Los Impuestos y la Cobertura de Salud: Cinco Consejos al Presentar la Declaración de Impuestos

31 de marzo de 2016
Por: Kevin Counihan, Director General de los Mercados de Seguros Médicos, Centros de Servicios de Medicare y Medicaid

El año pasado, millones de personas obtuvieron cobertura de salud de calidad y a su alcance económico a través del Mercado de Seguros Médicos, y la mayoría se beneficiaron de los pagos por adelantado del crédito tributario de prima para reducir el costo de sus primas/cuotas mensuales. Ya que solo quedan unas cuantas semanas para presentar los impuestos, es un buen momento para darles un recordatorio a los consumidores nuevos y los que renovaron  sobre lo que necesitan saber cuándo presenten sus impuestos.

Para aquellos que volvieron al Mercado de seguros en 2015 para renovar su cobertura o escoger otro plan, el proceso de declaración de impuestos es generalmente el mismo al año pasado. Pero, para las personas que se inscribieron por primera vez para la cobertura del Mercado en 2015 el proceso puede ser nuevo. Todos los consumidores del Mercado deberían haber recibido ya en el correo  el Formulario 1095-A. Este documento incluye información importante que se necesita para completar y presentar una declaración de impuestos.

Los consumidores del Mercado que recibieron los pagos adelantados del crédito tributario de prima están obligados a presentar una declaración de impuestos para reconciliar dicha ayuda financiera. Esto es similar al proceso de reconciliación de los impuestos retenidos de los salarios durante el año, los consumidores reciben un reembolso mayor o menor dependiendo de si los impuestos correspondientes se retuvieron en base a los ingresos reales del contribuyente de impuestos y otros factores.

Es extremadamente importante que los que recibieron pagos por adelantado del crédito tributario de prima reconcilien estos pagos cuando presenten su declaración de impuestos. Las personas que no lo hagan por lo general tendrán un retraso en sus reembolsos, y no serán elegibles para recibir los pagos adelantados del crédito tributario de prima en los próximos años.

Los individuos que tengan cobertura de salud del Mercado u otros tipos de seguro también pueden haber recibido otros formularios adicionales llamados Formulario 1095-B o C-1095 de parte de su empleador, compañía de seguros, o el programa de gobierno que proporciona su cobertura, como Medicare o Medicaid. Los contribuyentes no necesitan incluir esta información a su declaración de impuestos o esperar a recibir el formulario antes de llenar sus impuestos federales, pero la forma debe ser conservada en un lugar seguro con otros documentos importantes de sus impuestos.

Un recordatorio importante: Como la mayoría de los declarantes de impuestos utilizan un preparador de impuestos o el software de preparación de impuestos, la mayoría de los contribuyentes sólo tendrán que responder a las preguntas cuando se les solicite.

Estamos aquí para ayudar. Los consumidores del Mercado que tengan preguntas deben comunicarse con el Centro de Llamadas del Mercado (1-800-318-2596). Recursos adicionales e información también está disponible en https://www.cuidadodesalud.gov/es/taxes/ o https://www.irs.gov/Spanish/Disposiciones-Tributarias-de-la-Ley-de-Cuidado-de-Salud-a-Bajo-Precio.

A continuación, resumimos cinco consejos útiles para los consumidores del Mercado y otros declarantes de impuestos cuando se trata de la presentación de impuestos este año:

