Countdown to the Health Insurance Marketplace


Posted by AzBlueMeanie:

10-days-to-open-enrollment_originalDid you know that in just 4 easy steps you and your family could be on
your way to getting quality, affordable coverage through the Health
Insurance Marketplace? Learn all you can now so you’ll be ready to apply for health coverage, compare plans side-by-side, and enroll in a plan on October 1.

Here is the latest information from the Department of Health and Human Services (HHS) to educate the public on the Health Insurance Marketplace:

Item 1: Obama Administration announces a coordinated effort to prevent and detect consumer fraud in the Health Insurance Marketplace

On Friday, Attorney General Eric Holder, Health and Human Services (HHS) Secretary Kathleen Sebelius, and Federal Trade Commission (FTC) Chairwoman Edith Ramirez met at the White House to kick off a comprehensive interagency initiative to prevent, protect against, and, where necessary, prosecute consumer fraud and privacy violations in the Health Insurance Marketplace. Representing key state partners in this critically important effort to protect consumers were Maryland Attorney General Douglas Gansler and Kansas Insurance Commissioner Sandy Praeger. Senior White House officials also attended the meeting.

Meeting participants reaffirmed their ongoing commitment to protect consumers from potential threats in this area. Building on a successful infrastructure that exists, the interagency officials highlighted the following new initiatives: 1) the dedication of the Marketplace Call Center as a resource and referral to FTC for consumer fraud concerns, with trained Call Center staff to effectively refer consumer threats and complaints; 2) connecting consumers to FTC’s Complaint Assistant through; 3) development of a system of routing complaints through the FTC’s Consumer Sentinel Network for analysis and referral as appropriate; 4) establishment of a rapid response mechanism for addressing privacy or cybersecurity threats and; 5) ramping up public education to empower consumers and assisters to know the facts and avoid scams.

The experienced and dedicated professionals at HHS, DOJ and FTC, together with their state and local partners, are ready to anticipate and respond to the law enforcement challenges that may arise with the launch of the Marketplace. They will be using tried and tested methods for combating fraud associated with other government programs, so that consumers can confidently and securely shop for affordable health insurance beginning October 1.

Consumers who report that their personal information may have been compromised will be given information about steps to take to prevent or respond to identity theft. If a consumer reports suspected fraud, his or her complaint will be entered into the FTC’s Consumer Sentinel Network database, which is used by federal and state law enforcement agencies to track potential fraud activity. Federal law enforcement officials will be able to monitor complaint activity for trends within and across all 50 states.

Consumer fraud experts from across state and federal agencies will continue to meet on a regular basis to monitor potential fraud associated with the Marketplace and ensure the strength of preventive measures.

Steps have been initiated to prevent and respond to individuals attempting to take advantage of the public during health care implementation. These measures include:

· Reporting fraud mechanism: A new feature of the Marketplace Call Center (1-800-318-2596, TTY 1-855-889-4325) will now enable individuals to report fraud simply by calling the 1800 number. Call Center operators have been trained to take a fraud complaint, and refer them to FTC’s Consumer Sentinel Network.

· Creating new pathways: offers easy access to connect consumers to FTC’s Complaint Assistant.

· Establishing a routing system for complaints through a centralized database: Routing complaints through FTC’s Consumer Sentinel Network will ensure federal, state and local law enforcement have access to consumer complaints and can analyze and refer those complaints as appropriate.

· Protecting personal data: Building on the certification of the Health Insurance Marketplace’s data hub on Sept. 6, 2013 as in compliance with the stringent security, privacy and data flow standards developed by the National Institute of Standards and Technology – the gold standard for information and independent security controls assessment – the interagency officials have also established a rapid response mechanism that will be employed in the unlikely event of a data security breach.

· Empowering consumers with information: Building on a proactive effort to inform consumers about potential fraud and privacy threats, the federal government is releasing new educational materials to empower consumers and assisters who are helping consumers navigate the Marketplaces. They include online tip sheets like
Protect Yourself from Fraud in the Health Insurance Marketplace
Tips for Assisters to Help Consumers Navigate the Marketplace
. The materials remind consumers that there is assistance, at no cost to them, available to navigate the Marketplace and that they should be suspicious of persons who ask for a fee before providing assistance.

In addition, the FTC and DOJ are hosting events this week in anticipation of the launch of the Marketplace:

· Thursday, September 19th, the FTC, [hosted] a roundtable in Washington, D.C. to discuss how to empower and protect consumers from scammers with the advent of the Health Insurance Marketplace. The roundtable will bring together experts on the health care law, federal and state consumer protection officials, representatives of legal services and community-based organizations, and consumer advocates to discuss key features of the law, state approaches to implementation, and how to help consumers avoid potential scams.

· Friday, September 20th, DOJ [hosted] a law enforcement meeting to convene state and local officials. This meeting is part of ongoing efforts urging State Attorneys General to work with HHS and federal, state, and local law enforcement to mount a substantial outreach campaign to educate consumers about how to prevent scams and fraud and protect their personal information in the Marketplace.

These comprehensive preventive and detection efforts build on the extensive experience and federal, state and local intergovernmental infrastructure that has protected consumers from fraud.

