The Real Deal: Healthcare Exchanges
Updated: Friday, August 2 2013, 10:24 PM EDT
ALBANY – In just a
matter of months, healthcare exchanges will be open for business here in New
York. The exchanges were mandated by the federal government under the
Affordable Healthcare Act. Insurers have already submitted their plans to the
state for approval and are expecting to hear back by late July on whether the
products they’ll offer in the exchange market are adequate.
Depending on where
you work, you may be forced to join a healthcare exchange if you need insurance. Employers with less than 50 full-time
employees will now be able to transition employees to an exchange instead of
offering traditional coverage. In most
cases, employers will still contribute to the cost of healthcare. Essentially, if you choose or are forced into
a healthcare exchange, you will go online, put in your coverage wants and needs
and “the exchange will spit out information to you to show you the number of
health plans available to you that might fit your needs and you'll be able to
shop and compare individual options on that basis,” says Bob Hinckley, Chief
Strategy Officer at CDPHP. Chances are
though, you won’t get any better of a price on premiums, “a consumer will see
more benefits on the exchange then they did in years past... I'm not so sure
they're going to see lower costs,” according to Hinckley.
exchanges will make it a bit easier for the employers but consumers will have
to do a lot more work. “The employer could
say, you're going to get $250 a week, here is access to the portal, here is
access to the different plans...pick the plan that's right for you and your
family, here's how much we will contribute, you contribute all or the rest,”
says Keith Dolan. Dolan is a broker with
Rose & Kiernan Inc. in East Greenbush and has been spending the last
several months counseling businesses on the Affordable Healthcare Law changes. Many small local businesses are deciding
right now, if they will offer insurance at all and if they do whether it will
be a traditional option or through one of the exchanges.
If you are not
offered insurance through your work and/or you decide not to buy into an
exchange, starting next year you will be penalized financially by the federal
government. In 2014, the penalty is
$95/adult, $47.50/child. In 2015, the
penalty jumps to $325/adult, $163.50/child.
In 2016 and beyond the penalty will be $695/adult and
$347.50/child. The fines, in some cases
can be cheaper than the insurance and that may cause a problem down the
road. “Our concern still remains that
the young invincibles, those 28,29,30 year olds who don't have real health
needs, won't join, instead will opt to pay the penalty,” says Hinckley which
would cause an unbalanced risk pool that could drive up prices.
Employers will have
to inform employees before open enrollment what kind of plan they are
offering. They will also be obligated to
help walk you through the process. The open enrollment period for the exchanges will begin in October.