-
- Attendees are in listen-only mode
-
- If you have a question use the chat box at the lower-left of your screen to chat with the presenter
-
- You may also email questions to
-
- acetacenterjsicom after the webinar
-
- Figure
-
- Can You Hear Us
-
- Can You Hear Us
- Figure
- The audio is being shared via your computer speakersheadset
- Figure
- If you canrsquot hear the audio make sure your computer audio is turned on
- Figure
- If yoursquore still having problems please contact the host using the chat box You may also call in using the number and passcode below to hear
- Call-in number 800-289-0462 Passcode 822831
- Figure
- ACE TA Center
- The Access Care and Engagement (ACE) Technical Assistance (TA) Center supports Ryan White HIVAIDS Program (RWHAP) health care service providers to
- 1
-
- 1
-
- 1
- Engage enroll and retain clients in health coverage
-
- 2
-
- 2
- Communicate with clients about how to stay enrolled and use health coverage
-
- 3
-
- 3
- Build organizational health insurance literacy thereby improving clientsrsquo capacity to use the health care system
-
- Figure
- ACE TA Center
- Target Audiences
-
- Target Audiences
-
- RWHAP staff including case managers
-
- RWHAP leaders and managers
-
- RWHAP clients
-
- Navigators and other in-person assisters that help enroll RWHAP clients
-
- Whatrsquos new for 2020
-
- Planning ahead for Open Enrollment (OE)
-
- Account Tune-Ups
-
- Questions and answers
-
- targethivorgace
- Todayrsquos presenters
- MIRA
- DORI
- LIESL
- ALICIA
- Session overview
-
- Audience poll
-
- Audience poll
- Have you been on an ACE TA Center webinar before
-
- Yes
-
- No
-
- Standard Open Enrollment timelinefor 2020 plans
- Figure
- Whatrsquos new for 2020 Considerations for Ryan White HIVAIDS Program Recipients and Staff
- What are co-pay accumulators
-
- Policies adopted by some insurance companies that no longer count the value of a manufacturerrsquos co-pay card towards an enrolleersquos deductible or out-of-pocket maximum
-
- Individuals would be required to pay full deductible themselves after the value of the co-pay card is used
-
- Can result in unexpected high pharmacy costs for clients
-
- Issuers and PBMs may refuse to apply manufacturer coupons to plan deductible and annual out-of-pocket maximums
-
- Centers for Medicare and Medicaid Services (CMS) recently ruled co-pay coupons must count towards deductible and out-of-pocket maximum when used for brand name drugs that have no generic equivalent
-
- The federal individual mandate requires most people to have health insurance or pay a penalty
-
- For 2019 the individual mandate will remain in place however the federal tax penalty for not having coverage is reduced to $0
-
- DC New Jersey and Massachusetts have state-level individual mandates which include a financial penalty
-
- Co-pay accumulator policies
- Individual Mandate
- Vermont individual mandate goes into effect in 2020
-
- Additional considerations Health plan enrollment and purchasing options
-
- Additional considerations Health plan enrollment and purchasing options
- 2020 Plan Landscape
-
- Silver loading is a practice whereby insurers increase premiums on silver-level plans to offset the loss of cost sharing reduction (CSR) payments
-
- Also has the affect of increasing advance premium tax credits (APTCs)
-
- Silver-loading continues to be permissible under federal law
-
- APTCs will shield many low-income consumers from premium increases
-
- Significant increase in out-of-pocket maximums $8150 (self-only) $16300 (family)
-
- STLDI traditionally provides coverage for a short period of time but federal regulations now allow contracts of up to 364 days
-
- Do not renew automatically
-
- Do not have to comply with Marketplace rules
-
- Not required to provide Essential Health Benefits including prescription coverage
-
- Can deny coverage for pre-existing conditions
-
- Can impose lifetime and annual limits
-
- Recent study found
-
- Brokers and insurers report increased enrollment in STLDI in 2019
-
- High rates of consumer confusion about coverage limitations lack of Marketplace protections cost implications
-
- States may limit plan duration set coverage standards or otherwise take action to limit availability and prevalence of sub-par plans
-
- Figure
- Short-term limited duration insurance (STLDI)
- Expansion of STLDI
- Consumers will need assistance to find plans that meet their care and treatment needs
-
- Bottom line
-
- Study conducted by Kleimann Communications Group ldquoTesting Consumer Understanding of a Short-term Health Insurance Planrdquo
- Enrollment and consumer assistance changes
-
- Expansion of non-Marketplace enrollment assistance
-
- More leniency for web-brokers and issuers to promote non-Marketplace-compliant products during enrollment appointment
-
- Agents and brokers may use unlicensed application assisters
-
- Changes to Navigator program functions
-
- Removes mandatory Navigator functions including post-enrollment support (appeals reconciliation using coverage) and tax referrals
-
- Reduces requirements for Navigators to ensure physical and other accessibility for people with a full range of disabilities
-
- Changes to Navigator training standards
-
- Reduces Navigator program training standards
-
- Reduces requirement that Navigators provide information in a culturally competent manner
-
- Department of Human and Health Services (HHS) will continue to require that Medicare Part D plans cover HIV treatments
-
- Step therapy and prior authorization are not permitted for coverage of HIV treatments
-
- Protected class protections remain intact
-
- Medicare Advantage plans may use step therapy for Part B drugs
-
- Enrollment and consumer assistance changes cont
- Consumers may need extra support from RWHAP recipients both during enrollment
-
- Bottom line
- and after
-
- Medicare Part D rule
- May impact access to long-acting injectable antiretrovirals (ARVs) expected to be available in the future
-
- Step therapy = starting patients on less expensive treatment requiring treatment failure before a recommended regimen can be covered
- Other changes
-
- Other changes
-
- Other changes
-
- New Special Enrollment Period (SEP) for off-Exchange enrollees whose incomes drop within APTC range