Health insurance for many Americans is going to change starting October 1. That is the date when the New York Health Benefit Exchange, an online marketplace for health insurance, becomes active.
What is a health insurance exchange?
Health insurance exchanges were one of the key parts of the Affordable Care Act (ACA), or “Obamacare” as it is commonly called.
Three years ago, President Barack Obama signed the Affordable Care Act into law, thereby changing how we all operate our health systems and how all Americans use healthcare. For health systems such as Ellis Medicine, the ACA has meant changing how we care for the community. We have dedicated a tremendous amount of resources and effort into not just caring for people in the hospital, but keeping them healthy in their homes. For many individuals, the ACA will mean change as well, specifically, when it comes to health insurance.
Who is affected?
On January 1, 2014, all Americans will be required to have health insurance or pay a penalty. Most Americans won’t see any change. Those who already receive health insurance through their employer (or their spouse’s/parents’ employer), or are already enrolled in Medicaid and Medicare are not affected and don’t have to do anything.
The exchange will serve people who currently do not have any health insurance, people who buy their own health insurance in the “individual market” (including self-employed people now in “Healthy New York”), and some people whose employers decide to drop group coverage now that their workers can buy insurance through the exchange. Small businesses will also be able to get group coverage for their employees through a special part of the exchange.
Do Your Homework & Shop Around
With health insurance exchanges opening October 1, individuals have three months to shop for health coverage to find the best option for them and their family. Just as you would compare all the features and benefits when buying a car, a new computer or camera, you will need to evaluate and compare health insurance exchanges. Each of the options is different and there isn’t one option that fits all.
When shopping for health insurance in the New York Health Benefit Exchange, you should come prepared with questions. While you aren’t comparing gas mileage of cars, you need to compare what doctors are included in the various insurers’ coverage and if you would rather pay a higher monthly payment, or a high deductible when you need healthcare.
You won’t be completely on your own when it comes to selecting the insurance that is best for you. New York State is contracting with not-for-profit agencies called “In-person Assistors” who will help people understand the various options. In Albany, Schenectady, and Rensselaer Counties, this function will handled by the Healthy Capital District Initiative (HCDI). You can reach HCDI at 518.462.7040.
How much will it cost?
One of the important aspects of the exchange is that most people who obtain health insurance through this new program will receive a taxpayer-funded government subsidy to reduce the cost. Subsidies – in the form of reduced premiums or of an income tax credit – will be available to individuals earning up to about $46,000 a year, with a family of three earning up to about $78,000. Plus, the exchange will also help people who qualify to sign up for Medicaid, which is entirely paid for by taxpayers and costs the beneficiary nothing.
If you qualify for a subsidy, you’ll also have to decide if you want to take it in advance in the form of a premium reduction or at the end of the year in the form of an income tax credit. While it seems better to get your money “up front” in the premium reduction, if your circumstances change (such as getting a pay raise), then the amount of your subsidy will change and you could end up owing money to the government at the end of the year. Whichever way you take it, the amount of your subsidy (based on income and family size) will be the same.
What health insurance plan should you choose?
In the Capital Region, eight insurers are participating in the New York Health Benefit Exchange. These insurers each offer different options for individuals and small groups to choose from – a choice of up to 40 different plans.
The least expensive monthly payment plan is the Catastrophic Plan, which is available to single adults under the age of 30. The remaining plans in ascending order of price are Bronze, Silver, Gold and Platinum. The Platinum Plan has the highest monthly premium, but most comprehensive healthcare services and lowest deductible. All of the insurance plans offered in the exchange have been reviewed and approved by the government, which requires certain benefits (varying by type of policy) and regulates the price.
Where should you start in your health insurance shopping?
One of the first questions you should ask yourself is whether you want to pay a higher monthly payment with low deductible or lower monthly payment with high deductible. The higher level plans provide additional coverage and protection in case you get sick, need surgery or are in the hospital. The lower monthly plans require paying more money out of your pocket if you need treatment.
You should also look at each option to look at what the plan offers and if your doctor is included in the insurer’s plan. If you have an exisiting relationship with a doctor, you should look at plans that include your doctor in it. If you don’t have a doctor, it’s time to start looking for one. If you live in Schenectady or Saratoga Counties, you can call Ellis Medicine’s Health Services Navigators at 1.888.633.4661 for help finding a primary care doctor. Regular check-ups with your primary care doctor keep you healthy so you are less likely to need to go to the emergency room or be in the hospital.
What happens if you don’t buy health insurance?
For those who don’t enroll in a health insurance plan, they will be penalized in 2014 with a $95 fee and $47.50 per child (up to $285 per family), or one percent of family income, whichever is greater. Those who don’t enroll will also not have access to the preventive care they need to stay healthy and be at risk for expensive medical bills if they need treatment. So, if you are contemplating not enrolling in a health insurance plan, at least be prepared by using a medical spending account to save money if you ever need it.
Getting through the changes, together
There’s a lot of work for us all. For organizations like Ellis, we are working to make sure our services are what you need, where you need them. We are also preparing to care for more patients who may use hospital and healthcare services more now that they have insurance.
For people looking to buy health insurance on the exchanges, you have shopping to do. Starting comparing the different plans to see which one is right for you. Ask your doctor and the different insurance companies about any questions you have about the plans. At Ellis, we are always here to help, so don’t hesitate to reach out to us.
There is a new era of healthcare upon us. Let’s all work together to be healthy!
NY State of Health
What is NY State of Health
Healthy Capital District Initiative
Tax Credit & Premium Estimator
Map of Health Plans Offered in NY State of Health