The Farley Report from Phoenix #192: 9-30-13

As Congress continues to fiddle while the country burns with anger at being held hostage by partisan posturing, I thought you might like to hear about something positive from the federal government that will start tomorrow regardless of whether or not they come to their senses.

October 1 is the big day for the opening of the Healthcare Exchanges, so I am sending you an excellent rundown on what these exchanges will mean to you, and how they can help dramatically improve your life -- especially if you are self employed, run a very small business, have an employer who does not offer you insurance, or currently buy on the individual market.

I owe a great deal of gratitude to my amazing constituent (and fellow self-employed HealthCare Group member) Corinne Cooper who gathered and edited all this information to be extremely user-friendly for all of us. Please feel free to distribute this accurate information to anyone and everyone.

  • The online Marketplace opens on October 1. You don't need to access the website on Oct. 1, and in fact you may be better off waiting for a few weeks. As long as you purchase a plan before Dec. 15, 2013, you'll be covered on January 1, 2014. 
  • At the top of each page there is a tab for Individuals and Families, and one for Small Businesses.
    • If you do not have any employees, use the tab for Individuals and Families.
    • If you have 2 to 50 employees, use the Small Business tab to access the SHOP market. 
  • There is lots of help available to understand and enroll:
    • You can use one of the websites listed above. They already have lots of information to help you understand the available options.
    • There is online chat available NOW to answer questions about the marketplace at the bottom right corner of each of these website, in English and in Spanish.
    • You can call an 800 number and talk to a real person:
      • For individuals and families, the number is 1-800-318-2596 and it is available 24 hours a day, 7 days a week
      • For small businesses, the number is 1-800-706-7893 and it is available Monday-Friday 9 a.m.-5 p.m. EST (that’s 6 a.m. to 2 p.m. in Arizona, until November 3, when daylight savings time ends. Then it is 7 a.m. to 3 p.m.)
    • You can call an insurance broker to help you.
    • You can get help from a navigator (someone trained to help you navigate the new system). To find a navigator near you, just scroll to the bottom of this page and insert your zip code: 
  • Most of the people who apply for individual or family coverage will receive a government subsidy to help reduce the cost of your coverage. 
  • Under the ACA, you can no longer be denied insurance coverage! 
    • You cannot be denied because you have a pre-existing condition, because you get sick, or because you have a disability. Everyone is entitled to coverage.
    • The rates that you are charged cannot be increased because of your health.
    • The only health issue that can affect your rates is tobacco use. 
  • If you are an older American, your rates may be higher than those for young people, but insurers may not charge more than three times the rate charged to young people. In most cases, your rate will be lower and your coverage will be better. 
    • Before October 1, you can estimate the rate that you will be charged at this website: http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/longdesc/az.htm
    • Just put in your age and the estimated rates will appear. These are rates actually being offered by insurers in the Arizona Marketplace 
    • NOTE: These rates do not reflect the subsidy that you may be entitled to if you earn less than 400% of the federal poverty rate. See the subsidy calculator tool above to see if you qualify.
    • After October 1, you will be able to see your actual rates, including any subsidy to which you are entitled because of your income.  
  • Under the Marketplace, you will be able to compare insurance plans apples to apples.
    • The ACA mandates that insurers offer certain coverage to qualify on the Marketplace.
    • So every insurer will be offering at least that coverage, and some will offer more.
    • After October 1, you will be able to see the insurance plans offered by every insurer who has qualified to offer a plan on the Marketplace.
  • There are 5 levels of insurance available on the Marketplace. 
    • The level DOES NOT mean the coverage is better or worse. Instead, it refers to the price of the coverage and the deductible and out-of-pocket expenses that you will pay. 
      • You can decide what combination of price and deductible makes sense for you. The higher the deductible you choose, the lower your premium will be, and the higher your out-of-pocket limit will be.
      • If you can add up what you paid out-of-pocket this year, it may help you to decide what premium/deductible is right for you.
    • You can find out more about each level of insurance here: https://www.healthcare.gov/how-do-i-choose-marketplace-insurance/
      • Bronze plan will have the lowest premiums and the highest deductibles
      • Silver plan will have the next lowest premiums and the next highest deductible. 
      • Gold plan will have higher premiums and lower deductible
      • Platinum plan will have the highest premium and lowest deductible.
      • There is also a Catastrophic Plan that offers very low premiums and very high deductibles to people under 30, and also to some people who have very low incomes and cannot afford the other plans even with a subsidy.
  • No matter which plan you choose, policies in the Marketplace must cover essential health benefits:
    • Essential health benefits are defined in the law.
    • The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. 
    • Essential health benefits must include items and services within at least the following 10 categories: 
      • ambulatory patient services; 
      • emergency services; 
      • hospitalization; 
      • maternity and newborn care; 
      • mental health and substance use disorder services, including behavioral health treatment; 
      • prescription drugs; 
      • rehabilitative and habilitative services and devices; 
      • laboratory services; 
      • preventive and wellness services and chronic disease management; and 
      • pediatric services, including oral and vision care. 

You can find out more about the Affordable Care Act Marketplace on these websites:

Of course, you can also contact me, Sen. Steve Farley at SFarley@azleg.gov and I will do what I can to help you. 

Again, please feel free to pass this information along to your friends and family on FB, via Twitter, or e-mail. We want every Arizonan to know about their new insurance benefit. 

Thanks for your continuing faith in me as your Senator.  

Steve

Steve Farley

Senator, District 9, Tucson

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