A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Health Connector Board Meets to Award Final 2016 Seal of Approval

Health Connector Board Meets to Award Final 2016 Seal of Approval

September 14, 2015

On Thursday, September 10, the Health Connector  Board discussed  readiness for Open Enrollment (OE) 2016,  including outreach efforts, and to deliver the final award of the 2016 Seal of Approval.  Materials from the meeting are posted here

Chief Operating Officer Vicki Coates provided consumer experience updates.  Coates first noted that total Non-Group Medical Enrollment stands at 175,605 members, a 1.2% increase from last month.  Non-Group Dental enrollment is 45,240 members, a 0.8% increase from last month.  Non-Group Enrollment for ConnectorCare is 129,657 members, an increase of 1.4% from last month.  Coates then said that the call center continues to hold the gains made in the last several months, with a lower call abandonment rate and average speed to answer than February and March.  Issue resolution has increased by 5% after holding steady for a few months and there are significantly fewer people reporting that they called more than three times without resolution.  First contact resolution, Coates reported, has increased 4.1% since May.  Overall satisfaction has increased 7% from July to August as lower wait times have resulted in higher satisfaction levels.  Coates also re-iterated that staffing is on track to match the anticipated increase in call volume associated with OE and staff are being trained to support customers’ shopping needs.

2016 Open Enrollment Readiness Update

During Open Enrollment, which runs from November 1, 2015-January 31, 2016, individuals in the non-group market can enroll in or switch plans for any reason without needing a qualifying event.  Currently, the Connector is in the final stages of determining eligibility and renewals for the upcoming OE.  118,000 households that applied for help paying for coverage and are eligible for a Qualified Health Plan (QHP) received eligibility notices.  The notice, it was noted in the meeting, is very “high level” and does not include information on the amount of tax credits an individual is expected to receive.  However, consumers will receive notices of their tax credit values before November 1st.  Once members receive their eligibility notices, they have 30 days to take action to update and finalize their eligibility if they choose. 

2016 Open Enrollment Outreach Update

The Connector performed a comprehensive consumer survey in July, surveying 1,086 residents representing those  currently enrolled in subsidized and unsubsidized health plans, dental plans, and a group of former enrollees.  The Connector also conducted several focus groups aimed at uninsured, current, and former members.  They held sessions in Lawrence, Lynn and Brockton, areas with high uninsurance rates, to learn about barriers to obtaining coverage and whether people felt comfortable using the Health Connector.

The survey found that, overall, the majority of insured respondents are satisfied with their experience as Health Connector members but room for improvement exists.  Dental plan enrollees were significantly less satisfied than health plan enrollees.  Additionally, satisfaction rates were skewed between lower-income subsidized members and upper income unsubsidized members - with lower income enrollees more likely to be satisfied. 

Uninsured respondents perceived that cost was the biggest barrier but insured members of similar income levels find their coverage to be generally affordable.  Uninsured individuals are more willing to risk not having coverage and show an inherent distrust in the health care system.  Individuals with families, however, were more interested in enrolling in health insurance.  Lastly, respondents emphasized that the process is still often confusing and expressed that having help with their application was useful.  To illustrate this point, the satisfaction rating of Navigators is relatively high compared to those of the Health Connector website or customer service. 

Survey and focus group data on plan selection and enrollment indicate that the top reasons people select the plan they enrolled in are to keep premiums low and have a plan that includes their doctor or provider.  More people report not understanding their benefits than understanding them.  Respondents noted that the enrollment process could be improved through better website design, better trained Customer Services Representatives (CSRs), simpler web navigation, and the ability for more plan comparisons. 

The top customer service issue appears to be linked to phone services, as shown by the number of respondents dissatisfied with long wait times and the fact that some CSRs appear to lack sufficient knowledge.  The Connector is addressing these problems by proactively hiring and training staff to add to the number of available CSRs during OE.  Fortunately, the Connector is emphasizing in-person assistance throughout the state through Navigators, Certified Application Counselors, Issuer Enrollment Assisters, Broker Enrollment Assisters, and new locations for support with trained CSRs.  Springfield, Fall River, Brockton, and Lowell will all be additional in-person centers staffed with trained Health Connector CSRs.  The permanent Boston and Worcester Centers will also have extended evening and weekend hours.

