Broker blog from Delta Dental

Tag: health care exchange

Catch up on selling Affordable Care Act plans

It’s open enrollment season for Affordable Care Act-compliant (ACA) dental plans on Health Care Exchanges (Marketplaces). Here’s what you need to know to sell ACA exchange plans to your individual clients.

Dates to know

  • November 1, 2021: Open enrollment begins.
  • December 15, 2021: Last day to enroll in or change plans for coverage that begins on January 1, 2022. (Please note that this date may be subject to extension.)
  • January 1, 2022: Coverage begins for those who enrolled by the December due date and have paid their first premium.
  • January 15, 2022: Last day to enroll in or change plans for 2022 coverage in the following states:
    • Federally Facilitated Marketplace states – AL, AR, DE, FL, GA, IA, IL, KS, LA, MI, MS, MT, OK, OR, TX, UT, VA and WV
    • MD, MN, NV, PA, and WA

After this date, individuals must qualify for a Special Enrollment Period to enroll in a new plan or change their current one.

  • January 30, 2022: Last day to enroll in or change plans for 2022 coverage in the following states:
    • CA, NJ and Washington DC.
  • February 1, 2022: Coverage begins for those who enrolled by the January due date and have paid their first premium.

The American Rescue Plan Act of 2021 expanded ACA access

In March, President Joe Biden signed the American Rescue Plan Act of 2021. Among its other effects, this law will lower premiums this year for most people who currently have a Marketplace health plan and expand access to financial assistance. The Centers for Medicare & Medicaid Services released a factsheet that breaks down the steps required for your clients to make the most of this expanded access.

The basics of exchanged-based dental plans

All plans offered through public exchanges are available in two forms:

  • Health plans that include dental coverage
  • Stand-alone dental plans

Both stand-alone plans and bundled plans are available as high and low plans.

  • High plans. These plans feature higher monthly premiums but lower coinsurance and deductibles. These plans may be appropriate for clients who anticipate needing extensive care over the course of the year.
  • Low plans. These plans have lower monthly premiums but higher coinsurance and deductibles. These plans have lower fixed monthly costs but higher out-of-pocket expenses for dental care. These plans may be better for clients who are in good dental health and anticipate only needing routine cleanings and exams.

Dental insurance is an essential benefit for children, but not adults

For children 18 and younger, dental coverage is considered an essential benefit. That means that dental coverage must be made available by insurers, either in the form of a stand-alone plan or as part of a bundled health plan. Because dental coverage isn’t an essential health benefit for adults, insurers aren’t required to offer it.

Selling Covered California has some unique aspects

As a public exchange, Covered California has much in common with other exchanges. However, there are some differences that are unique to California. One of the biggest is these is extra certification requirements beyond the ACA-mandated training.

As an insurance broker, you’re required to have additional certification to sell Covered California plans. Beyond the regular licensing requirements to sell insurance in California, you must also complete online course, pass an exam and submit various paperwork to receive certification as a Covered California agent.

Here are some other considerations for selling in California:

  • California permanently adopted an extended open enrollment schedule, running from November 1, 2021 through January 31, 2022.
  • California offers both PPO and HMO plans.
  • Children are granted dental benefits under health plans at no extra cost. Additionally, children under 19 can be added to family dental plans to get coverage of services like fillings and crowns.

Selling individual coverage through ACA-funded exchanges presents some unique challenges, but it can be worth the learning curve to reach otherwise underserved markets and receive the 10% premium per member commission. You can also take pride in knowing that you’re helping those without employer-based coverage gain the security that comes from having dental coverage. If you haven’t already, visit the Delta Dental Health Care Exchange page for brokers to get appointed and learn more.

Policy pops: Health care exchanges — 2019 enrollment results

3‑minute read

Join our guest blogger, Devin McBrayer, as she reviews the outcomes of the 2019 open enrollment period for health care exchanges. Devin is a Legislative and Policy Analyst based in Sacramento, California.

