Tag

exchanges

Sep 16
0

A Guide to Shopping for Health Exchange Insurance Plans

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In just two short weeks the online exchanges or health insurance marketplaces will open and millions of people will have the opportunity to begin shopping for various health insurance plans. Coverage won’t begin until January 1, 2014, but it is super important to know what you are getting into before choosing a plan.

The online exchanges are intended for small business owners and people who don’t receive health insurance through their job. If you are unsatisfied with your employer’s health insurance, you probably won’t be able to get a different plan through an exchange unless it costs you more than 9.5 percent of your income or if it doesn’t cover the required essential health benefits.

The first thing to consider when shopping for a plan is that all health insurance plans in the exchanges will be categorized into four tiers: bronze, silver, gold and platinum. Although all plans are required to cover essential health benefits, they differ in how you pay for them. The bronze plans have the lowest premiums but the highest out-of-pocket costs whereas the platinum plans are the opposite with the highest premiums and lowest out-of-pocket costs. In the bronze plans, the individual is expected to pay about 40% of health service costs with each tiered plan covering about 10% more ( so, silver: 30%; gold: 20%; platinum: 10%). The idea behind this is that if you are a generally healthy person who rarely needs more than preventative care, a bronze plan may work best for you. If you are someone who gets sick a lot and seems to need a lot of health services, a platinum plan may work best for you.

It may be easy to choose between a bronze and platinum plan, but maybe not between bronze and silver or silver and gold. One consideration is that the out-of-pocket costs for the bronze plans will be capped at $6,350. If you think the bronze plan monthly premiums are still too expensive for you, you may be able to apply for a Catastrophic Health Plan if you are under 30 or get a “hardship exemption.” In this type of plan, your monthly premium will be a lot lower but you’re only covered for 3 yearly primary care visits. If you’re have a medal plan however, you may be able to add benefits to your coverage.

Another huge consideration is the subsidies on your premiums for which you may qualify. The Advance Premium Tax Credit will be applied directly to your premiums, so you save immediately. Incomes up to 400 percent of the Federal Poverty Level will qualify for these tax credits with the lowest incomes receiving the largest credit. A general range for individual households receiving credits is an annual income between $11,490 – $45,960. If you want more specifics, you can try out the Kaiser Family Foundation’s Subsidy Calculator until October 1st.

So if you have an idea by now of what plan you’d like to go with, the last thing to do is pick an insurance company. Here is a list of estimated premiums for plans in the Baltimore area (many other states/areas can be found here). Each company will differ in the specifics on how much you pay for certain services. For example, one plan may cover completely your prescription drugs but charge you a little more for dental services. Besides price, you may want to consider how the health insurance company is run. I encourage people to check out the CO-OP insurance plans since they are non-profit and will probably put you, the patient, first.

Still confused? Don’t worry, once the exchanges open, many clinics and online/telephone support services will provide trained “Navigators” who will help you decide which plan is the best for you.

IMAGE CREDIT. [www.protocol.gov.hk].
Aug 21
0

To Be Young and Invincible

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After a year of AmeriCorps, living in poverty while dealing with Hopkins staff and students and Baltimore city youth (all intimidating in their own way), I do feel quite powerful and invincible. I’m moving to Africa and the world is mine for the taking! According to Joel Stein’s The Me Generation such narcissism and self-confidence is beneficial since it causes myself and others born between 1980 and 2000 to think that we can change the world for the better. At the same time, such traits are becoming a barrier to the success of the Affordable Care Act.

The Department of Health and Human Service recently announced a video contest, pioneered by the non-profit The Young Invincibles, that will give up to $30,000 in prizes to winners who convince the millennials to sign up for health insurance. A little bit of peer education – smart idea. Getting people ages 18-30 is an integral part of making Obamacare work and keeping critics at bay. Having healthy people to pay for insurance (or medical care of the poor) is a sacrifice that all other countries with national health care consider a no-brainer. And it should be. Getting young healthy people to pay for insurance means keeping insurance costs lower for everyone else (ideally).

Most critics have already been complaining about higher premiums costs under the ACA. But all premium increases (whether it’s an increase to an already existing plan or a comparison of the new plans in the exchanges) will have to be approved and out-of-pocket costs will be capped, eventually (unfortunately this requirement will also be delayed another year). Another consideration is that all health insurance plans will have to have minimum benefits so even if you’re paying more, you may be receiving more too. Slowly but surely states are releasing estimates of health insurance rates from the exchanges, and depending where you live it could be more or less. Plus people up to 400% of Federal Poverty Level will be receiving subsidies for health insurance.