· Since its creation in 1997, the HHS Senior Medicare Patrol has educated to more than 28 million Medicare beneficiaries and counseled more than 1.3 million individuals about specific concerns, one-on-one. Coupled with other outreach efforts, Medicare’s toll-free customer service operations sent nearly 45,000 inquiries to law enforcement partners for fraud investigations in 2012 alone. These direct-from-consumer leads ultimately supported the administration’s work to prosecute criminals, returning $6.7 billion to the Medicare Trust Fund in the last four years.

· In the last several years, the FTC’s Bureau of Consumer Protection has put a stop to more than 50 health fraud scams, government grant schemes, and mortgage relief services frauds, and has independently secured nearly $6 million in monetary relief for consumers. The Bureau conducts investigations, sues companies and people that violate the law, and educates consumers and businesses about their rights and responsibilities. The Bureau coordinates its work in these areas with federal, state and local partners.

· During the last four years, DOJ has successfully prosecuted more than 4,000 defendants in identity theft and aggravated identity theft cases, and convicted over 200 defendants in advance fee fraud cases, over 500 defendants in consumer fraud cases, and over 100 defendants in telemarketing fraud cases.

For more information on CMS’s efforts to protect consumers in the Marketplace, please visit:

Item 2: Rural areas gain assistance for enrollment in Health Insurance Marketplaces

Friday, Health and Human Services (HHS) Secretary Kathleen Sebelius announced more than $2.5 million to educate and enroll uninsured individuals and families living in rural America in new health coverage options through the Affordable Care Act.

Rural health organizations across the country will receive $25,000 each from HHS’ Health Resources and Services Administration (HRSA) to help people in their communities understand the benefits available to them, eligibility requirements and options in their State Health Insurance Marketplaces. These organizations include universities, local and critical hospitals, and other rural non-profit or public organizations.

“Soon millions of Americans in rural communities will have new opportunities for quality, affordable health coverage through the Health Insurance Marketplace,” said Secretary Sebelius. “Through these awards, trusted community providers will help people understand their coverage options, including whether they can get a discount on costs.”

The Department of Agriculture (USDA) is also helping with the national outreach effort through the Cooperative Extension Service. Through funding provided by the Centers for Medicare & Medicaid Services , USDA’s National Institute of Food and Agriculture is working with the University of Georgia to establish a network of educators to help uninsured and underinsured consumers make informed decisions about participating in the Health Insurance Marketplace. The University of Georgia will use the $1.25 million inter-agency agreement to coordinate outreach activities in 12 states.

“Nearly one in five uninsured adults in the United States live in a rural area, and there is a great need to educate rural consumers about their insurance options under the Affordable Care Act,” Secretary of Agriculture Tom Vilsack said. “USDA and its partners in the Cooperative Extension Service are uniquely positioned to connect with local communities in rural America, providing valuable education and outreach to consumers about their healthcare options.”

The awards complement other federal efforts underway that help consumers make the best health care choices for themselves and their families. Along with the new, consumer-focused
website and the
24-hour-a-day consumer call center
, these new tools will help Americans understand their coverage options and select the plan that best suits their needs when open enrollment in the new Health Insurance Marketplace begins October 1, 2013.

For a list of HRSA awardees, please visit:

Item 3: More, higher quality options for seniors in Medicare Advantage

More beneficiaries are choosing higher quality Medicare Advantage (MA) plans, and for the fourth straight year enrollment is projected to increase, Health and Human Services (HHS) Secretary Kathleen Sebelius announced Friday.

The average MA premium in 2014 is projected to increase by only $1.64 from last year, coming to $32.60. Access to the Medicare Advantage program will remain strong, with 99.1 percent of beneficiaries having access to a plan. The average number of plan choices will remain about the same in 2014 and access to supplemental benefits remains stable. Since passage of the Affordable Care Act, average MA premiums are down by 9.8 percent.

MA quality continues to improve as over one-third of MA contracts will receive four or more stars, which is an increase from 28 percent in 2013. Over half of MA enrollees are enrolled in plans with four or more stars, a significant increase from 37 percent of enrollees last year. The Centers for Medicare & Medicaid Services (CMS) calculates star ratings from 1 to 5 (with 5 being the best) based on quality and performance for MA and Medicare prescription drug plans to help beneficiaries, their families, and caregivers compare plans.

“As a result of the Affordable Care Act, Medicare Advantage and Prescription Drug Plans remain strong and continue to provide improved benefits and low premiums for beneficiaries,” said Secretary Sebelius. “And as a reminder, it is business as usual when it comes to their Medicare benefits: people with Medicare do not need to enroll in the new Health Insurance Marketplaces.”

Earlier this year, CMS announced that the average estimated basic Medicare prescription drug premium plan in 2014 is projected to be $31 per month, holding steady for four years in a row. 100 percent of people with Part D will have access to a plan with lower premium than what they paid in 2013. More than 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act, an average of $1,061 per beneficiary. The Affordable Care Act closes the “donut hole” over time. This news comes on the heels of historically low levels of growth in Medicare spending. From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy.

The Annual Open Enrollment period for health and drug plans begins on October 15 and ends December 7. Each year plans costs and covered benefits can change, and Medicare beneficiaries should look at their Medicare coverage choices and decide what options best meet their needs. For more information on Medicare Open Enrollment and to compare benefits and prices of 2014 Medicare health and drug plans, please visit:

For more information about the Health Insurance Marketplace including official resources, research, news, and events visit

Marketplace Updates

For information on how to sign up for
coverage through the Health Insurance Marketplace, including text
message and email updates visit

State by State Fact Sheets

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