Cinco consejos para quienes presentan declaraciones de impuestos

  1. La mayoría de la gente sólo tiene que marcar una casilla: La gran mayoría de los declarantes de impuestos tienen una cobertura que califica (incluyendo la cobertura de un empleador, Medicare, Medicaid u otra cobertura) y sólo tendrán que marcar una casilla cuando presenten sus impuestos para indicar que cada una de las personas en su hogar tuvieron cobertura en el año 2015. Este año, muchos consumidores recibirán en el correo de parte de su empleador, compañía de seguros, o el programa de gobierno que proporciona su cobertura, como Medicare o Medicaid, un nuevo formulario llamado formulario 1095-B o un formulario 1095-C. Los contribuyentes no tienen que incluir esta información con su declaración de impuestos o esperar a recibir el formulario antes de llenar sus impuestos, pero si deben conservar este formulario en un lugar seguro con otros documentos relacionados con sus impuestos. Para obtener más información sobre todas estas formas, visite el sitio web del IRS: https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/Preguntas-y-Respuestas-acerca-de-los-Formularios-de-Informacion-de-Cuidado-Medico-para-Individuos.
  1. Los consumidores del Mercado deben presentar una declaración de impuestos para reconciliar cualquier pago anticipado del crédito tributario de prima que recibieron para poder mantener su elegibilidad para esta ayuda en el futuro: Todos los consumidores del Mercado deberían haber recibido ya en el correo el Formulario 1095-A. Este formulario incluye información importante que se necesita para completar y presentar una declaración de impuestos. Es extremadamente importante que los que recibieron pagos por adelantado del crédito tributario de prima reconcilien estos pagos cuando presenten su declaración de impuestos. Las personas que no lo hagan por lo general tendrán un retraso de su reembolso, y no podrán ser elegibles para el pago anticipado de los créditos tributarios de prima en los próximos años. 
  1. La multa por no tener cobertura aumentara. Para aquellos que podían costearse un seguro médico y optaron por no obtener la cobertura, la multa por no tener la cobertura mínima esencial en el año 2015 subió hasta un 2 por ciento de los ingresos familiares o $ 325 por persona. La multa se prorratea según el número de meses que una persona no está asegurada. La multa sube de nuevo en el año 2016. Si alguien no tiene cobertura o una exención en el año calendario 2016, pero podría pagar la cobertura, la tasa aumenta a $695 por persona o el 2,5% de los ingresos, lo que sea mayor. Para más información, visite https://www.cuidadodesalud.gov/es/fees/.
  1. Algunas personas que no tuvieron cobertura de salud en el año 2015 calificaran para una exención: Mientras que los que pueden costear la cobertura de salud pero optaron por no inscribirse por lo general tienen que pagar una multa, algunas personas que no pudieron pagar una cobertura o cumplen con otras condiciones específicas pueden recibir una exención. Usted puede encontrar más información en línea del Mercado o del IRS en https://www.cuidadodesalud.gov/es/health-coverage-exemptions/exemptions-from-the-fee/ o https://www.irs.gov/Spanish/Disposiciones-Tributarias-de-la-Ley-de-Cuidado-de-Salud-a-Bajo-Precio-para-Personas-Físicas-y-Familias. 
  1. Hay ayuda disponible. Si la gente tiene preguntas acerca de los formularios de impuestos del Mercado, como se califica para las exenciones, o la multa, deben ponerse en contacto con el Centro de Llamadas del Mercado. El centro de llamadas está abierto todo el día, todos los días llamando 1-800-318-2596. recursos adicionales e información también está disponible en https://www.cuidadodesalud.gov/es/taxes/ o https://www.irs.gov/Spanish/Disposiciones-Tributarias-de-la-Ley-de-Cuidado-de-Salud-a-Bajo-Precio.

The Marketplace Risk Adjustment Program: Promoting Access, Quality, and Choice for Consumers

By Kevin Counihan, CEO of the Health Insurance Marketplaces
Dr. Patrick Conway, CMS Acting Principal Deputy Administrator

This week, CMS brings together health care stakeholders and experts to discuss an esoteric sounding, yet important, topic: the individual and small group market risk adjustment programs created by the Affordable Care Act (ACA).  Risk adjustment is critical to making the ACA’s better-known market reforms work well for insurers and consumers. By reducing incentives for issuers to try to design products that attract a healthy risk pool, risk adjustment lets issuers compete on quality, price, and products that meet the needs of all consumers, protecting consumers’ access to a range of robust options.

Risk adjustment is a longstanding and important part of the Medicare Advantage and Medicare Prescription Drug Programs and has proven effective in making these programs work well for seniors.  Likewise, the ACA’s risk adjustment program is already delivering on its promise of affordable coverage that meets consumers’ needs. But, there is always room for improvement.

