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HealthBeat

HealthBeat: ‘What about...?’ Answers about N.H.’s new health insurance marketplace

On Tuesday, one of the most visible and talked-about provisions of the federal health care reform law opens for business: state insurance exchanges, or marketplaces. The marketplace is supposed to be one way people without insurance get covered – the main goal of President Obama’s Affordable Care Act, also known as Obamacare.

In New Hampshire, about 170,000 people don’t have any health insurance. If they don’t get coverage next year – either through their employer, through the exchange, through a public program like Medicaid, or another option – they’ll face a fine.

Here’s a look at what this change will mean and how it will work in New Hampshire. As you’ll see, not every question can be answered in a simple “yes” or “no.”

What is the marketplace? Is it the same as the exchange?

The marketplace is basically a website (though there is a call-in center as well at 1-800-318-2596 or TTY 855-889-4325) where people and small businesses can go to shop for insurance policies and find out if they are eligible for tax credits toward the premium or other costs.

It is the same as the exchange; a few months ago, federal officials stopped calling the sites “exchanges” as critics ramped up their opposition.

For consistency, we’ll use marketplace in this guide.

What happens on Oct. 1?

Tuesday is the first day people can shop for or buy plans on the marketplace. (Despite a possible government shutdown, the rollout should be unaffected, reports say.)

You can go to HealthCare.gov to look at the New Hampshire policies, or schedule a meeting with someone trained to help people use the site.

Small businesses looking for group plans have to wait until Nov. 1 due to a glitch, federal officials announced last week.

Who does this affect?

Anyone can shop for a plan on the marketplace, but experts expect about 65,000 people – mostly self-employed or part-time workers – will buy insurance on the New Hampshire marketplace next year.

One study estimated that 52,000 people on the New Hampshire exchange will qualify for federal tax credits that are part of Obamacare, too.

Does this affect Medicare?

No. Medicare enrollees are unaffected. So are veterans who get VA health care.

I have insurance through my employer. Does this affect me?

Not necessarily. Anyone can shop on the marketplace, but there may not be a benefit to doing so if your employer offers insurance that meets federal standards for coverage and affordability.

If you have adequate, affordable coverage through your work, you can still check out and purchase the plans offered on the marketplace, but you won’t be able to get a tax credit, or any employer contribution, toward the plan you select.

I own a business. Does this affect me?

It might. Businesses with 50 or fewer full-time-equivalent employees (FTEs), based on the number of hours worked, can buy policies through the marketplace.

Businesses with fewer than 25 FTEs may be eligible for tax credits to offset the cost of the employer contribution to the plan premiums.

But federal officials announced last week that a glitch has delayed the start of the small business marketplace until Nov. 1.

Businesses with more than 50 FTEs that do not offer insurance meeting federal standards for affordability and coverage may face a penalty if their employees purchase subsidized coverage on the marketplace.

Will I be able to choose my own insurer and plan?

Right now, Anthem Blue Cross Blue Shield is the only company selling plans on the marketplace in New Hampshire. The company has written 11 different policies.

What will insurance on the marketplace cost?

That depends. Anthem recently released details of the 11 plans it will offer, categorized as either Platinum, Gold, Silver or Bronze, based on the coverage offered and the cost.

The prices also vary based on a person’s age and income, and whether the plan is for just one person or a family.

On average, the mid-range plans being offered in New Hampshire will cost $360 a month for an individual plan, slightly higher than the national average, but lower than the costs in neighboring states.

The most consumers will pay out-of-pocket on top of their premiums is capped next year at $6,350 for individual policies and $12,700 for family plans in 2014.

Is there any way to reduce that cost?

Yes. People who make up to 400 percent of the federal poverty level, or $45,960 for an individual and $94,200 for a family of four, are eligible for tax credits toward their premium costs.

Other credits are available to help very poor people pay co-insurance costs, too.

When would the plan start?

The policies will go into effect Jan. 1, for people who have enrolled and made a first payment before Dec. 15.

How long do I have to purchase coverage?

The open enrollment period will last until March 31 of next year. It will reopen Oct. 1, 2014, for 2015 plans, but only until Dec. 7.

If I lose my insurance after March 31, do I have to wait until October to enroll?

No. Losing your insurance, losing your job, moving to a different state, having a child and getting married all count as events that would allow you to enroll mid-year.

Getting sick after open enrollment ends doesn’t.

Who’s running the marketplace website?

