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Enrolling in right tier Obamacare plan can save you money


Monday, November 2, 2015, 12:01 AM

This year’s open enrollment, which started on Nov. 1 and ends on Dec. 15, is about half as long as it was last year.

This year’s open enrollment, which started on Nov. 1 and ends on Dec. 15, is about half as long as it was last year.

Whether you go for the gold — or the bronze, silver or platinum — plan when the time comes to select or change your health care coverage as part of Obamacare, you’ll want to make sure you have all the facts first.

New Yorkers have more options than ever before when it comes to picking a health plan, especially if they are doing so through NY State of Health.

Last year, the statewide health insurance marketplace offered coverage plans from 11 different private individual providers. This year, there will be 16.

All plans will continue to cover the basic 10 tenants of medical care laid out by the Affordable Care Act: doctor’s visits; hospital stays; emergency care; maternity and newborn care; mental health and substance abuse disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventative and wellness services; and chronic disease management — as well as pediatric dental and vision care.

More than two million New Yorkers are currently insured through NY State of Health’s Qualified Health Plans, Medicaid or Child Health Plus programs. Participation in the marketplace increased across every county in the state last year, according to a 2015 Open Enrollment Report from the New York State Department of Health.

Ten percent of the state’s total population was enrolled in a health plan under the ACA last year (more than twice the number of New Yorkers who enrolled in the plan during its first open enrollment period in 2013), and that number is projected to increase.

One thing that is not increasing during this open enrollment period, however, is the amount of time you have to make decisions regarding your health plan.

This year’s open enrollment, which started on Nov. 1 and ends on Dec. 15, is about half as long as it was last year. That means it’s more important than ever to understand your options regarding your insurance coverage.

Navigating the ins and out of your health insurance options is not easy, but it is necessary if you want to make sure that come Jan. 1, you’ve enrolled in the right health plan for your individual needs. One of the more confusing parts of picking a health plan is determining which of the four coverage levels — bronze, silver, gold or platinum — is right for you.

What metal tier you select will impact how much you pay in premiums and out of pocket for your health care. The general rule of thumb is that the higher the metal grade, the more your insurance costs are covered by your provider: bronze (60%), silver (70%), gold (80%) and platinum (90%).

The tradeoff for having your insurance provider pay for more of your plan coverage is that your premiums will be higher, which makes weighing the benefits versus the costs for each coverage level vital. These include premiums, deductibles, co-pays and co-insurance costs, as well as provider networks, drug formularies, extra services like dental and vision for adults, and your expected health care needs for the year ahead.

“Review your options and use plan finders to identify the plan that best meets your needs and preferences,” advises Pat Barry, features editor of AARP Media.

Doing so will give you the most comprehensive assessment of your health insurance on different plans, as well as at different metal tiers amongst a single provider’s offerings.

Depending on your income, the cost of your health plan might be offset through financial aid. According to the NYSDOH, nearly 75% of New Yorkers enrolled in its Qualified Health Plans had their insurance costs reduced through financial assistance last year. The average tax credit was $ 220 in 2015, and Donna Frescatore, executive director of NY State of Health, says the value of tax credits is going to increase in the coming year.

According to a 2015 study conducted by the Kaiser Family Foundation, the vast majority of New Yorkers — more than 220,000 — are currently enrolled in silver tier insurance plans, compared to bronze (60,399), gold (38,775) or platinum (45,786).

One thing New Yorkers need to look out for when comparing health plans is the “highly variable premiums that have been showing up one year to the next with the exchange plans,” says Gail Wilensky, an American health economist and senior fellow for the international health care organization Project HOPE.

In July, the New York State Department of Financial Services announced the annual rate changes for health insurance premiums. While the health insurance rate for individual New Yorkers is still 50% lower than it was before the Affordable Care Act went into effect, those premium rates will increase this year an average of 7.1% over last year.

For low-income New Yorkers concerned about how rate hikes will impact their ability to afford health coverage, the state has introduced a new Essential Plan that offers the same basic health-care coverage as other plans in its marketplace.

Under the Essential Plan, there will be no monthly premium for households at or below 150% of the federal poverty level ($ 17,655 for a household of one; $ 36,375 for a household of four). And there will be a $ 20 monthly premium per adult for households at or below 200% of the federal poverty level ($ 23,540 for a household of one; $ 48,500 for a household of four).

“It’s not just an investment in your health, it’s an investment in your financial security,” says Sinsi Hernandez-Cancio, director of Health Equity at Families USA.

“Even if you got coverage this year from the marketplace, don’t just re-enroll in what you have. Go online, or call or go to in-person assistance and find out what other methods might be better options,” Hernandez-Cancio adds.

“(Most) people who have insurance through the marketplace might actually have more affordable options if they change.”


Health – NY Daily News

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