That’s why CMS recently released a white paper (https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/RA-March-31-White-Paper-032416.pdf) that evaluates our experience with the risk adjustment formula to date and analyzes possible changes. The white paper provides data and analysis about how the program has operated in the past, so that information, best practices, and ideas for improvement can be shared. And that’s why we’re bringing a broad range of stakeholders together to discuss these issues.

As we consider comments and feedback in our meeting on Thursday, March 31, on the future of the ACA’s risk adjustment program, we will keep in mind key principles to simultaneously make improvements while staying true to the goals of the program.

Promoting Access, Quality, and Choice for Consumers with Diverse Health Care Needs

Before the ACA, Americans with pre-existing medical conditions were often left out of the health insurance market. Now, because of the ACA, Americans with pre-existing condition can no longer be charged more or denied coverage just because they’ve been sick.

This means that insurance companies have had to adapt to a new way of working.  Instead of “medical underwriting” – a practice where an insurance company requires you to disclose your health status to determine whether to offer you coverage, at what price, and with what exclusions – insurance companies must offer you coverage regardless of your health status and can’t charge you more for being sick.

Risk adjustment is an essential part of making the individual and small group markets work well under a system where everyone, including people with pre-existing conditions, can buy high-quality coverage.

Through risk adjustment, insurance companies with sicker-than-average enrollees receive payments from other health insurance companies with healthier-than-average enrollees. That means that issuers make or lose money based on the characteristics of the products they offer, rather than how sick or healthy their enrollees are. This, in turn, lets issuers compete in the market by designing products that meet the needs of all consumers, rather than designing products to be unattractive to those who are sick.

For example, thanks to risk adjustment, it can make financial sense for issuers to develop specialized care management programs to meet the needs of people with chronic or other conditions. If such plans attract more expensive enrollees, issuers know they will be compensated by risk adjustment.

We are already seeing some Marketplace plans innovate in this area to meet the needs of consumers with challenging health issues, for example by offering plans that focus on diabetes management and other chronic illnesses. Risk adjustment may also help new or smaller businesses participate in the market without fear of attracting a large number of sick enrollees in any particular year.

Assessing the Marketplace Risk Adjustment Program

The risk adjustment methodology was designed with input from trade associations, insurance companies, actuaries, clinicians, economists, and other members of the public. It was implemented through rulemaking with a public notice and comment period. CMS worked closely with health insurance companies to ensure that the risk adjustment program uses the best available data. And all insurance companies – large and small, new or established – play by the same rules.

The first finding of the CMS white paper is that the risk adjustment program has largely worked as intended to date. For the 2014 benefit year, the formula successfully transferred $4.6 billion from issuers with healthier enrollees to issuers with sicker enrollees.  Our data and an outside independent analysis (http://health.oliverwyman.com/maximize-value/2016/02/a_story_in_four_char.html) found that the main determinant of whether an issuer received a payment is the relative health of their enrollees, which is a sign of health for the program.

These analyses also show that the formula hasn’t favored large plans over small plans, or the reverse, indicating no bias by the size of the plan or insurance company. We expect performance of the program to improve with experience. Accurate risk adjustment payments depend on issuers accurately collecting, managing, and submitting data on their population’s health. While the ACA-compliant individual and small group markets are still relatively new, these core capabilities appear to have worked well in 2014 and we expect will contribute to successful health plan operation even in a market without risk adjustment.

What’s Next?

We have recently made and announced a number of changes to risk adjustment. In response to issuers’ requests for earlier information, we distributed risk adjustment data reports to insurance companies earlier this month to help them with setting their 2017 rates. These early reports rely on the information insurance companies report to CMS, and so they are only available in markets where sufficient issuers had submitted their data, and they are only as accurate as the data provided. This is why it is important that the companies focus on data management to fully and accurately report their experience and try to do so as early in the year as feasible.

We have also made some other adjustments to the methodology for the 2017 plan year including using more recent data, updating medical and drug trends, and incorporating preventive services into companies’ risk adjustment calculations.

