Although fierce battles over the healthcare plan continue, New York State has implemented an exchange that will let New Yorkers shop for comprehensive health plans. Many will get affordable health insurance they could not obtain otherwise. ‘Sixty-two percent of bankruptcies are caused by health bills,’ said Elisabeth Benjamin, vice president for health initiatives for the Community Service Society of New York.
It’s finally here: Affordable health insurance.
After years of fierce battles on Capitol Hill — which are still not over as a government shutdown looms — the system of health insurance exchanges, created by President Obama’s Affordable Care Act, is set to open on Oct. 1.
If you are currently uninsured, or are seeking to replace the coverage you have, you can soon start to compare and shop for comprehensive health plans on New York State's official marketplace, New York State of Health.
Many will be entitled to financial aid that will dramatically lower the cost of their plans.
Some 1.1 million New York State residents are expected to buy their health insurance on the state's exchange by the time it is fully implemented, including 615,000 individuals and 450,000 employees of small businesses, according to the New York State Department of Health.
"On Oct. 1, we start a historic time when people will have an opportunity to get very significant help so they can get health coverage," said Ron Pollack, executive director of nonprofit health care advocacy group Families USA.
For some, the exchanges could be a path toward improving their health and their finances.
"Sixty-two percent of bankruptcies are caused by health bills," said Elisabeth Benjamin, vice president for health initiatives for the Community Service Society of New York, which has been chosen by New York State to set up a network to help New Yorkers enroll on the exchange.
"This is an important moment to get health security, and for many, economic security."
Open enrollment begins on Oct. 1 and extends until March 31, 2014. Coverage for those who enroll this year could start as early as Jan. 1.
But even as the curtain lifts on the new insurance marketplaces, many are still in the dark about what it all means.
According to a poll conducted by the Kaiser Family Foundation, four in 10 people believe the health law has been repealed or overturned. About half say they don't understand how it will impact their own families.
The Daily News is here to help.
This special report will give you a roadmap for understanding your new coverage options.
If you need personal guidance on how to choose a plan, we'll tell you where to find free help.
We'll also clear up some common misconceptions and answer some frequently asked questions.
First, you should know the basics.
As of next year, Medicaid in New York State will be covering more people, including low-income adults without children who had previously been excluded.
Anyone under the age of 65 with an income of less than 138% of the federal poverty level — $15,856 for an individual and $32,499 for a family of four — will be covered.
If your income ranges from 138% to 400% of the federal poverty level — up to $45,960 for an individual or $94,200 for a family of four — you may be eligible for financial assistance in purchasing coverage through the exchange.
Subsidies will be sent directly to the insurance company. You will not have to lay out that money and then wait to be reimbursed.
The level of financial aid you receive will be based on your income and your family's size. The savings could be thousands of dollars a year.
"A family won't have to spend more than a small percentage of their income to purchase a plan in the marketplace," said Kathleen Stoll, director of health policy at Families USA.
Let's say you are a family of three in Queens with an annual income of $39,000. If you choose a silver plan — one of the tiers on the exchange — that costs $8,772 a year, the cost of the plan to you will be $2,460 or $201 a month, according to the New York State Department of Health.
The remainder of the premium — $6,312 — will be covered by the subsidy.
Even individuals who don't qualify for subsidies could see lower premiums next year.
Approved 2014 health insurance rates on the exchange will be 53% less expensive than what is currently on the market because more people will be entering the insurance pool, New York State announced.
"Before, the cost of buying an individual policy, particularly in New York, was prohibitive," said Bertram Scott, president of Affinity Health Care, a not-for-profit local health insurance provider that will be participating in New York's insurance marketplace.
"Those who are uninsured will now have access to affordable health care like they never had before."
While the plans from the 16 insurance companies that will be selling on New York's marketplace will vary in cost and will have different doctors and providers in their networks, each must cover the same core set of ten benefits, including maternity care, prescription drug coverage and hospital stays.
Keep in mind that as of Jan. 1, most people, with exceptions, will be required to have health insurance or pay a penalty if they don't.
The penalty starts at $95 or 1% of your income — whichever is higher — in 2014, and is phased in over time to $695, or 2.5% of your income, by 2016.
No doubt that for many there will be work to be done in making the right decision.
Madeline Aviles, a 60-year-old Bronx resident, has already begun to research the health law and how it will affect her.
She was laid off from her job as a human resources manager at a local hospital in January and is currently uninsured.
When Aviles, who suffers from osteoarthritis in her hand, looked into buying a policy, she found the cost — $500 to $650 a month — prohibitive.
But after speaking to a counselor at Community Health Advocates, a consumer health care program operated by the Community Service Society, she learned that she could be paying as little as $75 to $85 a month for an exchange insurance plan.
"Now I will be able to treat my condition. That is really awesome," Aviles said.
"This program is not only assisting me, it's also going to support my fellow hard-working, tax paying American citizens."
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You are not alone.
There are plenty of places to go to learn more about the exchanges and to get help in enrolling in a plan.
Here are some key resources you need to know about:
New York State of Health's customer service center
Trained reps are ready to take questions by phone from individuals and business owners.
Call toll-free at 1-855-355-5777.
Navigators
Face-to-face guidance will be available at offices set up throughout New York City. Trained experts will be on hand to walk you through the enrollment process.
To find an office near you, go to nystateofhealth.ny.gov.
Information
Do your homework. Check out the following websites to brush up on the insurance marketplace:
Nystateofhealth.ny.gov The official website for New York State of Health.
Healthcare.gov The federal government's official health insurance website.
Kff.org The Kaiser Family Foundation, a nonprofit focusing on major health care issues, offers a treasure trove of information and helpful online tools, including an animated video on the Affordable Care Act and a health insurance subsidy calculator.
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