Maryland health insurance exchange
Largest insurer on Maryland Health Connection proposes 26 percent hike
By Carla Anderson
July 8, 2014
The open enrollment period for Obamacare in Maryland has ended for 2014. People who get married or divorced, change jobs, have a child or experience another qualifying event may be eligible for a special enrollment period. Enrollment for Medicaid and the Children’s Health Insurance Program (CHIP) continues throughout the year. Individuals who don’t have health insurance that provides minimum essential coverage may have to pay a penalty: $95 or one percent of income, whichever is greater. Some individuals, such as those who are uninsured less than three months of the year or who recently filed for bankruptcy, are exempt from the penalty. See HealthCare.gov for a full list of exemptions.
Open enrollment for 2015 coverage through the marketplace begins Nov. 15.
Maryland Health Connection, the state-run marketplace, has experienced numerous challenges including technical problems, legal disputes, the executive director’s resignation, and more.
Severe technical problems have plagued the Maryland Health Connection website. Some consumers who were unable to sign up for private insurance were temporarily enrolled in the state’s high-risk insurance program, at the state’s expense. Problems with determining who qualifies for Medicaid means the state may make about $20 million in unnecessary payments over two years. Maryland fired its prime contractor, Noridian Healthcare Solutions, and hired Deloitte Consulting to adapt Connecticut’s successful technology for use by Maryland. Consultants put the cost of rebuilding the Maryland Health Connection website at up to $60 million.
Maryland Health Connection has been criticized for its lack of transparency. News outlets have informally complained about inadequate disclosure of website problems, and the Kent County News filed a formal complaint with the state’s Open Meetings Compliance Board. Industry experts, state and federal legislators, and the state comptroller have all questioned the mostly closed-door meetings during which exchange officials decided to rebuild the state’s website rather than transition to the federal site.
In addition, the Maryland Health Benefit exchange, which oversees the marketplace, has repeatedly delayed the launch of the Small Business Health Options Program (SHOP). Work on the SHOP website was put on hold in February, and the launch date pushed back until Jan. 1, 2015. As of April, small businesses can purchase policies and receive tax credits by working directly with insurers or through brokers or third-party administrators (TPAs). Thirteen insurers are selling small-business plans.
Despite all of the problems, Maryland exceeded its enrollment goal of 260,000. As of May 31, 372,517 Marylanders obtained health insurance coverage: about 72,000 enrolled in qualified health plans (QHPs) and 300,000 qualified for Medicaid or the Children’s Health Insurance Program (CHIP).
The vast majority of those enrolling in QHPs selected plans offered by CareFirst BlueCross BlueShield. CareFirst captured nearly 94 percent of enrollees, followed distantly by Kasier with about 5 percent, Evergreen Health Cooperative with 0.7 percent, and All Savers (part of United Healthcare) with 0.4 percent.
Insurers submitted rate proposals for 2015 in early June. CareFirst proposed much higher rates in 2015: an average of 26 percent more for individual policies and an average of 6 percent more for small businesses. Kaiser requested a 12.1 reduction, and Evergreen proposed a 10.3 percent reduction. All Savers requested a 4.8 percent increase. Two insurers who weren’t part of Maryland’s marketplace in 2014 submitted rate proposals for 2015: Cigna Health and Life Insurance and UnitedHealthcare of the Mid-Atlantic. The Maryland Insurance Administration is reviewing all proposals and will announce the final lineup of carriers and rates by late summer.
Maryland was an early adopter of the health insurance marketplace envisioned by the Affordable Care Act (ACA). While many other states waited to see the outcome of the Supreme Court challenge to the ACA, Maryland moved ahead. The Maryland Health Benefit Exchange (MHBE) was signed into law in April 2011, with additional legislation passed in May 2012. The MHBE was later rebranded as the Maryland Health Connection. In December 2012, the Maryland Health Connection was among the first six state-based exchanges to be approved by the federal government.
Maryland Health Connection is overseen by a nine-member board. On June 25, Carolyn Quattrocki was named to a one-year term as executive director of the board. She began serving in that role on an interim basis in December 2013 following the resignation of Rebecca Pearce.
Maryland Health Connection functions as a clearinghouse, meaning any QHP can sell policies on the exchange. Any health plan with significant market share in the state is required to participate in the marketplace. After two years of operation, the exchange has the option to adopt an active purchaser model. Health plans are limited to selling four benefit packages per metal level (platinum, gold, silver, and bronze).
Maryland health insurance exchange links
Maryland Health Connection
Maryland Health Benefit Exchange (MHBE)
Information about exchange planning and development
State Exchange Profile: Maryland
The Henry J. Kaiser Family Foundation overview of Maryland’s progress toward creating a state health insurance exchange.
Health Education and Advocacy Unit, Office of the Attorney General
Serves residents and other consumers who receive health care from a Maryland health care provider or health insurance provider.