As we contemplate making additional changes, we want to get more input from the public. And that’s the purpose of the public meeting on risk adjustment. As outlined in more detail in the white paper, some of the ideas we want to discuss include: whether and how to account for partial year enrollment in the model; whether and how to develop a prescription drug model, accounting for newer high-cost medications; whether and how to pool high risk enrollees; and whether and how to recalibrate the model based on data for the individual and small group populations, instead of a commercial dataset drawn from the employer market.

We look forwarding to hearing feedback from the public about these and other possible changes to the risk adjustment program.

We will continue to listen and learn to make sure we operate this vital program to maximum effect. We will take feedback and suggestions through April 22, 2016, and will keep the public informed as we consider proposals to change and improve the risk adjustment program in 2018 to serve the goals of providing affordable coverage and better care for millions of Americans.

CMS Invites Quality Innovation Network-Quality Improvement Organizations to Submit Special Innovation Projects to Expand Their Reach in Improving Care Delivery

By: Patrick Conway, MD, MSc
Acting Principal Deputy Administrator
Deputy Administrator for Innovation and Quality
CMS Chief Medical Officer

Kate Goodrich, MD MHS
Director
Center for Clinical Standards and Quality

Jean Moody-Williams, RN, MPP
Deputy Director
Center for Clinical Standards and Quality

Dennis Wagner, MPA
Director, Quality Improvement and Innovation Group
Center for Clinical Standards and Quality

The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) Program is constantly evolving to help ensure that Medicare beneficiaries receive better care, better health, and greater value. Today, CMS is announcing the program’s next evolution: two projects focused on supporting and scaling quality improvement innovations.

With this announcement, Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) can collaborate with health care providers and/or partners to compete for 28 Special Innovation Project (SIP) awards that fall within two topic categories totaling $8 million.

SIPs are two-year quality improvement projects that align with the goals of the CMS Quality Strategy (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/CMS-Quality-Strategy.html) and emphasize the power of partnerships. There are two categories of SIPs for QIN-QIOs to consider:

  1. “Innovations that Advance Local Efforts for Better Care and Smarter Spending,” which will address healthcare quality issues that occur within specific QIN-QIO regions.
  1. “Interventions that are Ripe for Spread and Scalability,” which will focus on expanding the scope and national impact of a quality improvement project that has experienced proven but limited success. The expectation is that similar benefits would be experienced on a large scale if spread throughout the greater health care community.

The scalability category aligns with the CMS Strategic Innovation Engine (SIE) (http://sie.qioprogram.org/), a new endeavor launched in August of 2015. The SIE is working to rapidly move innovative, evidence-based quality practices from research to implementation through the QIO Program. In consultation with the SIE Executive Leadership Council, CMS is seeking projects that:

  • Streamline patient flow in various health care settings, including hospital units, outpatient clinics, primary care offices, ambulatory surgical centers, and cancer centers resulting in efficiencies, improved satisfaction, decreased mortality, better care, healthier people, and smarter spending.
  • Work with health plans and/or care coordination providers to deploy an integrated approach to post-acute care that results in enhanced care management, safe transitions from one care setting to another, improved health outcomes, and reductions in harms.
  • Increase value, patient affordability, and appropriate use of specialty drugs by applying evidenced based criteria to prescribing practices and by monitoring effectiveness when providers have a choice(s) among equally effective drugs with differing costs.
  • Address acute pain management. For example, more is needed to assist sickle cell patients: from accurate identification of their illness to education of emergency department staff on sickle cell disease while addressing the cultural stigmas often associated with the disease.
  • Utilize big data analytics to reduce preventable harm in healthcare.

We encourage those in the larger healthcare community who are leading quality work in these areas, with interventions and proven results, to reach out and explore potential partnerships with QIN-QIOs. Through collaboration with healthcare providers, patients, families, and other key stakeholders, QIN-QIOs have tremendous potential to take those interventions to the national level and improve the health care delivery system by tapping into new settings of care and building upon the knowledge gained by people working on the front line of providing quality health care.

The QIN-QIOs selected to carry out these SIPs will leverage their data-driven approach, extensive partnerships, and the voices of patients and families to positively impact Medicare beneficiaries in their communities and nationwide.

