COMMONWEALTH CARE: OPEN ENROLLMENT, PREMIUM & CO-PAY INCREASES, ELIMINATION OF “PLAN TYPE IV”

Open Enrollment
Commonwealth Care Open Enrollment will be May 1 to June 13, with plan changes effective July 1. During this time, Commonwealth Care members can change their health plan for any reason. Members who are happy with their current health plan do not need to do anything; they will stay enrolled with their current health plan. In addition, plan premiums and co-payments will be increasing as of July 1st so members need to research the best plan for them.

The Connector will be doing outreach via mailings to members, who will receive a custom Open Enrollment packet that will contain:

1. a letter explaining the process,
2. a notice of copayment changes,
3. a form with plan options and costs, and
4. a comparison grid for plans available in the member’s area.

Messages about open enrollment should be included on members' premium invoices as of early April. Mailings from the state should be sent during the weeks of 4/21 and 4/28.

Open Enrollment Process:

• Members can switch plans by mailing in their open enrollment form or by calling the Connector at 1-877-MA-ENROLL. Members should not call to switch plans until they have received their open enrollment packet in the mail.
• Premium paying members have an extra 60 days to switch plans, from July 1 - August 27. This is an opportunity for individuals who don't respond to their open enrollment packet and who may be surprised when they receive their July premium bill.

Premium Increases:
Effective July 1, Commonwealth Care premiums are increasing and there will be changes to what is considered to be the lowest cost plan, depending on the town. REMINDER: Most Commonwealth Care members are in Plan Type I with no premiums; those in premium-paying categories constitute roughly 28% of all Commonwealth Care members. They pay a monthly premium for the lowest cost plan in their area. If they choose a higher cost plan, they pay a higher premium. Prices differ by town. The lowest cost plan for someone who lives in Boston is not necessarily the same as the lowest cost plan for someone who lives in Revere.

Co-Payment Changes:
Effective July 1, Commonwealth Care co-payments are increasing by varying levels. Out of pocket maximums - or annual caps on co-pays - are also being initiated and will be tracked electronically by the health plans.

*** IMPORTANT***

Because the Commonwealth Care plans have re-negotiated their state contracts, the premiums may have changed in many circumstances. Members will need to look closely at their open enrollment packet to determine whether the monthly premium for the plan they are currently on has changed. If it has, they will face a decision about whether to pay more for the plan they are on, or to switch to a lower cost plan that may or may not be in network for their providers. For example, a patient who lives in Boston on Network Health Plan Type III (200% - 250% FPL) is currently paying $75 per month. As of July 1, their premium will become $111 per month, with NHP becoming the cheapest option for that patient, at $77 per month. Throughout this process, we will need to watch for patients whose Commonwealth Care plans become unaffordable, and who, as a result, might switch to a plan outside our network.

Elimination of Plan Type IV:
In the past, individuals between 200% and 300% of the federal poverty level could choose between 2 Commonwealth Care plans: Plan Type III (with lower premiums and higher co-pays) and Plan Type IV (with higher premiums and lower co-pays).

Effective July 1, the state is eliminating Plan Type IV and will only offer Plan Type III in this income range.
Many of the existing Plan Type IV members are heavy utilizers of the health care system, and probably chose this option for the lower co-pays.

All 4,500 of the Plan Type IV members will be converted to Plan Type III automatically on July 1. They should pay attention to their open enrollment packet, which will explain the differences in cost (lower premiums but higher co-payments).

We recognize that there have been challenges related to cost and provider networks since the beginning of Commonwealth Care implementation, and we will work with the plans and with state agencies to highlight and hopefully resolve any glitches that may result from the open enrollment process. The auto-assignment is another process with which we've encountered some challenges. That process is also changing on July 1, and I will send a separate email summarizing those changes.

For more information see:

• Plans By Region, lists which plans are available across the state.
• Enrollee Premium Contribution Comparison, compares premium amounts per health plan by income level from 2007 to 2008.
• Health Benefits and Copays, lists health benefits and patient-pay amounts for each health visit or service (copays).
• Health Plans in Commonwealth Care, describes each health plan and special programs they offer. Where one lives determines which health plans are available.

Or go to http://www.mahealthconnector.org/

• Click on "Commonwealth Care" on the lefthand side of the page
• Click on the "Open Enrollment" link on the righthand side of the page

-Adapted from: Commonwealth Care open enrollment e-mail, April 10, 2008 and Commonwealth Care - Open Enrollment; July 1 Changes e-mail, April 24, 2008, Kim Simonian, MPH, Community Benefit Programs, Partners HealthCare, and materials from The Connector website: www.mahealthconnector.org.

4/08