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Key Terms
Private insurance plans sold on healthcare.gov with monthly premiums subsidized for some people
ACA or Obamacare Insurance
Open Enrollment
Open Enrollment
Special Enrollment
2016
JANUARY 1 FEBRUARY 1 NOVEMBER 1
The new health insurance calendar
Next Open Enrollment: Nov. 1, 2016 -- Jan. 31, 2017
OCTOBER 31
Open Enrollment
Open Enrollment
Special Enrollment
2017
JANUARY 1 FEBRUARY 1 NOVEMBER 1 OCTOBER 31
Utah’s ACA sign-ups exceeded 175,000 in 2016
Sources: State-Level Data From from the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; ; March 31, 2015 Effectuated Enrollment Snapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html HHS/CMS Health Insurance Marketplace; ASPE Issue Briefs: October 1, 2013 –April 19, 2014; November 15, 2014 – January 16, 2015; HHS News Release, “In Utah, 124,142 people are signed up for coverage through the Health Insurance Marketplaces,” 2/11/15 HHS News Release, “In Utah, 140,221 people are signed up for coverage through the Health Insurance Marketplaces,” 2/18/15 ASPE Issue Brief (3/10/15); http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf Marketplace Plan Selection by Age in States Using the HealthCare.gov Platform, By State (1); 11-15-14 to 2-15-15 (including SEP activity through 2-22-15); Health Insurance Marketplace Open Enrollment Snapshot - Week 11; January 10, 2016 - January 16, 2016; Released: 1/20/16; Health Insurance Marketplace Open Enrollment Snapshot - Week 13 January 24, 2016-February 1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html
175,637
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
Nationally, 20 million Americans have gained health insurance due to the ACA and Medicaid Expansion
Source: The Office of the Assistant Secretary for Planning and Evaluation’s (ASPE) analysis of the Gallup-Healthways Well-Being Index survey data through February 22, 2016.
16.7%
15.7%
16.3%
15.9%
16.7%
16.6%
15.7%
14.0%
12.5%
9.1%
10.2%
11.6%
11.9%
10.6% 10.7%
11.2%
10.6%
13.4%
13.2%
11.6%
10.3%
15.6%
13.3% 13.2%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Q2
UT:Census/SAHIE
UT:DOH(BRFSS)
UT: Gallup-Healthways
Utah’s uninsured rate is decreasing… …but the most recent data indicates a slowdown
Census SAHIE: https://www.census.gov/library/publications/2015/demo/P60-253.html DOH (BRFSS): http://ibis.health.utah.gov/pdf/opha/publication/ins/InsHighlights_2014.pdf Gallup Healthways: http://www.gallup.com/poll/184514/uninsured-rates-continue-drop-states.aspx?utm_source=Well-Being&utm_medium=newsfeed&utm_campaign=tiles
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015)
Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health
6 plans
26 plans
34 plans
24 plans
1 plan
Humana (6) Molina Healthcare (3) Select Health (60) University of Utah (5)
2015: 101 Plans 2016: 74 Plans
Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health
2014: 91 Plans
Gold
Silver
Bronze
Catastrophic
Platinum
5 plans
19 plans
27 plans
21 plans
2 plans
5 plans
29 plans
40 plans
27 plans
0 plans
2014-16 Individual Marketplace Comparison Salt Lake County
0% 101% 400% 100%
Who is eligible for premium subsidies?
Income as % of the Federal Poverty Level (FPL)
NO YES 53,000 Utahns
in the Gap
Sliding-scale subsidies make insurance more affordable
Source: http://www.coloradohealthinsurancebrokers.com/wp-content/uploads/2013/08/2015-2016-FPL-Chart-1024x314.jpg
For 2016, a family of four can earn $97,000 a year and receive a premium subsidy
If your income/family size is on this chart, you qualify for a subsidy
The Hernandez Family Income: $26,000 Residence: Salt Lake City, Utah Ages: Dad : 33 Mom: 29 Kids: 11, 7
Annual income: $26,000
% of poverty level: 109%
Monthly premium: $458
Subsidy pays: $410 per month
The Hernandez’s pay: $48 per month
Benchmark Silver Plan
Primary doctor: $5 Specialist doctor: $15 Emergency room care: $150 Generic drugs: $6
Plan Details
2016 rate change: + $4/month
Deductible: $1000 Out-of-pocket maximum: $1,500 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
Annual income: $44,000
% of poverty level: 222%
Monthly premium: $537
Subsidy pays: $274 per month
The Shumways pay: $262 per month
Benchmark Silver Plan
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $500 Generic drugs: $10
Plan Details
Deductible: $2,300 Out-of-pocket maximum: $10,900
2016 rate change: +$1/month
The Shumways Income: $44,000 Residence: American Fork, UT Ages: Dad : 24 Mom: 23 Kid: Newborn
Source: https://www.healthcare.gov/see-plans/
Mr. and Mrs. Smith Income: $42,000 Residence: Santa Clara, Utah Ages: 60, 62
Annual income: $42,000
% of poverty level: 267%
Monthly premium: $1,188
Subsidy pays: $865 per month
The Smiths pay: $323 per month
Benchmark Silver Plan
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $10
Plan Details
Deductible: $2,500 Out-of-pocket maximum: $13,700
2016 rate change: + $13/month
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
The Simonsen Family Income: $135,000 Residence: Alpine, Utah Ages: Dad : 35 Mom: 44 Kids: 11, 7
Annual income: $135,000
% of poverty level: 555%
Monthly premium: $757
Subsidy pays: $0 per month
The Simonsen’s pay: $757 per month
Benchmark Silver Plan
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $10
Plan Details
Deductible: $2,500 Out-of-pocket maximum: $13,700 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
Annual income: $21,000
% of poverty level: 89%
Expected contribution: 100%
Monthly premium (for 2): $482
The Smith’s pay: $482
Subsidy pays $0
The Smith Family Income: $21,000 Residence: Orem, Utah Ages: Dad : 35 Mom: 33 Child: 7 Child: 11
No Subsidy
The Smith’s healthcare costs would be 27% of their total income
Who lives in the Coverage Gap?