The QIO Program’s 14 QIN-QIOs work with providers, community partners and beneficiaries on multiple data-driven quality improvement initiatives to improve patient safety, reduce harm, engage patients and families, improve clinical care and reduce healthcare disparities. For more information about the CMS QIO Program and for a complete list of QIN-QIOs, please visit the QIO Program website (http://www.qioprogram.org/).

Taxes and Health Care Coverage: Five Tips for Tax Filers

By: Kevin Counihan, CEO of the Health Insurance Marketplaces, Centers for Medicare and Medicaid Services

Last year, millions of people purchased quality, affordable coverage through the Health Insurance Marketplace, and most benefitted from advance payments of the premium tax credit that lowered their monthly premiums. With the tax filing deadline a few weeks away, it’s a good time to remind everyone – both new and renewing consumers – about what they need to know when they file their taxes.

For those who returned to the Marketplace in 2015 to renew coverage or pick a different plan, the tax filing process is generally the same as last year. But, for the millions who signed up for Marketplace coverage in 2015 for the first time, the process may be a new one. By now, all Marketplace consumers should have received a statement in the mail from the Marketplace called a Form 1095-A. These statements include important information needed to complete and file a tax return.

Marketplace consumers who received advance payments of the premium tax credit are required to file a tax return to reconcile that financial assistance. This is similar to the reconciliation process for taxes withheld from wages during the year – consumers receive a larger or smaller refund depending on whether the appropriate taxes were withheld based on the tax filer’s actual income and other factors.

It’s extremely important that those who received advance payments of the premium tax credit reconcile these payments when they file their tax return. Individuals who do not do so will generally see their refunds delayed, and are not eligible to receive advance payments of the premium tax credit in future years.

Individuals with Marketplace or other types of health coverage may also have received additional forms called a Form 1095-B or 1095-C from their employer, insurance company, or the government program that provides their coverage, like Medicare or Medicaid. Taxpayers don’t need to attach this information to their return or wait to receive the form before filling their federal taxes, but should keep it in a safe place with other tax records.

An important reminder: Since most tax filers use a tax preparer or tax preparation software, most filers just need to answer questions when prompted.

We are here to help. Marketplace consumers having questions should contact the Marketplace Call Center (1-800-318-2596).  Additional resources and information for is also available at www.healthcare.gov/taxes or www.IRS.gov/aca.

Here’s summary of five helpful tips for both Marketplace consumers and other tax filers when it comes to filing taxes this year:

Five Tips for Tax Filers

  1. Most people just need to check a box: The vast majority of tax filers have qualifying coverage (including employer coverage, Medicare, Medicaid, or other coverage) and will just need to check a box when they file their taxes to indicate that that everyone in their household had coverage for 2015. This year, many consumers will receive a new form called a Form 1095-B or a Form 1095-C in the mail from their employer, insurance company, or the government program that provides their coverage, like Medicare or Medicaid. Taxpayers don’t need to attach this information to their return or wait to receive the form before filling their taxes, but should keep it in a safe place with other tax records. For more information on all these forms, visit the IRS website at: https://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals
  1. Marketplace consumers must file a tax return to reconcile any advance payment of the premium tax credit they received in order to maintain eligibility for future help: By now, all Marketplace consumers should have received a statement in the mail from the Marketplace called a Form 1095-A. These statements include important information needed to complete and file a tax return. It’s extremely important that those who received advance payments of the premium tax credit reconcile these payments when they file their tax return. Individuals who do not do so will generally see their refunds delayed, and are not eligible for advance payment of premium tax credits in future years.
  1. The fee for not having coverage is increasing. For those who could afford health insurance and chose not to get coverage, the fee for not having minimum essential coverage in 2015 has increased to 2 percent of household income or $325 per person. The fee is pro-rated based on how many months a person is uninsured. The fee goes up again for 2016. If someone doesn’t have coverage or an exemption in the 2016 calendar year, but could afford coverage, the fee increases to $695 per person or 2.5% of income, whichever is higher.
  1. Some people who didn’t have health coverage in 2015 will qualify for an exemption: While those who can afford health coverage but chose not to enroll generally have to pay a fee, some people who couldn’t afford coverage or met other conditions can receive an exemption. You can find out more information online from the Marketplace or IRS at https://www.healthcare.gov/health-coverage-exemptions/exemptions-from-the-fee or https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families.
  1. Help is available. If people have questions about Marketplace tax forms, qualifying for exemptions, or the fee, they should contact the Marketplace Call Center. The call center is open all day, every day at 1-800-318-2596. Additional resources and information for is also available at healthcare.gov/taxes or www.IRS.gov/aca