The open enrollment period to purchase Affordable Care Act (ACA)-compliant individual health insurance coverage off the health insurance exchanges for 2019 has come to an end. Sign-ups were off to a slow start at the beginning of the enrollment period, leaving many experts fearful that ACA plans would experience a significant decrease in enrollment. However, total enrollment only decreased by about 3.8% nationwide on Healthcare.gov, much of this due to a 15% reduction in new sign-ups. 

While the total enrollment drop in individual health insurance plans on the exchange may have been less drastic than expected, it is still worth exploring why new enrollment decreased considerably and why year-to-year enrollment continues to decline. Several 2018 policy changes, combined with a growing economy, could help explain the decrease in enrollment in ACA plans for the 2019 plan year. 

Are policy changes to blame?

In 2018, Congress reduced the tax penalty for not having an ACA-compliant health insurance plan to zero, effectively eliminating it. The federal government also shortened the open enrollment period and reduced marketing for open enrollment. Simultaneously, the federal government passed several rules that expanded the availability of cheaper and less comprehensive insurance plans such as short-term limited duration plans. No tax penalty for lack of coverage, combined with a shorter sign-up period and more plan options outside the exchanges, may help explain the enrollment decrease.

The impact of the economy

Another possible explanation for the drop in enrollment could be attributed to an improving economy. When open enrollment started on November 1, 2018, 2 million more jobs were added to the economy than were added at the same time in 2017. As more people head back to work, it’s possible that they’re gaining access to employer-sponsored health insurance, eliminating the need to renew their ACA plan. 

What does this mean for dental?

Any loss in enrollment for medical coverage also means less people enrolled in dental coverage on the exchange. (As a reminder, dental coverage is an essential health benefit for children but not for adults.) 

In the exchanges, dental coverage is included in some health plans or consumers can get a stand-alone dental plan and pay a separate premium. However, there is no way for consumers to purchase a stand-alone dental plan without also purchasing a medical plan on the health care exchange. Pushing for states and the federal government to allow for the independent purchase of stand-alone dental plans on state and federal health insurance exchanges is a top priority for the Public & Government Affairs team at Delta Dental.

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Plain language policy: States move forward to stabilize insurance markets

Join our guest blogger, Stephanie Berry, as she unpacks state reactions to the removal of the ACA’s individual mandate. 

Stephanie is a Senior Legislative and Policy Analyst based in Sacramento, California.

As we reported recently, ending the penalty for individuals who choose not to purchase medical coverage (the individual mandate) could further destabilize the individual market. However, state policymakers aren’t waiting for further federal action on the ACA — leading to a notably active regulatory year as states are taking matters into their own hands. Here’s a summary of activity:

Weakening ACA regulations

Idaho unveiled a plan that openly defies the ACA by announcing earlier this year that the state would allow health plans to be offered that don’t comply with the ACA’s regulations on pre-existing medical conditions, essential health benefits, annual caps on benefits, and other key tenets of the law. These plans, of course, would be quite a bit cheaper than ACA plans and are designed to attract younger, healthier individuals. Because Idaho announced its intention to skirt ACA regulations, the federal government responded that it would step in and enforce the law if the state followed through with its plan.

Similarly, the Iowa legislature enacted a bill that allows non-ACA compliant plans to exist by creating an exemption for plans offered by the Iowa Farm Bureau, an association that is meant to serve Iowa’s farmers. To pass federal muster these plans cannot be called health insurance and therefore, cannot be regulated by the federal government or the Iowa Department of Insurance. It is likely that we will see other states follow suit.

Establishing reinsurance programs

Several states have introduced legislation to create state reinsurance programs — a way for carriers offering individual health insurance to get compensated for covering high healthcare costs. While bills are making their way through the legislatures in Louisiana, New Jersey, and other states that would require the state to apply for a federal waiver, Maryland has already enacted legislation that will support a reinsurance program by levying a surcharge on medical and dental carriers. This enacted legislation was designed to mirror the federal tax that was suspended for 2019.

Imposing state individual mandates

Finally, state legislatures — particularly those with state-based exchanges — are attempting to impose their own individual mandate that would require individuals to maintain health care coverage or pay a penalty. Legislation has been introduced in Connecticut, Vermont, New Jersey, Maryland, and Washington, but currently, only New Jersey’s bill — AB 3380 — appears close to enactment, while the bill in Washington has already died. It remains to be seen whether these individual mandate bills will be able to gain more traction this year or next.

