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An Obamacare Buyer’s Guide

by Melissa Bailey | Sep 30, 2013 2:49 pm

(3) Comments | Commenting has been closed | E-mail the Author

Posted to: Health

Thomas MacMillan Photo Starting Tuesday, New Haveners can begin shopping in a new marketplace for health care plan—a plan they’ll need to have in place by March 31, or face a penalty.

The shopping begins as Connecticut officially launches its version of Obamacare, aka national health care reform.

On Monday morning, New Haven city officials announced the kick-off of efforts to educate people about a new “health insurance marketplace,” and help them sign up for coverage. New Haven has been chosen as one of six “navigators” in the state, coordinating a team of “assisters” who will help people sign up.

Read on for an explanation of how it will all work:

Here’s the lowdown:

What’s Obamacare?

A new federal law, officially called the Affordable Care Act, that aims to get all Americans covered by health care insurance.

Most people get health insurance through their employers. Others get covered through government plans. Others buy their own private plans. Obamacare aims to expand offerings in those three categories—and reduce the number of people who have no insurance at all.

The law works in two main ways: It provides incentives for people and businesses to buy health care, and penalizes those who don’t.

Melissa Bailey Photo What if I’m uninsured?

By March 31, every U.S. citizen has to buy health insurance or face a penalty. (The initial deadline is Jan. 1, but there’s a three-month grace period.)

A penalty? Ouch. How much?

That depends on your income. In 2014, it’s $95 or 1 percent of your income, whichever is greater. The fees go up from there: In 2015, $325 or 2 percent of income, whichever is greater; and in 2016, $695 or 2.5% of income, whichever is greater.

People will have to pay the fee when they file their federal taxes.

Where can I buy health insurance?

Connecticut is opening a new healthcare marketplace Tuesday called Access Health CT. The marketplace (also called a health-care “exchange”) allows you to comparison shop, like you might do for airline tickets on Expedia.

Who’s eligible to shop in the marketplace?

Anyone who lives in Connecticut.

Depending on your household income, you have different options: If you make up to 138 percent of the federal poverty level ($16,000 for an individual), you can sign up for Medicaid, the government health care plan. If you make between 138 percent and 250 percent of the federal poverty level, you may qualify “cost sharing reductions” that would lower your co-pays. If you make between 138 and 400 percent of the federal poverty level ($46,000 for an individual), you’re eligible for a subsidy.

If you make more money, you can still shop in the marketplace, but you won’t get any special rates. Access Health’s Kate Gervais said people should still apply, even if they think they make too much money. A family of four with a household income of $90,000 would qualify for help.

How many plans are there?

Three health insurance companies are offering plans in Connecticut’s marketplace. The plans come in different tiers—“gold” for more expensive plans with lots of coverage, “silver” for middle-ranging plans, and “bronze” for cheaper plans with higher deductibles. The point is to help consumers compare plans.

How do I sign up?

Call 855-805-4325 or sign up online here. There’s no fee for the consultation. The call center is staffed to expect an average call time of 45 minutes, according to Access Health CT CEO Kevin Counihan.

Will women pay more than men?

No.

Before Obamacare, health insurance companies in Connecticut could charge women up to twice as much as men for health care premiums. Now the rates for both genders have to be the same.

What if I have a preexisting medical condition?

Your life just got better. Starting Jan. 1, health insurance companies can’t refuse to cover you or charge you more based on your condition.

What if I already get health insurance through my employer?

Not much will change. You can just stay put.

What if I already have a private health insurance plan?

You could save money. The Kaiser Family Foundation estimates that 48 percent of people who currently buy their own health insurance will be eligible for tax credits. Those who are eligible will get an average tax credit of $5,548 per family. Check out Kaiser’s subsidy calculator here.

No one will have to pay more than 9.5 percent of their annual household income for insurance, said Dr. Mario Garcia, head of New Haven’s health department.

What about undocumented immigrants?

They’re not required to buy insurance. And they’re excluded from government health care plans and subsidies.

The children of undocumented immigrants, however, may be eligible for help, if they were born in the United States.

And legal residents are eligible for help, even if they’re not citizens.

What about businesses?

Businesses with more than 50 full-time-equivalent (FTE) employees have to buy insurance for their workers or face penalties beginning in 2014. The penalty is $2,000 per full-time worker. (To count “full-time equivalent” positions, add up all your part-time workers’ hours and see how many 40-hour-a-week full-time positions that equates to.)

Businesses can buy insurance through the new marketplace, too.

Do small businesses get a break?