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CMS Strong Start for Mothers and Newborns Strategy II Initiative Second Annual Evaluation Report

By Patrick Conway, M.D., CMS Principal Deputy Administrator and Chief Medical Officer

Today, we at the Centers for Medicare & Medicaid Services (CMS) are pleased to announce findings from the second annual evaluation report for the Strong Start for Mothers and Newborns Strategy II Initiative. As noted with the release of our first annual report, Strong Start Strategy II seeks to build on work conducted by the Partnership for Patients and Strong Start Strategy I to improve newborn health through a reduction in early elective deliveries. Babies are generally healthier and have better long-range outcomes when they are born full-term.  Strategy I contributed to a 64.5% nationwide drop in early elective deliveries from 2010 to 2013.

The Strong Start II (hereafter referred to as Strong Start) builds on this success through prenatal care enhancements addressing the psychosocial needs of pregnant women eligible for Medicaid and CHIP.  Strong Start is an important federal initiative geared toward testing innovative approaches to improve maternal and infant health outcomes in low-income families.

Research consistently shows that infants born preterm (before 37 completed weeks of gestation) have higher mortality risks and may endure a lifetime of developmental and health problems when compared to their counterparts born after 37 weeks’ gestation.

Prenatal care enhancements provided through Strong Start are designed to promote overall maternal and infant health and particularly to reduce incidence of preterm birth and low birth weight.  The second annual report presents the progress Strategy II has made since its inception.

Strong Start has continued its partnership with 27 organizations representing nearly 200 provider sites in 32 states, Washington, D.C., and Puerto Rico.  The program continues to provide enhanced services through three approaches:

  • Group Care – Group prenatal care that incorporates peer-to-peer support in a facilitated setting for three components: health assessment, education, and support.
  • Birth Centers – Comprehensive prenatal care facilitated by midwives and teams of health professionals, including peer counselors and doulas.
  • Maternity Care Homes – Enhanced prenatal care at traditional prenatal sites with enhanced continuity of care and expanded access to care coordination, education, and other services.

Enrollment increased dramatically in the second year of program operations, with a total of 23,000 women enrolled from March 2013 to the end of the first calendar quarter of 2015. Enrollment is expected to continue to grow to more than 40,000 participants by the program’s end in February 2017.  Additionally, participants continue to express overwhelming satisfaction, with 90% stating that they were either very satisfied or extremely satisfied with their prenatal care.

In addition to their standard schedule of prenatal care visits, Strong Start participants receive enhanced care visits in accordance with their psychosocial needs.  Enhanced visits provide services such as care coordination, referrals to local resources, prenatal health education, and peer support.

Upon enrollment, Strong Start participants have several risk factors, including many pertaining to psychosocial needs:

  • Depression upon enrollment (nearly a quarter of participants report being depressed at intake)
  • Unstable housing
  • Unemployment
  • Unmet mental health and dental needs
  • Food insecurity
  • Unmarried or unpartnered status

Results from the second year evaluation indicate that, as was found in the first year, Strong Start participants have:

  • Lower rates of cesarean section than national averages, though there is wide variation among and within models
  • Higher rates of breastfeeding than national averages among similar populations

In addition, the new report finds that Strong Start participants have:

  • Overall preterm birth rates similar to national averages despite the high-risk population served
  • Lower preterm birth rates than national averages within racial-ethnic groups (Black , White, Hispanic)
  • Vaginal birth after cesarean rates that are nearly twice the national average

Although findings must be interpreted with caution because they are descriptive, we are pleased with what we have found thus far. Substantial progress was made during the second evaluation year in developing resources, particularly obtaining state Medicaid claims linked to vital records, which will enable development of a control group and an analysis of costs.  The third annual report is anticipated to contain analysis of further participant-level data, case studies based on site visits, and an initial analysis of linked data from states.