Source: https://www.healthcare.gov/see-plans/; Image source: Fotozalc
In 2016, 13 of Utah’s top 20 ZIP codes for ACA enrollment were outside of Salt Lake
County
Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016
RANK CITY SELECTIONS % INCREASE 1 Lehi (84043) 3,501 19% 2 South Jordan (84095) 3,346 12% 3 American Fork (84003) 2,948 17% 4 Pleasant Grove (84062) 2,931 20% 5 St. George (84790) 2,829 10% 6 St. George (84770) 2,742 11% 7 Draper (84020) 2,624 13% 8 Bountiful (84010) 2,455 5% 9 Spanish Fork (84660) 2,377 24%
10 West Valley City (84119) 2,368 3% 11 West Valley City (84120) 2,345 13% 12 Provo (84604) 2,289 22% 13 Herriman (84096) 2,276 20% 14 Clearfield (84015) 2,258 3% 15 Riverton (84065) 2,255 23% 16 Cottonwood Heights (84121) 2,254 6% 17 Orem (84058) 2,196 24% 18 Orem (84057) 2,193 16% 19 Ogden (84404) 2,189 1% 20 Layton (84041) 2,110 12%
County Open Enrollment #3
(1/9/16) % Change since Open Enrollment #2
(2/22/15) County Population
(2014)
Salt Lake
52,360 7.1%
1,091,742
Utah
32,987 17.3%
560,974
Davis
14,263 9.8%
329,692
Weber
9,753 5.2%
240,475
Washington
10,437 12.4%
151,948
Cache
5,672 8.0%
118,343
Tooele
2,086 4.4%
61,598
Box Elder
2,023 9.4%
51,518
Iron
2,380 12.2%
47,269
Summit
3,034 13.3%
39,105
Uintah
1,039 7.1%
36,867
Sanpete
1,272 7.4%
28,477
Wasatch
2,118 5.7%
27,714
Carbon
638 -2.6%
20,660
Grand
904 -12.1%
9,429
Utah and Washington counties continue to lead ACA sign-ups in Utah
Sources: [OE2] Plan Selections by ZIP Code in the Health Insurance Marketplace (November 15, 2014 thru February 22, 2015) http://aspe.hhs.gov/health/reports/2015/MarketPlace-Enrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm [OE3] Plan Selections by ZIP Code in the Health Insurance Marketplace: (November 1, 2015 thru January 9, 2016) https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016
Enrollment by Age
Utah children are enrolling in ACA insurance at 2.67x the national average
Utah
U.S.
24%
31% 16%
13%
16% Under 18
18-34
35-44
45-54
55-64
9%
26%
16% 21%
27% Under 18
18-34
35-44
45-54
55-64
Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, 2015 - December 26, 2015.“ https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-january-enrollment-report.
Premium subsidies make health insurance more affordable
Impact of subsidies on actual consumer costs
ACA enrollment by % poverty level
Source: Reduction in Average Monthly Premiums from Advance Premium Tax Credits in States Using the HealthCare.gov Platform (1) 11-15-14 to 2-15-15 (including SEP activity through 2-22-15)
Consumer
Cost
$248
Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, 2015 - December 26, 2015.”
1%
33%
25%
21%
18% Under 100%
100% to 150%
150% to 200%
200% to 250%
250% to 400%
Half of existing ACA consumers switched health plans in 2016
Origin of all consumers
Plan selection by re-enrolled consumers
Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, 2015 - December 26, 2015.”
Source: "State-Level Data From the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; For the period: November 1, 2015 - December 26, 2015.”
70%
30%
51%
49%
Newly enrolled
Re-enrolled
Switched plan
Same plan
RyLee Curtis
Utah Health Policy Project 801.433.2299 x8 [email protected]
Jason Stevenson
Utah Health Policy Project 801.433.2299 x7 [email protected]
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