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Insurance exchange to offer more coverage options

Published: Saturday, July 20, 2013 5:30 a.m. CDT
Caption
(Illustration by Caleb West, photos by H.Rick Bamman)
Enrollment in the Health Insurance Marketplace, or the Exchange, will open Oct. 1 as a centralized location for small businesses and individuals and families to shop for health insurance. In Illinois, there will be four "metal" levels of coverage — platinum, gold, silver and bronze — with dozens of insurance options offered at every level.

Editors note: This is the first in an occasional series from the Kane County Chronicle that will examine the multiple changes to health care in America in 2014 due to the federal Affordable Care Act.

Future stories will focus on how local families, businesses and health care systems will be affected by the various aspects of the law.

Shopping for health insurance soon will be as convenient as choosing between Frosted Flakes and Cheerios at a grocery store.

But expect to have to sift through much more information than sugar and calorie content to figure out which one is best for you.

In the largest step toward fully implementing the Affordable Care Act, Illinois will open its Health Insurance Marketplace, often referred to as the Exchange, on Oct. 1.

The Exchange is a website that will serve as a central location for residents and small businesses to compare and choose from dozens of insurance plans. Six providers – including well-known companies like Blue Cross Blue Shield – have proposed 165 plans that are awaiting approval.

Each plan will be categorized in one of four “metal” levels – bronze, silver, gold and platinum – with bronze the lowest and platinum the highest in terms of coverage, breadth, depth and services.

Mike Claffey, spokesman for the health care division in Gov. Pat Quinn’s office, said specific prices for plans would be made public in September after the federal government reviews and approves the plans state officials recommend at the end of July.

“The team has been working extremely hard to get everything in place for an Oct. 1 launch,” Claffey said. “There are a lot of departments working together to help put the pieces in place.”

State officials have said they initially expect 500,000 residents to seek insurance when the Exchange opens Oct. 1 and expect it to increase to 1 million people by 2016. State officials have been training community organizations to act as counselors for those needing assistance understanding premiums, deductibles, copays and other insurance issues.

Quinn announced Wednesday that the state received a $27 million federal grant to disperse to 44 community organizations for the training and outreach that will be needed.

“We know that many of those of who are eligible for subsidized coverage through the ACA have never, or rarely, had access to comprehensive health coverage,” said Jennifer Koehler, director of the marketplace. “We have a big job to do between now and Oct. 1 in terms of educating our target population.”

Claffey said in addition to the Oct. 1 opening date, Dec. 15, Jan. 1 and March are important dates to know. While open enrollment in the health insurance marketplace begins Oct. 1, coverage won’t kick in until Jan. 1 at the earliest. March is when the marketplace will close enrollment until the following fall.

“To be covered on Jan. 1, you have to sign up by Dec. 15,” Claffey said. “There will be no payments until the insurance starts in January.”

Those who don’t purchase a plan and remain uninsured – despite being able to afford insurance – will have to pay a penalty on federal taxes. The penalty would start at $95, or 1 percent of annual income, for working, uninsured residents before increasing significantly in each following year of going without insurance.

Many could also find benefits to purchasing insurance through the marketplace. Illinois is one of 25 states that has or is expected to accept expanded Medicaid coverage. In Illinois, the expanded Medicaid coverage means that 600,000 residents who do not currently qualify but have an income level at 138 percent of the federal poverty line – roughly $16,000 per year – will be covered.

Those with higher incomes also can receive a subsidy, though it will be less as the income increases.

Because the Illinois Legislature didn’t pass a governing structure and funding mechanism for an insurance marketplace, the state entered into a partnership with the federal government. The partnership puts the state in control of recommending plans, driving enrollment and educating the public while the federal government will approve the plans that can be purchased and make direct payments to carriers for those who receive subsidies.

Ann Ford, executive director for Illinois Network of Centers for Independent Living, said Oct. 1 cannot come fast enough. Her organization, which serves people with disabilities and has a center in Kane County, is one of the 44 that will receive money to train in-person counselors.

Ford, who has a disability and could not receive health insurance until she was eligible for Medicare, said the new law that requires insurance companies to accept people with pre-existing conditions will open a new world to thousands of people.

“We have a lot of outreach to do to people because many have never had insurance,” Ford said. “We can’t wait to walk them through what will finally be available to them.”

Know More

To learn more about the Insurance Marketplace visit:

• The state website on health care reform, www2.illinois.gov/gov/healthcarereform/Pages/default.aspx • The federal website on health care reform, www.healthcare.gov

By the numbers: The Tri-Cities and the Insurance Marketplace

The Affordable Care Act, enacted in March 2010, guarantees insurance for all Americans.

A Health Insurance Marketplace will open Oct. 1 that will offer dozens of insurance plans to citizens and small businesses. People who apply may qualify for lower costs on premiums or out-of-pocket costs; savings are based on household income and size. Some people will qualify for tax credits or subsidies to help pay for their insurance, and others will be newly eligible to enroll in Medicaid.

An estimated 9 percent of adults, or 7,182 people, in Batavia, Campton, Geneva and St. Charles townships are uninsured. Of those people, the following will be eligible for Medicaid or a subsidy once the Insurance Exchange opens: • 1,704 people will be newly eligible for Medicaid • 4,235 people will be eligible for tax credit in the insurance marketplace • 1,243 people can use the insurance marketplace but don't qualify for a tax credit • 1,341 people are undocumented non-citizens, may remain uninsured regardless

Source: Illinois Health Matters

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