PLATTSBURGH — Open enrollment for the health-insurance exchange in New York state starts Oct. 1. for coverage effective Jan. 1, 2014.
Erika Walker, the Adirondack Health Institute community health advocate for Clinton, Essex, Franklin, Hamilton, Warren and Washington counties, said the New York State of Health portal is the official place for New Yorkers to find health-insurance information.
It is a way for individuals and small-business owners to gain access to insurance, check eligibility (including possible financial assistance), calculate monthly costs, provide plan comparisons, receive in-person assistance and more.
“This is a brand new way to get health insurance. It’s scary, yet exciting,” she said at a recent Health Care Forum hosted by the North Country Chamber of Commerce.
North Country Chamber of Commerce President Garry Douglas said individuals must have insurance by Jan. 1, 2014.
The deadline for employers to notify employees of their insurance options, including the State of Health marketplace, is Oct. 1. The Department of Labor has indicated there will be no penalty for those who do not do so.
Walker said in 2014, most individuals without health insurance will face a penalty of $95 per adult and $47.50 per child, up to $285 or 1 percent of their annual family income, whichever is greater.
In 2016, those figures are scheduled to increase to $695 per adult and $347.50 per child, up to $2,085 or 2.5 percent of family income.
The mandate that companies with more than 50 full-time employees are required to offer an insurance plan has been postponed until at least 2015, Douglas said.
92 PERCENT RISE
The Affordable Care Act, signed into law on March 23, 2010, is intended to increase the quality and affordability of health insurance so more people can get coverage, Walker said.
She said between 2000 and 2009, the price of insurance increased by an average of 92 percent, while income levels increased an average of 14 percent.
The average cost of insurance is $12,000 per year for an individual and $24,000 for a family, Walker said. That was causing many employers to cut back on providing insurance, which is one reason 2.7 million New Yorkers are uninsured.
10 REQUIRED BENEFITS
Insurers have to offer at least 10 essential benefits, Walker said. The required benefits are: access to ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental-health and substance-use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive/wellness services and chronic-pain management; and pediatric services.
SILVER AND GOLD
Another goal of the Affordable Care Act is to standardize benefits and costs to consumers.
In New York, insurers can offer plans on four levels — bronze, silver, gold and platinum — with varying levels of benefits and consumer contributions. They don’t have to offer plans on all four levels, but to take part in New York State of Health and other exchanges, they must offer at least a silver and a gold plan.
Walker said some of the benefits of the Affordable Care Act are restrictions on denial of coverage due to pre-existing conditions and a prohibition on dropping coverage if someone becomes ill.
The Adirondack Health Institute is a joint venture of Adirondack Health, Community Providers Inc. and Hudson Headwaters Health Network. It is one of several health-care navigators that have been created as the Affordable Care Act takes effect.
Douglas said the chamber is part of the New York Benefits Alliance, a coalition of seven Upstate chambers with more than 9,000 health insurance accounts.
He said people can get assistance in choosing insurance through navigators such as the Adirondack Health Institute, the chamber’s Plattsburgh-North Country Service Corporation or their own insurance broker.
“The North Country Chamber of Commerce is in the health-insurance business for small employers and the self-employed,” he said. “We’re ahead of the curve there.”
Walker said the main thing is to realize assistance is available.
“You don’t have to do this alone,” she said.
For more information, visit www.nystateofhealth.ny.gov or www.adirondackhealthinstitute.org.
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