Insurance Exchange - What's It Gonna Save (Or Cost) You?

Last week we talked about the new on-line Health Insurance Exchange where you can buy insurance beginning October 1st. The question is how much will this new way of buying health insurance save – or cost – you and your family?

It seems like a simple question, how much will insurance under this new system cost us?

The answer is it depends. You’ll have four types of plans to choose from- bronze silver gold and platinum – based on how much premium you’re willing to pay and how much you’re willing to pay towards the cost of your health care such as deductibles and co-pays. If you’re under 30 years old or low income, you’ll also have the option of choosing catastrophic coverage only which of course will have lower premiums but only covers major events as is the case with insurance we’re all used to, the lower the premium the higher the costs when you need care. So between now and October 1st everybody planning to enroll should be thinking about your family’s health care needs and past service use. For example, do you expect a lot of doctor visits and medications? Your answers to those questions will, in part, determine how much coverage will cost you.  

The other big factor that will determine how much this costs you is what state you live in. That’s because, to a large extent, everybody’s health risks are mixed into the premium “soup” so if you’re young and healthy you may wind up paying a little more that you would have before to cover the costs for folks who are not  and if you’re older or have health issues, you may end up paying a little less than you have before for the same reason. In Florida, for example, some expect the average insurance premium to increase by 35% due in part to the cost of covering 3.8 million people who are currently uninsured. 

This is one of the biggest issues opponents site, the new  laws essentially require people who can afford it to take care of people who can't. Others say that the reality is when someone without who can afford health insurance coverage gets care, at a hospital for example, we all pay the bill anyway. The fact is there are several ways we will all pay for the new system. For example the laws regarding which employers need to provide what health care insurance to employees have changed and there is a fee associated with opting out. You can be sure that businesses will pass these new costs on to their customers/us.

Even folks who decide to be uninsured will help pay for the new system. So if you decline to be covered this year, for example, you’ll have to pay 1% of your annual income or $95 whichever is less.  The fees for kids is $47.50 each (family maximum for 2014 is $285) and that amount goes up each year (by 2016 it’s the higher of 2.5% of income or $695 per person)  (to avoid paying the fee you’ll need to have "Minimum Essential Coverage" which includes any marketplace plan or individual plan you may already have,  any employer or retiree or COBRA plan, Medicare, Medicaid, CHIP,  Tricare or VA for military, Peace Corp plan, or  possibly others). The only exclusions are folks who are uninsured for less than 3 months, very low income, no tax return due to low income, would qualify under new Medicaid income limits but State didn't expand eligibility, Indian tribe, participate in Health Care Sharing Ministry or member of religious sect that objects to health insurance, others can apply for exemption in Marketplace).

How Will You Know If You’re Eligible For Financial Assistance?

The new assistance feature is decided based on your total household income and the number of people in your family. So, for example, if you are an individual earning under $28,725, then your health insurance company has to lower your out of pocket costs for “Essential Health Benefits” so that includes your deductibles and co-insurance.   There’s a scale for families with one to eight members that shows the maximum income they can earn in order to qualify. (Individual $28,725, Family of 2  $38,775, Family of 3  $48,825, Family of 4  $58,875, Family of 5  $68,925, Family of 6  $78,975, Family of 7  $89,025,  Family of 8  $99,075) and this maximum amount will go up each year.

Children’s Health Insurance Program (CHIP) and Medicaid are also still available.  Medicaid has been expanded in some states as well.

What do we need to know to begin using the Health Insurance Exchange?

The process involves four steps: 

  • First you’ll set up account by provide basis information, choosing your user name and password, and setting up a security question.
  • Next you’ll fill out the Application by filling on information about you, your family, income, household size, and current health coverage. 
  • The Exchange will then find the insurance MP finds options that meet your needs and you can compare those options.  It will show you plans and also free or low cost options if you qualify such as Children’s Health Insurance Program (CHIP).  It will tell you if you qualify for lower cost on your premiums and out of pocket costs, copayments, and co-insurance.  You will see all of the details on costs and benefits.
  • The last step is enrolling and deciding how you’ll pay your premium.

$8 million has been dedicated in grants to assistance from trained helpers called “Navigators” though there been some push back from states including Florida about their qualifications and the confidentiality of information folks will be giving them.  Telephone and on-line helpers will also be available 24-7 to answer questions you can call 800 318 2596.  You can also get help from government agencies like state Medicaid CHIP offices insurance agents and brokers. Localhelp/ Help will be avail thru libraries. CVS.  Non profits.  Blue cross blue shield of Florida doubled its call center staff for Florida Has 11 retail offices.  Plan to open 5 or 6 more. Offering coverage in all 67 counties.

Shari Olefson's picture
Shari Olefson

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