Final Award of 2016 Seal of Approval

The goal of the 2016 OE period is to simplify the consumer shopping experience by reducing the total number of plans available.  25 Qualified Dental Plans (QDPs) will be offered, a comparable number to the number of plans offered in 2015.  However, for Qualified Health Plans (QHPs), the number of plans offered has been reduced by 34% to a total of 83 plans, including 13 Bronze plans.  There were 14 Bronze plans reported in July but CeltiCare withdrew its plan.  Seven ConnectorCare Plans will be offered based on a review of program needs and Silver plan rates.

The Connector reports that 90% of their members will be renewed into the same plan for 2016.  The remainder are in plans closed by carriers who will be mapped to a similar plan offered by their same carrier.  Advance Premium Tax Credit (APTC)-only and unsubsidized members will see increases in premiums similar to the broader merged market, while both ConnectorCare and Dental members will see slight decreases.  The ConnectorCare program in particular attributed the 2.1% decrease in underlying selected Silver plan premiums to the introduction of new, lower cost Silver plan designs from Tufts Health Plan Direct, which covers 57% of current ConnectorCare members.    

Standardized plans remain the core of the Health Connector’s 2016 QHP product shelf, with eleven carriers submitting standardized plans on their broadest commercial networks and two carriers, Harvard Pilgrim Health Care (Focus) and Fallon Community Health Plan (Direct Community Care), offering designs on additional networks . Non-standardized plans represent approximately 30% of the proposed 2016 QHP shelf, including, one Platinum, seven Gold, and seven Silver, about half previously offered in 2015.  Two carriers, Harvard Pilgrim (Focus Network- MA Best Buy HMO 2000 and Best Buy H.S.A. PPO 2000 with coinsurance) and Minuteman (MyDoc Bronze Plus) have elected to offer frozen plans, wherein members are eligible for renewal but closed to new enrollment for 2016. 

There are several shopping changes for OE that will provide additional information to consumers comparing QHPs.  There will be preset filters showing Silver and Gold plans by default, with pop-up messages explaining the filtering process and how additional metallic tiers can be shown.  There will also be pop-up messages during Bronze check-out reminding customers to review the cost sharing associated with their purchase and ensure that they can afford potential out-of-pocket costs.  The other pop-up message occurs during Catastrophic plan check-out, highlighting limited benefits and the inability to apply APTCs to these plans.  The shopping process also now has a stand-alone provider search tool to help consumers find providers and determine which plans include those providers within their network. 

For the QDP product shelf, five issuers have submitted at least one offering for each of the three required standardized plan designs: Pediatric-Only, Family High, Family Low.  Six non-standardized plan designs have been proposed by three issuers, five of which were offered in 2015, with one new plan design- Delta Dental EPO Family Basic Exclusive Network.

Bronze Plans in Detail

The updated Federal Actuarial Value (AV) calculator subsequently required the closing of all 2015 Bronze Plans because they no longer met the AV requirement of 60%.  A number of carriers therefore modified their Bronze Plans with higher levels of cost sharing, which unexpectedly also coincided with an increase in 2016 Bronze plan premiums.  The Connector plans to map 2015 Bronze Plan members to 2016 Bronze plans as a result of the rate changes.  To mitigate consumer impact and confusion, the Connector will be sending special communication to all 2015 Bronze subscribers explaining the mapping, highlighting the changes in the Bronze cost sharing and encouraging shopping and comparing plans for 2016 (Slide 13). 

The meeting was concluded by an affirmative vote to recommend awarding the 2016 Final Seal of Approval to all recommended standardized and non-standardized QHPs and QDPs proposed by: Altus Dental, Blue Cross Blue Shield of MA, BMC HealthNet Plan, CeltiCare Health Plan, Delta Dental of MA, Fallon Health, Guardian, Harvard Pilgrim Health Care, Health New England, Metlife, Minuteman Health, Neighborhood Health Plan, Tufts Health Plan Direct, Tufts Health Plan Premier, and UnitedHealthcare. 

The next meeting will be held on October 8th

       ---- Michelle Savuto