Stay tuned for more health care policy updates from Delta Dental, and get to know our policy experts.

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Dental and the ACA in 2017

New reports speculating on the future of the Affordable Care Act have come out almost daily since America elected Donald Trump to be the next president. Here at Delta Dental, our leadership involved with health care reform breaks down what all the hubbub may mean for the dental benefits industry in 2017.

Clients and enrollees won’t feel effects of any major changes for a few years

No “significant change to the health care market — medical or dental” is expected for three or four years, says Jeff Album, Delta Dental’s vice president of Public and Government Affairs.

“Repeal and replace has changed to repeal and delay,” Album says. “It’s clear that both Congress and the new administration are going to want to minimize disruption to the existing system.”

Album expects Congress will take action early in 2017 to defund parts of the law, but postpone when that takes effect. In the meantime, lawmakers will determine how the replacement will look.

As the new law is developed, he says, Delta Dental will take an active role by helping the industry “define its advocacy agenda” in terms that best serve existing and prospective customers’ needs.

Health Insurance Tax could be modified or repealed in 2017

Early this year, Album says, Congress will likely seek to find common ground on the future of taxes associated with the law, including the Cadillac tax and the health insurance tax (HIT). The HIT tax, charged to insurance carriers based on premiums earned, was put on a one-year moratorium for 2017.

The fate of the HIT is the “biggest question” this year for the Actuarial and Underwriting departments at Delta Dental as they prepare for 2018, says Tom Leibowitz, vice president and chief actuary.

Overall, Leibowitz says he expects rates for dental benefits will continue to stay largely stable for 2018.

“Unlike health care, dental had fairly small impact on rating requirements from the ACA,” he says, “so those huge cost increases that have been seen on the public exchanges for medical are not taking place in the dental world.”

Public exchanges are sticking around for now, and Delta Dental will stick with them

Delta Dental and its affiliate companies have already started work on 2018 exchange plan offerings.

“We are committed to the exchanges as long as they’re a viable platform through which we can sell standalone pediatric and family dental plans,” says Andrea Fegley, vice president of Legal & Regulatory. “Participation in public health care exchanges aligns well with our mission to advance dental health and access.”

Public exchange benefit offerings complement Delta Dental’s existing business strategy, adds MohammadReza Navid, vice president of Sales.

“Regardless of the ACA’s future, Delta Dental will continue to find innovative ways to increase dental access for all,” Navid says.

Both agreed that the company’s planning and strategic initiatives will keep Delta Dental at the forefront of the industry.

What you should know about exchange dental benefits

It’s the fourth year of open enrollment on the public health care exchanges, and your clients probably still look to you to help them navigate the new marketplace.

Find the right exchange dental plans for your individual or small business clients by evaluating the pros and cons of stand-alone dental coverage.

Pediatric dental benefits embedded in a medical plan are often subject to high deductibles (except in California).

Dental expenses in such plans usually aren’t covered until a combined medical-dental deductible (often in the thousands of dollars) is met. Check the plan’s details to determine if certain categories of dental services are waived from the deductible. In a stand-alone plan, certification requirements ensure that only a small deductible, if any, must first be satisfied.

Stand-alone dental coverage is typically worth the premium—even if enrollees only go for twice a year exams, x‑rays and cleanings.

The premium for a stand-alone HMO dental plan usually costs less than two checkups at the dentist each year without insurance. PPO dental coverage costs more, but can still pay for itself with just two visits per year. With both types of dental plans, cleanings, exams and x‑rays are often covered at 100% or no copay. If more expensive care is needed, the cost savings only grow from there.

Individuals enrolled in a stand-alone dental plan can clearly benefit from cost savings and improved oral health. Small businesses, meanwhile, can offer meaningful benefits that can save employees money while meeting Affordable Care Act coverage requirements.

Want more insight? Check out the Delta Dental guide to Health Care Reform for Brokers and Consultants.

See what Delta Dental offers in your marketplace by visiting healthcare.gov or your state-based exchange.

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