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Make healthy choices, Obamacare enrollment period underway


Monday, November 2, 2015, 12:01 AM

While the options for health-care coverage have increased, the window of time to take advantage of your affordable health care options is getting shorter.

While the options for health-care coverage have increased, the window of time to take advantage of your affordable health care options is getting shorter.

Life is all about choices, which is never more apparent than during the annual open enrollment period for universal health care.

Since the Affordable Care Act, better known as Obamacare, went into effect two years ago, the ways in which Americans select their health care coverage has changed significantly, and New York is no exception.

According to the NYS Department of Health, which operates NY State of Health, the statewide health insurance marketplace, 2.1 million New Yorkers are currently receiving their health care through insurance plans provided through the ACA — private plans, Medicaid or Child Health Plus.

That number is projected to increase during the third annual open enrollment period, taking place now through Dec. 15 (with changes going into effect on Jan. 1, 2016).

While the options for health-care coverage have increased, the window of time to take advantage of your affordable health care options is getting shorter.

This year, you’ll have about six weeks to either sign up for a new health insurance plan or make changes to your current plan — about half as much time as you had last year.

Whether you’re new to the marketplace or are thinking about updating your current insurance, Donna Frescatore, executive director of NY State of Health, says now is the time to shop around.

“It pays to shop because many New Yorkers will be pleasantly surprised to learn that the value of tax credits in their community increased for 2016 compared to this year,” Frescatore says.

“NY State of Health allows consumers to anonymously shop and compare plans and check their eligibility for financial assistance through the interactive View Plans Now feature (nystateofhealth.ny.gov/individual).”

In addition to the potential for increased tax credits, this year New Yorkers will also have a new health plan option to consider through the state’s health insurance marketplace called the Essential Plan.

“The new Essential Plan makes coverage even more affordable for hundreds of thousands of New Yorkers,” says Frescatore.

It comes with no annual deductibles and free preventative care, as well as the same essential benefits covered by all insurance plans under the ACA, but at a fraction of the cost — $ 20 per month or nothing at all depending on your income.

Eligibility is based on income ($ 23,540 maximum for an individual, $ 31,860 (household of two), $ 40,180 (household of three) or $ 48,500 (household of four). More information can be found online at nystateofhealth.ny.gov.

Aside from taking time to compare health insurance plans, the Department of Health also recommends New Yorkers keep these items in mind as they navigate the open enrollment process.

*Premiums. Depending on the amount of financial aid you are eligible to receive through the ACA, you may or may not still have to pay a monthly fee for your health insurance — whether you require medical care in a given month or not.

The rule of thumb, says the Department of Health, is that the higher the monthly premium, the lower the out-of-pocket expenses are for your medical treatment. However, it’s important to do the math regarding your monthly premiums before you select a plan to make sure you can afford the monthly charges required of your coverage.

*Out-of-pocket costs. Aside from the monthly premium, the second most important cost to consider when looking at a health plan is its out-of-pocket expenses.

This is the amount of money you will pay any time you receive medical care through your plan. These costs include deductibles (the amount you pay prior to your health plan starting to pay for services); co-pays (the fixed amounts for doctor’s visits, drug prescriptions, hospital visits and other services you’re responsible for covering as part of your plan); and co-insurance (not all health plans come with co-insurance costs, but if the health plan you’re considering does, it’s the percent of the cost you’re required to pay in tandem to your health plan).

In addition to the above, it’s important to know your out-of-pocket maximum, too. That’s the most you’ll have to pay for your health care in a given year. Every plan comes with an out-of-pocket maximum, and it’s important to know what yours is before you enroll.

*Metal levels. Within the health insurance marketplace, health plans are categorized into four different metal levels — bronze, silver, gold and platinum — each of which comes with different benefits and costs to the consumer, though all metal levels offer the basic health care coverage laid out by the ACA.

The Department of Health says that depending on income, the silver level is a strong option for some people because financial help is available to lower out-of-pocket costs. But it’s important for individuals to compare metal levels based on their own circumstances.

*Covered services. Before you start looking into a health plan, it’s important to know what you want and need out of your health insurance.

All health plans under the ACA cover 10 basic services, the out-of-pocket costs of which are the same across the board. But depending on your individual needs, you may want additional services that fall outside of this umbrella.

Things like provider networks, drum formulary and premium are different depending on the provider, and some plans cover extra services such as dental or vision care for adults. So take these into account when considering your coverage options.

*In-network doctors. The doctors and hospitals contracted as part of a particular health plan vary depending upon the provider. Seeking medical care outside of your network can become expensive, so if you have preferred doctors or hospitals you’d like to continue to use under your new coverage, take the time to confirm they are still a part of the provider network of your new plan.

*Drug formulary. Before you enroll, it’s important to know what types of prescription drugs are covered under a particular health plan you’re considering. Make a list of the drugs you are currently taking and cross check it with the plans you’re thinking about picking. It’s also important to figure out how much you’ll pay each time you fill a prescription before you pick a plan.

Something else New Yorkers need to keep in mind is that the penalty for not having health insurance is going up in 2016.

Starting next year, the fee for not having a health plan will be 2.5% (up 0.5% from last year) or $ 695 per person ($ 347.50 per child under 18), whichever is higher. Those fixed numbers are more than double the fees for not being insured last year.


Lifestyle – NY Daily News

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