On Tuesday, Americans can begin buying health insurance through state exchanges created by federal health reform. Journalists have spent months trying to understand the reform law in an attempt to explain it to their readers, but unraveling the act can be a confusing and tiresome process. With open enrollment knocking at the door, Trudy Lieberman of Columbia Journalism Review asked for advice from Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs an insurance counseling program. She suggests looking at enrollment as a four-step process that she hopes will make the process easier for people.
Step 1 is looking at the health insurance buying cycle, Lieberman writes. Initial enrollment is from Oct. 1 through March 31, and can be done at HealthCare.gov. Those eligible include anyone who doesn't have employer coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan, also known as children's Medicaid. Kentuckians can also enroll at the state health insurance exchange, Kynect, by clicking here. Questions about the act can be directed to a call center at 1-855-459-6328 from 8 a.m. to 7 p.m. Monday through Friday, and Saturday from 9 a.m to 4 p.m.
Step 2 is the mechanics of enrolling, which includes having an email account and information about your household, residency, immigration status and income, which will let people know what insurance they qualify for, Lieberman writes. "People with employer-provided insurance may still need to visit the exchange to see if they’re eligible for exchange coverage. Employers with more than $500,000 in annual sales that offer group coverage must give all workers a document that tells them about the existence of the exchanges, and the premium that a worker would pay for the lowest-priced plan the employer offers for single coverage. This form lets workers know if their employer coverage is affordable according to the government. If it isn’t, they can shop in the exchange and receive a subsidy. Their families, however, cannot receive a subsidy."
Once a person has entered the information, he or she will find out how much of a subsidy they can get, Lieberman writes. Subsidies can either be applied to each insurance payment, which means lower monthly costs for coverage, or the purchaser can wait and collect it at the end of the year like a tax refund. Kentucky has five providers: Anthem, UnitedHealthcare, Humana, Bluegrass Family Health and the Kentucky Heath Cooperative. Not every company is offering a policy in every area of the state. Rates will be available starting Tuesday.
Step 3 is choosing a policy from options given the names of precious metals. "The platinum policies not offered on some exchanges cover about 90 percent of someone’s medical costs; the gold plans 80 percent; the silver 70 percent; and the bronze 60 percent," Lieberman writes. "As a point of reference, the gold plan is basically the old Blue Cross model that most Americans had for the last four decades and was considered good coverage." From there, people have to decide, "Do they want to pay a high premium up front in return for lower co-pays; a set amount for a service; lower coinsurance; a percentage of the bill; or, a lower deductible?"
The premium is calculated on four factors: age, where you live, how many people are on your policy and whether you use tobacco. Depending on the state, tobacco users can face a surcharge of up to 50 percent; Kentucky's is 40 percent.
The final step is finding and reading the disclosures, which is something consumers have to take the initiative to find on their own, Lieberman writes. "Shoppers can find out about the policy elements, deductibles (and what they apply to), coinsurance and co-pays for different services (especially common ones like diagnostic tests and outpatient surgery), amounts for different services, and fees. It also spells out some services that are not covered and provides sample charges for common conditions." (Read more)
People who don't sign up for insurance will face a fine of 1 percent of their annual income, or $95, whichever is higher. The fee increases every year. There also is a penalty for not providing coverage for children. (Read more)