The beginning of 2014 heralds the full implementation of the federal health care reform law – the Affordable Care Act. For most New Yorkers, the new law will have no noticeable impact. For the 2 plus million New Yorkers who lack health insurance or who pay for it themselves, the new law offers dramatic changes.
For New Yorkers who have insurance coverage through the government – like Medicare or Medicaid – or from their employer, the changes resulting from the new law are good news.
For example, effective January 2014, health insurance companies can no longer deny coverage or hike consumers’ insurance rates due to having a pre-existing health condition.
Also, the new law requires most health insurance plans to allow coverage for children until their 26th birthday. If the parents or guardians are already carrying a family plan, they will not be required to pay anything extra for this additional coverage. If they have a plan that only covers themselves, or themselves and a spouse, they will have to purchase a family plan during the next open enrollment period. Even then, the cost will likely be far less than paying for both their plan and a separate policy for their offspring.
For those who do not have coverage through the government, through their employer, or through their parents, they then can shop for coverage through the New York State of Health Marketplace.
At the Marketplace, consumers can see all of their options and enroll. Information about available insurance plans is written in plain language, and all the plans have to cover a good set of benefits—including doctor visits, hospitalizations, maternity care, emergency room care, prescription drugs and more.
In the New York State of Health Marketplace, consumers can take advantage of the insurance plans having been neatly sorted into categories so they can compare them more easily. The categories are Bronze, Silver, Gold and Platinum, and are not based on the quality of care, or the amount of care received. They are based on the costs of medical care, and how much the insurance company pays. Bronze level of care has higher deductibles, but lower consumer premium costs. Platinum, on the other hand, has higher premium costs, but the lowest out-of-pocket costs.
Based on their income, many lower and middle income people will be able to pay for their coverage on a sliding scale, or even qualify for free or very low-cost coverage. New Yorkers can find out if they qualify for a subsidy by going to the New York State of Health Marketplace website at: https://nystateofhealth.ny.gov/, or they can call 1-855-355-5777.
The amount that some consumers save on their premium depends on their income and family size. Many people will qualify for some level of this tax credit. For example, there are lower premiums if their income is less than about $46,000 for an individual, $62,000 for a family of two, or $94,000 for a family of four.
In the past, it was practically impossible to compare insurance plans “apples to apples,” with seemingly infinite combinations of premiums, co-pays, deductibles, annual coverage limits, co-insurance levels, and out-of-pocket maximum amounts.
All of these changes should make it possible for those currently without health coverage to obtain affordable care. While there may be other ways to offer coverage – such as expanding Medicare to all of those under the age of 65 – the Affordable Care Act is currently the only game in town. For those millions of New Yorkers who currently live without health insurance protection, the ACA offers hope. If the program eventually reaches the success of the law in Massachusetts – the state law that was the model for the ACA – nearly all eligible Americans will have coverage.
Let’s hope that the program works, for the sake of the tens of millions of Americans who currently live on the edge of medical and/or financial catastrophe.
Blair Horner is the Legislative Director of the New York Public Interest Research Group.
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