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October 1, 2013Sign-up delayed for small businesses
October 1, 2013
STAFF REPORT
Here’s what you most need to know about Louisiana’s health benefit exchange.
Q: What is the exchange and when can I enroll in it?
A: The exchange is designed to find health coverage that allows people and small businesses to compare plans head-to-head, including coverage premiums and out-of-pocket costs. Consumers can also find out if they qualify for assistance to help pay coverage costs. Coverage should begin Jan. 1, 2014. Enrollment is open now through March 31, 2014.
Q :What happens if I don’t enroll and don’t have an insurance plan?
A: A key provision of the Affordable Care Act is the mandate requiring most people to purchase insurance coverage by Jan. 1, 2014. Individuals who choose not to purchase health insurance may be subjected to a penalty fee. Employers with more than 50 staffers are mandated to offer health insurance to employees or pay a penalty after Jan. 1, 2015.
Q: Who is overseeing the exchange for Louisiana?
A: The Affordable Care Act requires exchanges be established in every state by the start of 2014. Louisiana opted to use an exchange created through a federal-state partnership or a federally operated exchange. Questions about health insurance can be directed to the Office of Health or the Office of Consumer Advocacy at the Louisiana Department of Insurance at 1-800-259-5300.
Q: How many people are expected to use it, and who is eligible?
A: The state estimates that 20 percent of Louisiana’s population currently has no health insurance, whom the program will benefit. Others who have insurance might also go on the exchange in search of a better deal.
Any Louisianan may use it. But only some are eligible for tax credits that can total thousands of dollars and help pay for exchange health plans. If you can already get “affordable” insurance through your employer, or if you earn more than 400 percent of the federal poverty level ($94,200 for a family of four), you are not eligible for assistance. An employer plan is considered unaffordable if personal coverage costs more than 9.5 percent of household income.
Q: If I get insurance on the job, will the exchange change that?
A: No. You may continue getting coverage through your job or seek alternate coverage on the exchange.
Q: If I qualify for Medicaid, can I get that through the exchange?
A: Yes. An adult earning less than $15,857 a year, and a family of four earning less than $32,500, would qualify for Medicaid. There are no premiums, but there may be co-payments. You can enroll in Medicaid or Louisiana’s Children’s Health Insurance Program through the exchange.
Senior citizens and others who have Medicare will keep getting insurance the way they do now.
Q: Do some people get help paying premiums and cost-sharing on the exchange?
A: People earning 138 percent to 400 percent of the federal poverty level may qualify for payment assistance or discounts. A recent study by the nonprofit Kaiser Family Foundation found that about half of the people enrolled would be eligible for subsidies in the form of tax credits. These are paid in advance by the government, meaning the consumer pays only the net amount (premium minus subsidy) each month.
An online calculator to help people estimate their potential subsidy is available at kkf.org/interactive/subsidy-calculator.
Q: Is my personal information at risk on the exchange?
A: To get coverage, you’ll need to provide private information such as your Social Security number (to verify citizenship), income and family size. State officials say they have to demonstrate to the federal government that the have a privacy policy in place.
Q: What do these plans cover, and how do they compare with what is now available?
A: The health reform law requires that plans cover “essential health benefits: that aren’t necessarily covered by every plan now, such as doctor visits and outpatient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, behavioral health treatment, prescription drugs, rehabilitation, laboratory services, preventive services, chronic-disease management and pediatric services, including oral and vision care for children.
Through the marketplace, you can check which plans your primary-care doctor of preferred hospitals participate in, which can help you choose a plan.
Q: What different levels of plans are available?
A: Four categories will be offered – bronze, silver, gold and platinum. All offer the same essential health benefits, but the level determines the premiums, co-payments, co-insurance, deductibles and out-of-pocket costs. A silver plan, for example, would cover 70 percent of health costs, leaving you to pay 30 percent.
The state Department of Insurance is reviewing the forms and rates filings from insurers, and then the exchange will certify the plans. In the meantime, officials have posted examples of possible premiums and payment assistance at … One example if a family of four earning $48,000 a year, which could expect to pay $252 a month, or $3,024 a year, for a silver plan. These are net totals, after subsidies have been applied.
Q: Can you get the same types of plans outside the exchange?
A: Yes. Every carrier who will be offering plans on the marketplace is required to offer the exact same plans outside of the exchange, too.
But you can’t get subsidies for plans outside the exchange.
Q: Which small businesses are eligible to use the exchange?
A: Small businesses with 50 or fewer full-time employees can get insurance through the exchange in the Small Business Options Program. They may be eligible for the tax credits if they have fewer than 25 full-time employees and pay at least half of the premium for each employee, with a group average annual wage less than $50,000 a year.
The health reform law doesn’t penalize small businesses with 50 or fewer workers that don’t provide health insurance. But businesses with more than 50 full-timers (those averaging 30 hours a week) that don’t offer health insurance (or those that offer coverage that doesn’t meet minimum standards) will face penalties in January 2015.
Q: Will the advent of the exchange affect small businesses’ bottom lines?
A: No one knows, but some small business leaders are concerned.
Q: I’ve heard there were some delays with health reform. Is everything on schedule to start getting onto the exchange now?
A: The federal government recently announced a delay in fining businesses with more than 50 employees that don’t provide health insurance, but those employers can’t get insurance through the exchange.
Q: What if I decide I don’t want to get insurance?
A: Most Americans will be required to have health insurance starting next year or face a penalty. For individuals, that penalty starts at $95 a year in 2014, or up to 1 percent of income, whichever is greater. By 2015, the penalty rises to $695 a year for individuals and $2,085 for families, or 2.5 percent of income.
Q: How do you get help understanding and enrolling in benefits?
A: Help is available for individuals, families or small businesses through the Louisiana Insurance Commissioner’s Office or at www.healthcare.gov.
The first provision of the Affordable Care Act – the Health Insurance Marketplace or Exchange – is open across the nation. Open enrollment continues through March 31, 2014. This online exchange is designed to help individuals purchase health insurance and, if income allows, obtain subsidies to cover the cost.