In New Hampshire, the site has been designed and built by the federal government.

State officials had a say in approving the insurance plans being sold here, and in training and educating people who will help consumers use it.

No state money was used setting up the site or training the helpers.

There are people trained to help consumers use the site?

Yes. There are several kinds of people who can help consumers and businesses work with the marketplace.

The federal government is paying two organizations in the state – Bi-State Primary Care Association and Planned Parenthood of Northern New England – to hire and train people called navigators.

Navigators will be able to help people find information about the plans online and determine if they are eligible for subsidies or Medicaid.

Another agency, the New Hampshire Health Plan, is poised to receive a one-year federal grant to train additional assisters. They’ll be given the same training, but will only do this work for one year.

Professional insurance agents and brokers offer another kind of assistance; they already help individuals and businesses select insurance plans and are paid by the insurance companies for that work.

Agents and brokers are the only people who can actually recommend one plan over another based on a individual’s circumstances.

Navigators and assisters can help people find information but cannot recommend plans.

To schedule an appointment for enrollment assistance with Planned Parenthood of Northern New England, visit ppnne.org, call 1-866-476-1321 or email getcoverednh@ppnne.org.

A Bi-State Primary Care representative said the best way for getting information around the clock is to go to the federal website or call the 800 number above.

What will the plans cover?

Federal law requires the plans offer “essential health benefit” coverage for 10 areas: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

That doesn’t mean that all policies are created equal.

Some plans could have a higher copay, while others could limit things like physical therapy visits. Plans may also come with different coverage for prescription drugs.

You’ll have to read the actual policy to make sure what you need is covered.

I’ve heard the plans will be more expensive than the plan I have now. Why?

Before now, not all plans covered those 10 “essential health benefits,” so the new plans could be more expensive because they cover more.

In New Hampshire, the pool of people to be covered by the marketplace will also include people who used to be in the “high-risk pool,” and because their care is generally expensive, the cost is being shared by everyone on the marketplace.

What information do I need to sign up?

You’ll need some specific information to fill out the application, especially to determine if you’re eligible for a tax credit.

First, you need the Social Security Number for everyone who would be covered by the policy.

You also need information about your household income, and the cost of any insurance offered by your employer or the employer of anyone else in the household.

Will my doctor accept insurance from the marketplace?

That depends. Anthem, the only company selling plans on the exchange in 2014, is working with a narrowed network of providers for those plans; 10 hospitals (including Concord Hospital) and 26 percent of primary care providers in the state are not in the network.

I have an individual plan, insurance I purchased on my own, not through an employer. Starting next year, do I have to buy my individual plan on the marketplace?

No. Consumers can shop for coverage on or off the exchange. The tax credits and subsidies are available only for plans sold on the marketplace.

Also, young adults have another choice: They can get coverage through their parents’ health plans until they’re 26 years old.

Can I get coverage off the marketplace with a network that includes my doctor?

Possibly.

Anthem’s individual plans off the marketplace use the same narrow network as ones on it.

But Assurant, one of the smaller health insurance companies in the state, does sell individual plans with a broad network, and was approved by state regulators Friday to sell them next year.

Another company has applied to sell individual plans with a broad network off the marketplace next year as well, and could be approved early this week. The rates for the plans will be made public after their effective date, Jan. 1.

What if I don’t buy coverage anywhere?

Anyone without insurance coverage after March 31, 2014, faces a financial penalty when they file their taxes.

The fine in 2014 is 1 percent of your yearly income or $95, whichever is higher. The fee increases in 2015 and again in 2016, when it will be 2.5 percent of income or $695, whichever is higher.

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

Legacy Comments3

Ms. Palermo: Do you know what will happen to people under 140% of the poverty line if Medicaid is not expanded in NH? I know they will not eligible for financial assistance through the marketplace, but will the still be subjected to the fines if they don't buy insurance?

Hi F-o-F, There are hardship exemptions for some people in the ACA, detailed here https://www.healthcare.gov/exemptions/ One of them (the last on the list in the link above) is if you would have been eligible if the state expanded Medicaid. Other categories of exempt people include: people who are homeless or were homeless during 2014; who were evicted from their home or faced foreclosure; who filed for bankruptcy in the past 6 months; who recently experienced domestic violence. There are others; the full list of exemptions is in the link. Hope that helps!

Thank you - it does help. It's good to know that these folks will not be kicked while they are down. Nonetheless, I hope the legislature decides to expand medicaid.

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