Seth Diamond, Chief Operating Officer of MetroPlusHealth Health Plan, Answers Common Questions About the Affordable Care Act
Many online plans cost less than you think, expert says
Dec 19, 2014
December 20 is the deadline for enrollment at the NY State of Health online marketplace for residents who want their health coverage to begin January 1, 2015. With the current enrollment window closing soon, Seth Diamond, Chief Operating Officer at MetroPlusHealth Health Plan, answered questions that many New Yorkers still have about the Affordable Care Act and online enrollment.
“People can shop for the best coverage for themselves and their families at the best available price,” Diamond said of NY State of Health at https://nystateofhealth.ny.gov. “And many choosing insurance will qualify for subsidies that make their health insurance coverage more affordable. There are benefits far beyond just convenience when selecting health insurance online.”
Another enrollment period for the Marketplace extends December 21, 2014 until February 15, 2015, for health insurance coverage that will start on February, March, or April 1, 2015, depending upon what date the consumer enrolls.
“The Marketplace offers a choice of low-cost quality health plans,” said Diamond. “It’s also the only place you can receive financial assistance based on your income to lower your costs even more. We strongly urge people who are eligible to sign up before the deadline, regardless of which insurance provider they choose.”
Q. Why should I enroll?
“Health insurance is extraordinarily important to your family’s health and overall well-being, and will keep you healthier,” Diamond said. “Also, there is great peace of mind knowing that you and your family are covered not just for routine preventive care but also against catastrophic injury or illness. Unexpected medical bills are a leading cause of financial stress. And if you don’t sign up for health insurance, under the law you may have to pay a penalty.
“Clearly, having comprehensive quality health insurance is a plus for any consumer, especially when subsidies are available to help cover the cost,” he said.
Q: Am I eligible to enroll though NY State of Health?
To enroll for health insurance through the state Marketplace consumers must live in New York and must be a U.S. citizen, national or lawfully present immigrant (different immigration rules may apply for people eligible for Child Health Plus or NYS Medicaid). Enrollees also cannot be currently incarcerated.
Q. I already enrolled at NY State of Health last year. Do I have to sign up again?
“People who enrolled last year in a Qualified Health Plan and have not had any changes to their personal information will be automatically reenrolled in the same plan,” said Diamond. “But if they had any changes to their personal information and want to keep their plan, they must reapply by December 20 at NY State of Health for coverage to continue uninterrupted.”
Q. What will health insurance cost?
Many New Yorkers enrolling at NY State of Health can qualify for tax credits to help pay for monthly Qualified Health Plan (QHP) insurance premiums. For example, an individual may qualify for tax credits if he or she earns up to $45,900 a year; a family of four can qualify while earning up to $94,200 a year.
“In addition to tax credits, residents may also be eligible for assistance for co-pays, deductibles, and other out-of-pocket costs,” MetroPlusHealth’s Diamond said. “The Marketplace website will also help determine if you qualify for free or low-cost coverage from Medicaid or Child Health Plus. Consumers can quickly compare health plan options and apply for assistance that could lower the cost of their health coverage for 2015.”
Diamond explained how the financial assistance available through the Affordable Care Act might affect a family of four that makes $36,500 a year (between 150% and 200% of the Federal Poverty Level). The family would find numerous affordable options available to them on NY State of Health.
“The Marketplace offers a wide variety of plans. A health insurance plan that would normally cost $700 a month would be free after subsidies and other adjustments to a family of four with an annual income of $36,500. The same family would pay just $88 per month for a plan that normally costs $1000 per month, and $338 for a plan that costs $1250 per month,” he said.
“An individual who makes $17,600 a year would pay nothing for a plan that normally costs $250 per month, after subsidies and adjustments. For a plan that costs $325, the individual’s monthly cost would be reduced to $21, and for a plan that costs $400, the member would only pay $96 each month.
“A single parent with one child who makes $24,041 yearly would also be eligible for subsidies. They would pay $64 monthly for a plan that normally costs $600 per month, $164 for a plan that costs $700 per month, and $264 each month for a plan that normally costs $800.
“When looking at this scenario, it’s plain to see that individuals who meet certain criteria can receive significant savings and benefits,” Diamond said. “There are many factors and situations affecting what consumers will end up paying. These are explained more fully on the New York State of Health website. Consumers can also reach out to individual health plans if they have questions.”
Q: How can I apply?
“You don’t need a computer to apply for coverage,” Diamond said. “Consumers are encouraged to apply online, but they can also apply over the phone or in person.”
NY State of Health, the State’s official Health Plan Marketplace, is online athttps://nystateofhealth.ny.gov. The Marketplace also has a helpline open Monday to Saturday at 855-355-5777.
Many insurers also offer help over the phone. MetroPlusHealth customer service for example is available Monday to Saturday at 855-809-4073. There are also Marketplace Facilitated Enrollers (FEs), Navigators, brokers, agents and assistors available to help people enroll in the exchange in many different languages. The online Marketplace or an insurer like MetroPlusHealth at 855-809-4073 can help consumers locate these resources.
Q: What benefits are offered by insurance plans on NY State of Health?
“By law, in order to be listed on the NY State of Health Marketplace, health insurance plans must provide both ‘preventive care’ and ‘essential health’ benefits for members,” said MetroPlusHealth COO Seth Diamond.
Preventive care benefits are provided without cost-sharing – coinsurance, deductible or copayment – and include important primary care services such as vaccines for adults and children.
Essential health benefits include ambulatory patient services; hospitalization; emergency services; maternity and newborn care; mental health and substance abuse treatment; prescription medications; rehabilitative and habilitative services and devices; pediatric services, including oral and vision care; laboratory services; wellness services including chronic disease management.
Some insurance plans also offer optional riders that provide services such as vision and dental care for adults. Over 80 percent of consumers who enroll through the Marketplace for MetroPlusHealth, for example, choose an additional rider.
Q: When should I enroll?
December 20th is the deadline to enroll for coverage that would begin January 1, 2015.
Open enrollment continues to February 15, 2015. When consumers enroll between the 1st and the 15th of the months of January and February, their insurance will become effective on the first day of the following month. When they enroll on the 16th or later in January or February, their play becomes effective on the first day of the second following month (so a person who enrolls on January 16 will have their insurance become effective on March 1).
“There is also a Special Enrollment Period that follows the open enrollment period that ends February 15, 2015,” said Diamond. “Those that wish to enroll during that time need to have experienced a ‘qualifying event.'”
Qualifying events are:
- Losing coverage through your employer plan
- Aging off parent’s health plan at age 26
- Your health plan loses Qualified Health Plan status
- Gaining or becoming a dependent
- Gaining or losing subsidy status
- Citizen status change
- Relocation out of health plan’s service area
- Enrollment errors of the Marketplace
More New Yorkers may have chosen MetroPlusHealth than any other plan on the Marketplace in 2014, but, Seth Diamond says, “Choose the plan that’s right for you. The important thing is to enroll before the door shuts on 2015 coverage.”