By Michelle Andrews
OCT 25, 2013
Q. My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn’t provide proof that he has it they will automatically enroll him in a plan. We don’t have children, so why would we have to have pediatric dental insurance?
A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts. The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.
Pediatric dental coverage is sometimes offered as part of a regular health plan, but it’s also often sold on a standalone basis. So even though the health law requires that children in individual and small group plans have access to dental coverage, people are not required to buy separate pediatric dental coverage if they buy a plan on the state health insurance marketplaces, or exchanges, unless their state specifically requires it.
But people who buy plans outside the state marketplace may not have the same flexibility, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project.
Outside the exchange, “There’s no exemption for that requirement to have pediatric dental coverage,” he says. “So if you’re buying insurance outside the exchange you may have to meet it.”
It sounds as if your husband’s plan is a non-exchange plan. If that’s the case, he could shop for a plan on the exchange if he wants to avoid buying pediatric dental coverage.
On January 13, the U.S. Department of Health and Human Services (HHS) released updated enrollment figures for the Affordable Care Act’s (ACA) Exchanges during the first three months of operation. The report outlines the number of Americans who have accessed a state-based or federally facilitated Exchange as well as a demographic breakdown of new enrollees. This blog highlights some of the key Exchange enrollment trends.
Federal Exchange Enrollment Tops State-Based Exchange Numbers
Federal Exchange enrollment outpaced state-based Exchange enrollment with 1.2 million of the 2,153,421 individuals selecting a federal Exchange policy, and 950,000 choosing a state-based option during the October 1 – December 28, 2013, open enrollment period. This is a significant difference from just a few weeks as the state-based exchanges had shown larger numbers most likely as a result of reporting timing.
One of the likely reasons the federal Exchange has enrolled more Americans is the demographic composition of where the Exchanges operate. There are currently 34 states, representing a majority of the country’s population, using the federally facilitated Exchange, while just 16 states (plus the District of Columbia) operate their own Exchange. Further there are generally larger numbers of uninsured Americans living in states using the federal system. Of the 17 states with the greatest proportion of uninsured people, 14 are using the federal Exchange. It follows that there would be larger enrollment in places where more people need insurance.
Young Adult Representation Lacks Luster
Enrollment demographics have received much attention since the consensus is that a large number of new enrollees must be younger, healthier Americans. This population tends to amass fewer claims, allowing their premiums to subsidize older consumers within a health plan. According to reports during the early phases of open enrollment, the government was hoping the younger population would represent at least 40% of the newly insured. The January 13 report points out that 24% of Exchange enrollees through December 28, 2013, were between the ages of 18 and 34. This is proportionate to the number of Americans in this age group (26%), but lower than the proportion of uninsured people in this demographic (about 38%).
The report also indicates young adults may be waiting longer than the rest of the population to enroll in coverage. “The general expectation is that people who are older and sicker are more likely to select coverage earlier in the initial enrollment period,” the report states, “while younger and healthier people will tend to wait until towards the end of the open enrollment period (which concludes March 31, 2014).”
The growth in enrollment for young adults from October to December was larger than growth in other age groups, indicating that the overall share of young adults enrolling in plans is growing. Perhaps the initial technological difficulties caused some young consumers to disengage from the Exchange websites. Now that those glitches have largely been fixed, some may be giving the system a second chance.
While the main takeaway of the HHS report is the lower than expected young adult enrollment, there are other important facts to emerge from the first half of open enrollment.
Silver Plan Option Most Popular
In deciding what level of coverage to purchase, 60% of Americans have opted for “silver level” plans, meaning an average of 70% of health care expenses will be paid by the health plan. All other metal levels were significantly less popular: bronze (20%), gold (13%), platinum (7%), and catastrophic (1%).
Nearly 80% Receive Federal Subsidy
It’s also notable that 79% of consumers who have selected a health plan through an Exchange will receive a federal subsidy. Subsidies are available to those who do not qualify for Medicaid, but earn below 400% of the federal poverty line.
We will continue to keep you apprised of any updates to the enrollment figures and any additional information on demographic trends relevant to our clients. In the meantime, please visit www.BeWellInsurance/wordpress.com to view past blogs and Legislative Alerts. Or you may visitwww.HealthcareExchange.com for more blog posts, polls, surveys and numerous resources.
It’s important to note that the federal health care reform initiative discussed in this blog is referred to by several different acronyms including ACA, PPACA and ObamaCare. No matter what the term, Be Well Insurance Solutions will continue tracking and reporting on key health care reform trends that are impacting Brokers, payroll personnel and key stakeholders.
[Author: Michael Gomes, Executive Vice President, BenefitMall]
After months of feeling ignored in favor of government-funded navigators, producers are finally enjoying their time in the spotlight. They’re also enjoying a bit of sweet vindication as a Republican-led House panel releases a report accusing navigators of committing significant errors and risking privacy.
Navigators, which were appointed in the Affordable Care Act rollout to help consumers enroll in health plans, have been giving enrollees bad information and haven’t done enough to protect privacy, the report said.
“Documents call into question the effectiveness of the Navigator program and the Obama administration’s ability to safeguard consumer information,” the House Oversight Committee concluded. Click Here for full story: http://bit.ly/1bQmn0z
At around 10:00 p.m. Thursday (11/21/13), a HHS spokesperson, who asked to remain anonymous because the announcement is not yet official, divulged that the 2015 open enrollment period will be delayed one month, ostensibly to give insurers more time to set rates and to give consumers more time to shop for plans. The open enrollment period change, which does not impact this year’s open enrollment at all, means that people will begin being allowed to enroll in exchange plans November 15, 2014, and the enrollment window will end on January 15, 2015.
Coincidentally, this move pushes the open enrollment start date back until after the 2014 mid-term elections, meaning that voters will get official word about potential 2015 federal marketplace policy rate increases a week after the mid-terms, whereas they would have heard about the rate increases prior to the elections had open enrollment started in October. If you think the press President Obama has been receiving since the exchanges launched has been bad, just wait until 2015. If 2015 rates are higher than 2014 many will consider the law to be a bigger train wreck than they do right now. The healthcare.gov complications have deterred many from participating in the exchanges, but in order for the exchanges to function as envisioned, more people, specifically the young and healthy, need to enroll. The delayed open enrollment deadline gives insurers more time to analyze the markets and set rates for the coming year, but if the young and healthy don’t join their risk pools during 2014, nothing the Administration does to change enrollment times will be able to help the impact on prices and competition in 2015.