What is the health insurance exchange?
A marketplace where individuals, families and small businesses can shop for health insurance and enroll online, over the phone or in person. People will be able to enroll in both private insurance plans and Medicaid, the government insurance program, through the exchange. The official name of New York's exchange is NY State of Health.
Where can I get help to understand my options on the health insurance exchange?
You can call the exchange, known as the NY State of Health, at 1-855-355-5777, or visit its website. Starting Tuesday, its customer service reps will be taking calls 8 a.m. to 8 p.m. Monday through Friday and 9 a.m. to 1 p.m. Saturday.
Navigators employed by nonprofit agencies throughout Central New York also will be available to assist you. Here's where you can find them:
Onondaga County
HealtheConnections 470-1847
Subcontactors: Benefits Specialist of NY, Northside Urban Partnership, Salvation Army, Southside Innovation Center.
ACR Health 475-2430
Syracuse Northeast Community Center 472-6343
Madison County
ACR Health 475-2430
Mohawk Valley Perinatal Network 732-4657
Oswego
ACR Health 475-2430
Oswego County Opportunities Inc. 598-4717
Cayuga
Cayuga County Chamber of Commerce 252-7291
ACR Health 475-2430
Insurance brokers and health insurance plans will also provide assistance.
Who can use the exchange?
The exchange is geared primarily for people who are uninsured or buy insurance on their own because they don't get it through an employer. The exchange can be used by individuals, families and small businesses with 50 or fewer employees. People who already get health insurance through their employer or the federal Medicare program do not need to use the exchange.
What information should I have available when I go to shop for insurance and enroll?
Information about everyone in your household including birthdays, Social Security numbers, last year's household income and an estimate of this year's household income.
What is the penalty if I don't get health insurance next year?
$95 or 1 percent of your income, whichever is greater.
Will I qualify for a federal tax credit and how do those credits work?
Individuals and families with incomes up to 400 percent of the federal poverty level are eligible for federal tax credits that will lower their health insurance premiums. This income level is equivalent to $45,960 for an individual and $94,200 for a family of four. The tax credit will be paid directly to the insurer and deducted from your monthly premium bill. To see if you qualify for a credit, use the premium and tax credit estimator on the state exchange's website.
Can I buy insurance on the exchange if I have serious health problems?
Yes. You cannot be charged more because of your health problem.
How much time do I have to enroll?
From Tuesday Oct. 1 through March 31.
When does the health insurance cover I purchase take effect?
Jan. 1
Will senior citizens lose their Medicare and be forced to buy insurance on the exchange?
No. Medicare isn't part of the health insurance exchange, so seniors don't need to do anything. The exchange will not affect seniors' Medicare choices and their benefits will not be changing.The exchange will not offer Medicare supplement (Medigap) insurance or Part D drug plans.
What size businesses can buy insurance through the exchange?
In 2014 and 2015 the exchange will be open to small businesses with 50 or fewer employees. That's what insurers call a "small group." In 2016, the exchange will be open to businesses with 100 or fewer employees. Before 2017, the state will decide whether to allow larger employers to buy insurance through the exchange.
Small businesses that use the exchange to provide health insurance to their employees may be eligible for a tax credit, which can help reduce the cost of providing this coverage.
If I have job-based health insurance, can I opt to get insurance through the exchange instead?
With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose an exchange plan instead, your employer does not need to make a contribution to your premiums. If your employer already pays a portion of your premium and you opt to get coverage through the exchange, you may not qualify for tax credits that will be available to many people buying insurance through the exchange. Those tax credits will lower premium costs.
You will not qualify for tax credits on insurance purchased through the exchange in 2014 if your employer's coverage is considered affordable and meets a minimum value standard, according to the U.S. Department of Health and Human Services. Employer coverage is considered affordable if the employee's share of the annual premium for self-only coverage is no greater than 9.5 percent of annual household income. A health plan meets the minimum value standard if it is designed to pay at least 60 percent of the total cost of medical services.
You can contact health writer James T. Mulder at jmulder@syracuse.com or (315) 470-2245. Follow him on Twitter @JamesTMulder
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