Q&A: What changes are coming to the New Hampshire insurance marketplace in 2015?
After offering only one carrier in its initial year, New Hampshire’s health insurance marketplace is expected to host a much wider range of options in 2015. Based on the material presented at an information session yesterday and comments from New Hampshire Insurance Department officials, we compiled the following outline addressing what the marketplace might look like next year.
What options will be available on the marketplace in 2015?
Where Anthem was the only available insurance carrier in 2014, four additional carriers – Assurant Health, Harvard Pilgrim Health Care, Maine Community Health Options and Minuteman Health – have applied to enter the marketplace for 2015. With these additional carriers, the number of distinct plans is also expected to grow from 14 in 2014 to more than 50 in 2015, while more hospitals will also be included statewide, Insurance Department Life, Accident and Health Legal Counsel Jennifer Patterson said. The details of the 2015 offerings are subject to change and still need to be reviewed at the state and federal level, but Patterson said the department will clarify any changes made between now and August, when the state will make its recommendations to the federal government.
Which hospitals will be covered through the available insurance plans next year?
New Hampshire Insurance Commissioner Roger Sevigny said each of the state’s 26 “acute care” hospitals is expected to fall within at least three of the available marketplace networks next year, and each county will have at least one hospital that meets those standards.
In Merrimack County, for example, Concord Hospital would be served by at least three carriers (Assurant Health’s Network Savings 1, Harvard Pilgrim’s New England HMO and New Hampshire Network, and Maine Community Health’s NH MCHO), Franklin Regional Hospital would be served by four (Anthem’s Pathway network, Assurant Health’s Network Savings 1, Harvard Pilgrim’s New England HMO and New Hampshire Network, and Maine Community Health Options), and New London Hospital would be served by four (Anthem’s Pathway network, Assurant Health’s Network Savings 1, each of Harvard Pilgrim’s networks and Maine Community Health Options) under the proposed networks outlined by the department. Harvard Pilgrim spokeswoman Mary Wallan said Harvard Pilgrim’s ElevateHealth has also arranged to include Concord Hospital in its marketplace network.
These and other preliminary details about the availability of networks in hospitals statewide will be available on the department’s website this week, Sevigny said.
What kind of plans will be available through the marketplace in 2015?
All of the providers that have applied for the 2015 marketplace will offer individual plans, while all except for Assurant Health will also have small-group coverage options, according to the insurance department’s presentation. Anthem, Harvard Pilgrim and Minuteman Health will offer HMO plans, while Assurant Health and Maine Community Health Options will offer PPO plans. Minuteman Health will also carry POS options.
What options will be available for people who seek medical treatment out of state?
At yesterday’s information session, several people raised questions about the availability of medical resources outside of New Hampshire. According to the material submitted to the department at this time, Anthem’s proposed network for 2015 would include two out-of-state hospitals: Maine Medical Center and Lahey Hospital & Medical Center. But at this point, Sevigny said it’s unclear what other out-of-state offerings might be available because the department hasn’t yet reviewed all of the plans.
Michael Wilkey, the department’s director of compliance and consumer services, said the department doesn’t have the authority to require an insurance carrier to contract with a hospital either within or outside of New Hampshire.
For more information about inclusion of hospitals in carriers’ offerings, Wilkey suggested contacting carriers directly or turning to the information available online when open enrollment begins later this year.
What will the insurance department be looking at as part of its review process?
The department will review the rates and forms of plans, as well as the “network adequacy” of the plans seeking approval. As defined by a state statute, the “adequacy” standard examines whether a network is “sufficient in numbers, types, and geographic location of providers.” Here, Patterson said, “the focus is not on particular providers being included, but rather on each consumer having access – or each covered person having access – to those services.”
What happens after the department completes its review?
The department does not hold final say over the plans that enter the marketplace for 2015. Instead, Patterson said the department reviews the plans and can choose to recommend ones to the federal government for final approval. The department will submit its recommendations to the federal government in August. From there, the Center for Consumer Information and Insurance Oversight is expected to decide in September which plans will be available on the marketplace, and open enrollment will begin Nov. 15.
When will more information about the details and costs of the insurance marketplace options for 2015 be available?
All of the details of the available plans, provider networks and rates will be available when the marketplace opens in November, Patterson said. “It’s possible that carriers might decide to make some of that information available earlier,” she said, “but particularly with respect to the rates, that’s not information that the department can release sooner.”
Wilkey, in response to a question from the audience at yesterday’s session, said many factors go into ultimately determining a carrier’s rates, including the demographics of the people within its existing “book of business” and its negotiations with particular medical institutions.
Where can someone send comments on the information released thus far?
Through July 8, you can send feedback to insurance department Communications Director Danielle Barrick at Danielle.Barrick@ins.nh.gov.
(Casey McDermott can be reached at 369-3306 or firstname.lastname@example.org or on Twitter @caseymcdermott.)