So if you’re young and invincible and will very soon need to start thinking about purchasing health insurance, the government has given over $67 million to organizations that will help people navigate the exchanges. United Way and Planned Parenthood are two of the most popular organization to receive grants while University of South Florida Association of Community Health Centers and United Way of Metropolitan Tarrant County (Texas) were among those to receive the highest amounts. Or if you want to start taking things into your own hands (feeding into those self-reliant stereotypes) these pointers from Kaiser Health News will serve you well. And if you’re still hesitant about even considering health insurance, this article from New York Magazine describing how vulnerable we truly are might change your mind.

Feb 19
0

Obamacare Keeps Calm and Carries On

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The final count is in! The federal government will be providing health insurance exchanges for 26 states. On February 15th, states had their last chance to opt for a federal partnership to run an exchange – essentially an online marketplace for health insurance. States will always have the option to take control of the exchanges themselves (which the feds would prefer), but for now only the other 24 states have chosen to set up their own and have them running by October 1st of this year.

Some states were skeptical that they would have the funds and manpower ready to meet that deadline. But many Republican-led states simply refused to run their own exchanges because they didn’t want to be a part of Obamacare, despite the fact that most Americans agree that exchanges will work best under state control. The department of Health and Human Services ideally wanted all of the states to take control of the exchanges and will have to work hard to adjust its original plans, as has so often been the case for Obamacare. The story of the president’s signature reform has been one of change.

Indeed, that we have exchanges at all is the result of a shift in position. The basis for the exchanges is the individual mandate, which requires all U.S. citizens (with certain exceptions) to have health insurance by January 1, 2014. Originally, President Obama was against the individual mandate – a topic hotly debated in his primary battle with Hilary Clinton. Once president, he saw that there was no other choice. Without the mandate, the government couldn’t require insurers to turn away sick people as some people might wait until they were sick to buy insurance.

As of now, uninsured people with pre-existing medical conditions have been able to enroll in the government’s Pre-Existing Condition Insurance Plan, but the Obama administration announced Friday that they had to cap the plan due to financial restrictions. Other changes have been made since Obama originally proposed his vision for health reform. Obama had wanted to include a public option or a publicly-run insurance plan (similar to Medicare, which is government-run) to compete with the private insurers in the exchanges. This would potentially drive down insurance premiums and lower administrative and medical service costs.

But a public option would be tricky to get right since it wouldn’t work if too many people were enrolled, or too few. If enrollments in a public option were too numerous, providers wouldn’t be able to “cost shift” – currently, by charging higher premiums to private, fee-paying patients, doctors and hospitals gain back losses from providing services to Medicare patients, Medicaid patients and the uninsured. Conversely, if there were severe enrollment restrictions and too few people were enrolled in a public option, it would most likely be those with a high risk. This would leave the public option bankrupt and private insurers rolling in the dough from having so many healthy people enrolled.

And of course a public option is considered by conservatives to be a first-step toward a single-payer health system (a health system in which one entity pays for all health services), which liberals would cheer, but which they believe to be dangerous government intrusion on the workings of the market.

As a compromise on the public option, the Senate offered a Medicare expansion to enroll people at the lower age of 55. Neither this nor the public option could get passed so the Consumer Operated and Oriented Plan (CO-OP) was born. A CO-OP is a non-profit insurance plan controlled by the patients it insures and must be included in all state exchanges. The government is offering low-cost loans to both new groups and existing ones. Twenty-four states have received loans and their CO-OPs will be highly monitored to make sure they will repay loans and are meeting goals.

Even after clearing so many obstacles, many are still skeptical the plan for Obamacare can be carried out. Will a federal exchange be ready by October? For one, it’s an enormous feat of information technology and logistics that will need to connect many government departments such as Homeland Security (to verify citizenship) and the IRS (to determine subsidy eligibility). By July, insurance plans for the exchanges are expected to be chosen, but will HHS have and choose the best plans?

Could the federally-run exchange look like a public option?

Will states eventually take over their own exchanges?

Will people even know about the exchanges by next year?

Will the exchanges really provide competitions for insurers?

And will policymakers be forced to make yet more changes to address these questions?

As America’s great experiment with healthcare reform unfolds, only time will tell.

IMAGE CREDIT. endthefedusa.ning.com.