Much work remains to be done to reduce significant risks and complications for pregnant women and infants, but these early results from the Strong Start evaluation show promise for improving pregnancy outcomes.  We remain committed to working together to deliver higher quality care, smarter spending, and better health outcomes for low-income pregnant women and their newborns.

Keeping Consumers Covered

By Health Insurance Marketplace CEO Kevin Counihan

The latest open enrollment period exceeded our expectations, with more than 12.7 million people signing up for coverage or automatically renewing their plans for 2016. To me, this success is confirmation that the Health Insurance Marketplace is providing a needed service to connect people to quality, affordable health care coverage. This year’s progress is also confirmation of the hard work that went into improving the consumer experience on HealthCare.gov to help people shop for the coverage that is right for them and their families.

Consumers are more engaged, savvier and better informed. New customers came in earlier, allowing them to have a full year of coverage, and 70 percent of returning customers actively selected a plan. And because of operational improvements, we have more precise enrollment data, so the 12.7 million already takes into account a larger share of cancellations that took place during Open Enrollment.

These are all good signs for consumers retaining coverage for the year to come. And now that Open Enrollment is over, we are focusing even more of our energy on helping consumers stay covered.

There are many reasons consumers choose to leave the Marketplace – perhaps the most common is that the consumer finds a new source of coverage outside of the Marketplace, including getting a job with employer coverage or becoming eligible for programs like Medicare and Medicaid. What we don’t want is for eligible consumers to lose their coverage because they have trouble navigating our processes. Below are some of the things we’re doing to make sure that consumers who are eligible for and need coverage throughout the year are able to stay covered.

Consumer Payment Experience

Some consumers who are just entering the Marketplace don’t pay their first bill. In some cases, a consumer changes their mind or has had a life change and no longer needs Marketplace coverage. But in others, it’s because they have trouble navigating the payment process, aren’t clear on when their payment is due, or simply forget to pay before it’s too late. If a consumer doesn’t pay their first bill, or what’s called their binder payment, their coverage is terminated by their insurance company.

We’re working to improve the consumer payment experience this year in a couple of different ways:

  • We’ve made improvements to our Marketplace outreach, reminding consumers to make their first payment. We’re sending consumers additional reminders, sending them earlier in the process and providing clearer guidance on when their payment is due.
  • We’re also working closely with insurance companies to reinstate consumers who had trouble during the payment process.

Data Matching

Another reason consumers may lose their coverage is if we don’t receive the information we need to confirm their eligibility. The law specifies that when we can’t verify key information like a Social Security number or income immediately through automatic checks against other Federal data, consumers can enroll in coverage for 90 or 95 days while we work with them to verify their eligibility. But after that, their coverage is cancelled or their financial assistance is adjusted or ended.

The fact that we cannot immediately confirm eligibility does not mean an individual is ineligible for coverage or financial help. It just means that the information a consumer provided can’t be instantly validated by our data sources. Reasons this occurs can be as simple as a Social Security number typo or a government database that has first and last names switched. For many consumers, the issue is a change in employment or wages since they filed their last tax return. That’s why the law gives consumers time to provide more information, and that’s why the majority of “data-matching” issues are resolved because consumers successfully submitted documentation that substantiates what they told us on the application. Nonetheless, in 2015, coverage was terminated or APTCs were adjusted due to data matching issues for about 1.7 million consumers.

As with other Marketplace rules, CMS is committed to both making sure the process works better and limiting access to coverage and financial assistance to those individuals who are indeed eligible. We’ve already made significant improvements that we believe will help to reduce the share of consumers who lose coverage or financial assistance due to data matching issues this year.

