By JIMMY LAWTON
The New York Health Exchange officially opened Oct. 1, but not without some hiccups.
Many St. Lawrence County residents may be eligible for subsidies, Medicaid and other benefits under the new program, but high traffic and computer glitches are causing frustration for some users who are attempting to log in.
Officials were working in the days that followed to increase bandwidth to meet the massive number of users attempting to shop on the new market.
While people always had the option of seeking out health insurance providers, the new exchange created under Pres. Barack Obama's Affordable Care Act has established a new market and forced insurers to provide coverage to people regardless of pre-existing medical conditions.
The exchanges are expected to reduce health care costs through a competitive market and insure about 1.1 million New Yorkers who did not previously have coverage.
Anne Marie Snell, who works as an exchange navigator through the St. Lawrence Health Initiative, said the ACA also bars insurance companies from putting annual limits on coverage.
“The goals are to increase access to health care coverage for all Americans,” she said.
On Tuesday, the market went online at www.nystateofhealth.ny.gov. Here, subscribers are able to view plans, compare costs, find out what subsidies they are entitled to, and sign up for insurance.
Snell, said subscribers will need to provide some personal information in order to access the market place and shop on the exchange. Required information includes address, telephone number, date of birth, citizenship, employment, household income, medical benefits, unemployment and tax records.
Snell said most people will already know the majority of the required information and will not need to provide documents in most cases.
"You aren't going to need documents for all of these, unless you don't know it already," she said. "Their may be some circumstances where documentation is required, but that is only if a problem arises."
Health providers on the exchange must provide four plan types, which are categorized as bronze, silver, gold and platinum.
For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. Under the bronze plan enrollees, on average, would be responsible for paying 40 percent of the costs. Each tier, up to platinum, increases insurance coverage by 10 percent with silver at 70 percent, gold at 80 percent and platinum at 90 percent.
While these give baseline figures, plan details will vary between providers. In St. Lawrence County, people using the exchange will be able to choose between three providers -- Excellus Blue Cross Blue Shield, MVP Health Plan and Fidelis Care.
While shopping on the exchange, subscribers will be able to compare all four plans provided by all three providers.
While the coverage should be comparable between providers, there will be differences that may work better for people based on their health and lifestyle, Snell said. Snell said navigators, like herself, would not encourage people to choose a particular plan, but simply help them understand the differences.
Premiums and Subsidies
In an attempt to make good on its name, the Affordable Care Act will raise Medicaid eligibility to 138 percent of the poverty level, which is $15,856 for and individual or 32,499 for a family of four.
For those who are not eligible for Medicaid and choose to purchase health insurance on the exchange, subsidies may be available. Individuals or families up to 400 percent of the poverty level may qualify for subsidies. Those amounts would be dependent and several factors including, age, income, tobacco use and family size.
A single person at 139 percent of the federal poverty level ($16,000 annually) would be eligible for a tax credit of up $1,996 (79 percent of premium) on a silver plan. That person would receive silver level health care for a payment of $539 a year.
The unsubsidized cost would be $2,535 per year.
A family of four at 139 percent of the federal poverty level ($32,700 annually) would be would be eligible for a tax credit of up $7,196 (87 percent of premium) on a silver plan. The family would receive silver level health care for a payment of $1,049 a year.
The unsubsidized cost would be $8,290 per year.
Snell said the subsidies very greatly, but encouraged anyone without insurance to visit the exchange and see what they can qualify for.
“I think people will be surprised at what they qualify for,” she said.
A tool available at http://kff.org/interactive/subsidy-calculator/ allows individuals to enter information and see what subsidies they qualify for.
Penalties, Now and Later
While the new act is expected to provide coverage to many currently uninsured New York State residents, it can result in a tax penalty for those who choose not to get health insurance coverage.
This year a fee of $95 or up to one percent of annual household incomes can be charged to taxpayers who are not insured.
That penalty will increase more than six times by 2016 when the fee is expected to be $695 with a cap of 2.5 percent of annual household incomes. Snell said the increase will be implemented gradually, with an increase to $325, or a 2 percent cap in 2015. Snell said the fee can be avoided if people can prove to the IRS that they can not afford to buy health care on the exchange.
“If an individual does try to enroll but coverage is unaffordable they can go though a process to have the penalty waived,” Snell said.
Many people will be able to access the exchange from their home, but for those without internet access or computers there are other options. Snell said people can use public computers at local libraries or some mobile devices. Those without access can 1-855-355-5777 for help in enrollment.
For those who feel they need help with the process, there are several even more options. Navigators, like Snell, have been trained to assist people the process. In St. Lawrence County, The Health Initiative, ACR for Health in Canton, and Community Health Center, have navigators or in person assistors.
The St. Lawrence County Chamber if Commerce, Health Initiative and Greater Watertown North Country Chamber also have trained individuals onsite. They will focus on helping small businesses navigate the exchange once they are allowed to enter the market.