By Mary Alice Murphy
Open enrollment for people who are looking for health insurance or want to see what other plans are available will last from Nov. 1, 2015 to Jan. 31, 2016. Representatives from beWellnm and the Office of the Superintendent of Insurance kicked off their Outreach Road Show to meet with members of the media, elected officials and give presentations to agents, brokers and enrollment counselors at Western New Mexico University's seminar room on Thursday, Oct. 8.
The presentations included those explaining the four health insurance companies working in New Mexico with the New Mexico Health Insurance Exchange-Presbyterian, Molina, Christus-St. Vincent and New Mexico Health Connections.
The Office of the Superintendent of Insurance sent the Superintendent John Franchini as its representative.
"I was appointed under the Public Regulation Commission as its first superintendent," Franchini said. "I was vetted by a 17-member independent committee made up of representatives from government, from private insurance providers, and from the Governor's Office."
He said he once owned his own insurance agency, but sold it to a broker. "I wanted to stay in Albuquerque, so I worked for New Mexico Mutual Casualty, which is the state worker's compensation carrier. I left them and this position came up. I had turned this job down before, but after the agency became a stand-alone after the voters approved separating it from the PRC, they offered me the job and I took it, because it would have more independence than it had formerly. It's not attached to the Governor's Office or the Legislature. Four members each from the Governor's Office and the Legislature make up the nominating committee, which has as its primary purpose to select the chairman for a four-year term and its sole job is to regulate the OSI. I don't know whether at the end of the year, they will reup me or pick another."
"As the superintendent, I have to follow certain statutes," Franchini said. "That sometimes causes problems."
He said for 15 years, the state had only two insurance providers, then it had five doing individual insurance, and since Blue Cross Blue Shield has pulled out of the exchange for at least a year (but not out of private insurance), four will remain in the exchange.
"I'm here to tell the public we have extensive markets and great choices," Franchini said.
He noted that in the southwest corner of New Mexico, Blue Cross Blue Shield has the most contracts with providers, but many local people will lose the insurance they had through the exchange with BCBS's pullout for at least a year.
"In the southeastern part of the state, New Mexico Health Connections,, Presbyterian, Molina, and Christus St Vincent have more enrollees," Franchini said. "We're concerned that some agents don't know about the other options."
New Mexico Health Connections is a co-operative run by a doctor who once ran Lovelace Insurance and the Lovelace Hospital. "He's smart about managing insurance and managing health care," Franchini said. "Several of their clients, because the purpose is prevention and maintenance of chronic health problems, after six months had stabilized. The co-op helped cut some patients' monthly costs from $15,000 a month to $1,500 a month."
Franchini noted that Presbyterian also has extensive telemedicine services, where the patient talks to a doctor over a secure Internet connection.
Molina has been the "carrier with heart," Franchini said. "The company first worked only with Medicaid clients. They have gone into the New Mexico market with modern clinics that have day care and places to wait that have drawn not just Medicaid clients but standard patients, too."
He said Christus in Santa Fe owns St. Vincent Hospital, has an extensive network in Texas, and is moving slowly to expand into the entire state of New Mexico.
Amy Dowd, the beWellnm chief executive officer, said the exchange serves those above Medicaid eligibility and the ages before Medicare eligibility. "Depending on income, the exchange outlines possible financial assistance for those buying insurance. They may qualify for assistance with premiums."
She stipulated that advance premium tax credits and cost-sharing reductions are available only for plans purchased through the New Mexico Health Insurance Exchange (NMHIX) at www.beWellnm.com , the online marketplace for comparing plans.
Dowd said, with the departure of Blue Cross Blue Shield, those members who purchased BCBS plans through the exchange would need to select a new plan for coverage that would begin on Jan. 1, 2016.
The discontinued plans are valid through Dec. 31, 2015, but a new plan should be put in place during the open enrollment period, which begins Nov. 1, 2015.
"At the end of last year's open enrollment, 52,358 total plans had been selected for 2015," Dowd said. "If they meet certain requirements, they can be eligible for financial assistance in paying the premiums."
A graph she showed indicated that the numbers in the exchange reflected a 63 percent increase from the prior year and a 4.1 percent reduction in the uninsured. The uninsured rate decreased from 18.6 percent in 2013 to 14.5 percent in 2014.
Seventy-six percent of the plans selected had financial assistance, and 49 percent had a premium under $100 a month after financial assistance. Twenty-eight percent of the potential marketplace population enrolled for 2015.
"We at beWellnm are the New Mexico version of the federal health exchange," Dowd said. "Our mission is to give people information and make them aware of available assistance, which includes free assistance with a broker. We have a call center, and lots of information at beWellnm.com."
She said those who want to shop online can estimate what a premium will be. "It will be updated for next year with new tools to assist the insurance shopper. The individual can link from the beWellnm.com website to the federal website. What they find may determine they are eligible for Medicaid. "We encourage everyone to shop during open enrollment. All plans are different each year, and your circumstances may have changed."
"If you are happy with your plan, you do not have to take action, and it will continue," Dowd said, "unless it is a discontinued plan. You will be notified if the plan is discontinued, and you still have four choices of carriers, each of which has multiple plan levels. Our role is as a free resource to all New Mexicans."
She said beWellnm is a "lean organization, with about 15-17 staff members. We use a lot of partners across the state. You can call us and we will connect you with a broker."
Dowd said Franchini makes sure that there are hospitals and doctors that take insurance covering the whole state.
"beWellnm is just an exchange," Dowd said. "Links on our site show the providers in each plan. In the shopping process, you don't have to do it alone. You can call 855-996-6449 and we will walk you through the steps at no charge. We will be doing enrollment events during the open enrollment period. We will have kiosks."
Tony Martinez of Molina Healthcare said it is the largest Medicaid provider in Grant County.
"We have staff in Grant County, who are remote employees that work out of their homes," Martinez said. "Molina was the only carrier to request a decrease in premiums, because we were able to manage the care of our members, so they cost less. For three years in a row, Molina has been the top accredited Medicaid provider in New Mexico.
"Molina is committed to serving the underserved," he continued. "Our primary line is and was Medicaid, but we also do the marketplace exchange and a Medicare/Medicaid special needs plan."
He said the company has been in business more than 35 years. Its founder was Dr. C. David Molina, an emergency room physician, who grew up as a migrant worker. According to Martinez, Molina opened a clinic in California and his practice grew as he went into insurance. His son, who is also a physician, is now the CEO of the company. His daughter, an M.D., is the executive vice president of innovations, and their brother is a lawyer and the company chief financial officer.
Visit www.beWellnm.com , as New Mexico's Health Insurance Exchange, for more information on the shopping process, what plans are available and how to estimate premium costs. Open enrollment begins Nov. 1 and continues through Jan. 31, 2016.