Yes. Companies with fewer than 50 FTE workers don’t have to buy insurance for their employees.

Those with fewer than 25 FTE workers may qualify for federal tax credits to help cover the cost of health care.

This marketplace sounds like a big operation. How much is it going to cost?

The new marketplace will cost about $34.5 million per year to run, according to Access Health’s Counihan. It’s paid for by a levy on all health insurance companies that are licensed to offer plans in Connecticut.

In addition, the federal government is paying for the expansion of Medicaid to all people with a household income of up to 138 percent of the federal poverty level.

How will this affect New Haven?

Between 17,000 and 23,000 uninsured people live in New Haven, according to city health director Garcia. The City of New Haven is serving as one of the state’s six “Navigator” hubs that will help people enroll in new health care plans through the marketplace.

As a “Navigator,” New Haven is helping to coordinate dozens of “assisters” in the city and county. Assisters are people trained to help people navigate the health care marketplace, Access Health CT.

How can I get help from one of these assisters?

By the end of October, Access Health CT will have a storefront office open at 55 Church St. It will be staffed by assisters. A host of neighborhood and community organizations will also have assisters available to help people. This includes the New Haven Free Public Library and Junta For Progressive Action, which will offer bilingual assisters.

Dr. Garcia said the city health department will be holding a series of “info sessions,” trying to put out the word about Access Health.

This all sounds like a big headache. I might just put this off for a while. Is that a problem?

Garcia said that if you don’t sign up by Dec. 15, you won’t have coverage by Jan. 1, so you may face a penalty.

The health insurance exchange will stay open until March 31. If you wait until after it closes, you won’t have access to the various forms of government assistance that will make insurance more affordable. You’ll have to wait until the exchange reopens next October, and it will only be open for three months next year.

The exchange will close on March 31?! What if I lose my job and my health insurance on, like, April 1? I won’t be able to get the special deals in the exchange?

You’ll still be able to get government help, if you qualify. Access Health’s Kate Gervais said there are exceptions for “life experiences,” like getting married or losing you job. If you have a “life experience,” even if the exchange has closed, you’ll be able to access the government support.

Thomas MacMillan contributed reporting.

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posted by: TheMadcap on September 30, 2013  11:18am

For the record, if a bronze plan would cost you more than 8.5% out of pocket in premiums after the subsidy, you’re not covered by the mandate and won’t be fined for not having insurance.
Also, if your current employer insurance costs you more than 9.5% out of pocket, you could be eligible to buy insurance on the exchanges.

Also also, it’s pretty funny no matter what the Republicans do they in fact can’t stop Obamacare.

posted by: Threefifths on September 30, 2013  3:34pm

This is snake oil and Three Card Monte.This is not a health care plan at all, it is a health Insurance plan.Based largely upon the failed model in place in Massachusetts since 2006. Everybody not covered by an employer will be required to purchase insurance under penalty of law, in much the same manner as you’re currently required to buy car insurance.As in Massachusetts, the health insurance plans people are forced to buy will cost a lot and won’t cover much. In a July 20 National Journal article Dr. David Himmelstein says.Nearly every day that he is in the clinic, Himmelstein says, he sees a patient who has problems paying for care “despite this reform.’ Some of them had free care before the 2006 law took effect but are now expected to handle co-payments. If you’re not poor enough to get a subsidy, say you’re making $30,000 a year, you’re required to buy a policy that costs about $5,000 a year for the premium and has a $2,000 deductible before it pays for anything. For substantial numbers of people, it’s effectively not coverage,’ Himmelstein said.The policy he described is about the cheapest Massachusetts plan available, according to the Physicians for a National Health Program report, which Himmelstein co-wrote.As private insurers use their marketing muscle to recruit younger, healthier people who’ll pay for but not use their benefits, the public option will be a dumping ground for the customers they don’t wan the middle-aged, the poor, those with pre-existing conditions.Bottom line This plan will leave tens of millions uninsured,a hundred million or more underinsured, and the same parasitic private interests in charge of the American health care system.

posted by: Esbey on September 30, 2013  3:51pm

My understanding is that you satisfy the mandate if you have insurance in place by the end of the March 2014.  From

http://www.pbs.org/newshour/rundown/2013/09/how-will-the-obamacare-mandate-impact-you.html

We have the explanation:

“Although the law takes effect Jan. 1, the initial enrollment period continues through March 31. Since people are exempted for a short coverage gap - less than three months - individuals that obtain coverage before the end of March will be exempt from the payment for that period.”

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