To help consumers avoid data matching issues during the enrollment process:

  • We’ve made improvements to the online application that makes it clearer when a data matching issue is created and we encourage people to provide key information if they failed to do so initially, such as providing a Social Security number or an immigration document number to resolve the issue in real time.
  • We added functionality that helps make sure consumers do not generate a new data matching issue if they have previously resolved that issue with the Marketplace. This keeps consumers from having to summit the same documentation year after year.
  • Going forward, the 2017 payment notice allows CMS to establish more appropriate income verification thresholds next year for consumers.

And, to help consumers resolve data matching issues once they’ve been generated:

  • As a result of working with advocates and assisters, we have made improvements to our notice language to more clearly explain what documents a consumer should submit to resolve data matching issues. And we are developing a new resource guide designed to both prevent income data matching issues and improve resolution of generated income data matching issues.
  • Going forward, the FY 2017 budget proposes funding that would give CMS the ability to improve our outreach, including to consumers with data matching issues. The CMS team reaches out to consumers as many as 14 times to make sure consumers know what information they need to provide.

Because of these improvements, we’re starting to see promising signs, including a noticeable reduction in the rate of data matching issues, and consumers responding to our outreach efforts earlier and in larger numbers. While we won’t have final numbers for a couple of months, we are strongly encouraged by the progress we have made and hopeful that our progress will help consumers who need and are eligible for coverage stay covered all year.

Bridging the Healthcare Digital Divide: Improving Connectivity Among Medicaid Providers

Andy Slavitt, Centers for Medicare & Medicaid Services (CMS) Acting Administrator,

Karen DeSalvo, National Coordinator for Health Information Technology (ONC) and Acting Assistant Secretary for Health

The great promise of technology is to bring information to our fingertips, connect us to one another, improve our productivity, and create a platform for the next generation of innovations.. Technology, when widely distributed and available, enables providers to improve patient care by distributing information and best practices and leading to better experiences of care for individuals in the health care system. And technology can make a significant difference in the rapidly modernizing Medicaid program.

Connecting All Parts of the Health System

That’s why today, we are announcing an initiative to bring interoperable technology to a broader universe of health care providers, including long-term care, behavioral health providers, substance abuse treatment centers, and other providers that have been slower to adopt technology. This announcement will help to bridge an information sharing gap in Medicaid by permitting states to request the 90 percent enhanced matching funds from CMS to connect a broader variety of Medicaid providers to a health information exchange than those providers who are eligible for such connections today. This additional funding will enhance the sustainability of health information exchanges and lead to increased connectivity among Medicaid providers.

Doctors and other clinicians need access to the right information at the right time in a manner they can use to make decisions that impact their patient’s health. The free flow of information is hampered when not all doctors, facilities or other practice areas are able to make a complete circuit. Adding long-term care providers, behavioral health providers, and substance abuse treatment providers, for example, to statewide health information exchange systems will enable seamless sharing of a patients’ health information between doctors or other clinicians when it’s needed. This sharing helps create a more complete care team to collaborate on the best treatment plans and goals for Medicaid patients.

Modernizing Medicaid

Today’s announcement is another example of how Medicaid is leading change for its beneficiaries and throughout the health care system. But this is more than a technology initiative. It is part of a comprehensive effort to make sure that the 72 million adults, children, seniors and people with disabilities served by the Medicaid program have access to high quality, coordinated care. Improving population health and addressing the needs of complex populations requires strong health information technology tools.

The benefits are tangible – from care coordination to medication reconciliation to public health reporting. Exchanging care information can support patients with multiple chronic conditions as they navigate specialists, hospitals, primary care, home health care, and pharmacies. Medication reconciliation for children in the foster care system avoids duplicative or missed treatments. And, public health reporting sounds the warning bell on potential public health disasters and improves the use of preventive measures, such as immunizations. This investment should also speed the adoption of alternative payment models that focus on the quality rather than the quantity of care provided. As the Medicaid program moves towards paying for quality, technology infrastructure and information exchange is needed for better care coordination.

CMS and ONC look forward to partnering with and supporting states in these and other critical efforts to modernize and connect the Medicaid program for the millions of beneficiaries they serve.

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