Health care exchange open for business for East Valley residents - East Valley Tribune: Health

Health care exchange open for business for East Valley residents

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Posted: Monday, October 7, 2013 2:14 pm

Arizonans lacking insurance can now begin the process of purchasing their own through the recently opened health insurance marketplace.

Arizona’s exchange, which is tied to the Affordable Care Act, is run by the federal government and presents applicants with insurance providers that offer a selection of services dependent on individual circumstances, including income and the number of people in the family. After people apply on the exchange’s website, healthcare.gov, they are given options to choose from that differ in the cost of premiums and co-pays, among other factors, and are classified as either bronze, silver or gold.

According to the health care exchange website, people who have access to insurance through their employer can use the marketplace to purchase a plan, although employers are not required to pay for a portion of an employee’s premiums if he or she opts out of the company plan. The online program also provides information about Medicaid or Children Health Insurance Program — known as CHIP — for people who qualify for them. People using those programs do not need to find their own private insurance.

“Anybody who is a citizen and has an address is free to buy insurance on the exchange,” said U.S. Centers for Medicare and Medicaid Services Regional Administrator David Sayen.

The Affordable Care Act, also called Obamacare, has a provision that most people need to have insurance in 2014 or else incur a fine of either 1 percent of their yearly income or $95 — whichever total is the highest — paid on their 2014 tax filings. Exceptions to the fine include people enrolled in government plans like Medicare, Medicaid and CHIP; people who receive a religious exemption; people who can’t afford the coverage; or people who are not enrolled in a plan for less than three months, among other exemptions.

Sayen said there are approximately a million people in Arizona who do not have health insurance, and he said about half could be eligible for federal subsidies that can reduce or even pay for the premium costs accrued from a plan. Prior to the start of the enrollment period, Sayen said he wasn’t sure how many people would enroll in the exchange, but he said the hope is to get as many people enrolled as possible.

“We know we’re targeting a little less than a million, and if had a choice, we’d have a little less than a million. We’d get everyone to be enrolled,” he said.

Any plan available on the marketplace cannot turn applicants away if they have a preexisting medical condition or illness, and the plans cannot charge women a higher rate than they would for men. Many insurance plans prior to the enactment of the Affordable Care Act charged women a higher premium than men, which Sayen attributed in part to costs related to maternity and gynecological care.

“Evidently, the female body gets a little more maintenance,” he said.

All of the plans on the market cover what are called essential benefits, which include emergency room visits, prescription drugs, preventative care, hospitalization and maternity. Certain plans can offer more than the essential benefits.

Enrollment through the insurance exchange began Oct. 1 — coverage kicks in as early as January 2014 — and ends on March 31. After this year, Sayen said enrollment is limited to the last three months of the year — October, November and December — to align with the insurance companies’ general practice.

One area that was not affected by the implementation of the Affordable Care Act this year is the employer mandate that requires employers with 50 or more employees provide medical coverage. That portion of the Affordable Care Act won’t come into effect until January 2015.

“Employers will hopefully use the time to find a way to procure their employees with [coverage],” he said.

More information about the exchange is available by visiting healthcare.gov or calling (800) 318-2596.

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