Boutin essential benefits
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Boutin essential benefits
- 1. The National Health Council’s Essential Health Benefits Marc Boutin Executive Vice President & COO National Health Council
- 2. The mission of the National Health Council is to provide a united voice for people with chronic diseases and disabilities.
- 7. Timeline for Engagements: Essential Health Benefits Proposed Rule Anticipated from HHS IOM Committee Meeting IOM Recommendations Expected DOL data expected in “Spring” Third and fourth IOM Committee meetings Develop essential health benefits package using FEHB plan as foundation in consultation with NHC members Develop ideal approach for HHS/State regulatory oversight Vet regulatory approaches with NHC members Share regulatory approach with HHS Commission actuarial analysis of the affordability of NHC’s essential health benefits package and discuss implications among membership Craft regulatory language that HHS could adopt and review with NHC membership Craft regulatory language March 2011 May July September November January 2012
- 10. Plan Premium Costs *The estimated premiums and the reduced OOP max for the platinum plan are actuarial estimates from ARC. Plan Estimated Annual Premium—Individual* OOP Maximums Total Cost BCBS Model $5,032 Platinum $5,205 $1,500 $6,705 Gold $4,627 $5,950 $10,577 Silver $4,048 $5,950 $9,998 Bronze $3,470 $5,950 $9,420
- 11. Room in Household Budget for Health Care? (c) Jonathan Gruber and Ian Perry, The Commonwealth Fund Reported Income (% poverty level) Necessities Necessities + Premium Necessities + Premium + Median OOP Cost Necessities + Premium + 90th Percentile OOP Cost <Poverty 17.30% 17.30% 17.30% 17.30% 101–150 7.50% 8.40% 8.50% 10.80% 151–200 3.70% 7.60% 9.00% 17.50% 201–250 3.00% 5.70% 8.80% 26.20% 251–300 1.10% 5.30% 6.90% 24.20% 301–350 0.70% 4.20% 5.30% 17.50% 351–400 1.20% 3.50% 3.90% 12.50% 401–450 0.50% 2.70% 3.70% 15.30% 451–500 0.40% 3.60% 4.70% 12.00% >500 0.20% 0.60% 0.60% 2.50%
- 12. At 250% FPL: Family of Four, One Person with Kidney Disease Actuarial analysis performed for NHC by Actuarial Research Corporation and Avalere Health Annual Income (Gross) $55,875 Median Necessities* (at 71%) – $39,671 $16,204 Maximum Premiums** – $4,500 $11,704 OOP Maximum*** – $5,950 $5,754 Per Month ÷ 12 ~ $480 Subtract the cost of taxes, child care, food, housing, transportation, and miscellaneous expenses of 10% Subtract ACA-defined maximum premium for family at 250% FPL (compared to ~$8,000 for a silver plan with no subsidy) Subtract reduced out-of-pocket maximum due to 250% FPL (compared to $11,900 with no subsidy) Divide by 12 for estimate of remaining funds in monthly budget
- 13. At 450% FPL: Individual with Rheumatoid Arthritis Actuarial analysis performed for NHC by Actuarial Research Corporation and Avalere Health Annual Income (Gross) $49,005 Median Necessities* (at 63%) – $30,873 $18,132 Platinum Premiums** – $5,205 $12,927 OOP Maximum*** – $5,950 $6,977 Per Month ÷ 12 ~ $580 Subtract cost of taxes, child care, food, housing, transportation, and miscellaneous expenses Subtract cost of premium for a platinum plan Subtract out-of-pocket maximum set by the ACA Divide by 12 for estimate of remaining funds in monthly budget
- 25. National Health Council Resources EHB Policy Recommendations (2011): http://www.nationalhealthcouncil.org/NHC_Files/files/EHB_UnitedPatientVoice.pdf EHB Actuarial Analysis (2011): http://www.nationalhealthcouncil.org/NHC_Files/files/EHB_ActuarialAnalysis.pdf EHB White Paper (2010): http://www.nationalhealthcouncil.org/NHC_Files/files/EHB_WhitePaper.pdf
- 26. Marc Boutin Executive Vice President & COO National Health Council [email_address]
Notes de l'éditeur
- FROM: BMS20060104_Quality Presentation_Revised_sm
- Create a baseline benefit package Use FEHBP BCBS Standard Option as a foundation Exclude dental and vision benefits, even though these are covered under the BCBS Standard Option Price the baseline benefit package Calculate covered charges and estimated premium for selected benefit package Calculate actuarial value (AV) Adjust premiums and cost-sharing for all four levels of benefit packages established by the ACA Platinum (90% of covered charges are paid by the plan) Gold (80% of covered charges are paid by the plan) Silver (70% of covered charges are paid by the plan) Bronze (60% of covered charges are paid by the plan)
- * The median percentage of a budget assigned to necessities was estimated by Gruber and Perry, April 2011. ** The ACA sets threshold levels for maximum premiums, above which people will receive subsidies. At 250% FPL, the maximum premium is 8.1% of income. *** The ACA sets reduced out-of-pocket maximums for people with limited income. A Rand study estimated total out-of-pocket spending related to kidney disease was nearly $9,000 in 2004.
- * The median percentage of a budget assigned to necessities was estimated by Gruber and Perry, April 2011. ** The actuarial analysis estimated an annual premium of approximately $5,205 for a platinum plan. At this level of income, there is no premium subsidy. *** The ACA sets the standard OOP Maximum at $11,900. At this level of income, there is no subsidy for the OOP Maximum. A Rand study estimated total out-of-pocket spending related to rheumatoid arthritis was around $4,800 in 2004.