Thursday, December 12, 2013
By JOE LAWLOR Staff Writer
While the uninsured or underinsured must wait until Oct. 1 to start purchasing health insurance on new health care exchanges, a key provision in President Obama's 2010 Affordable Care Act, they can begin learning now how the process will work.
The federal government this week rolled out a new website – www.healthcare.gov – that is designed to explain the choices available to individuals and small businesses with 50 or fewer employees – those most affected by the new exchanges.
Under the hew health care law, people must have health insurance or pay a penalty – the so-called "individual mandate" provision that was the subject of much debate and a 2012 U.S. Supreme Court ruling that mostly upheld the law.
The enrollment that begins in October is for coverage that starts in January 2014.
The website introduced this week is "a place where people will be able to do apples to apples comparisons," said Ray Hurd, regional administrator of the Centers for Medicare and Medicaid Services. "People will be able to purchase health insurance at rates that are affordable to them."
The insurance will be subsidized for families with incomes up to 400 percent of the federal poverty level, or about $94,000 for a family of four. The exchanges are designed for people who otherwise have a difficult time purchasing insurance because, for instance, they are self-employed or their employer doesn't offer it.
The website currently does not have specific rates, but by Oct. 1 at the latest, the specific information will be available, Hurd said. Meanwhile, Hurd said the site explains how the upcoming exchanges will work.
People will be able to choose from among four plans, bronze, silver, gold and platinum. For small employers, the website spells out the tax benefits available to them for offering insurance to their workers through the exchanges.
In Maine, two insurance providers will be offering plans, Maine Community Health Options, a newly formed health care co-op, and Anthem Blue Cross and Blue Shield.
Anthem and MaineHealth are currently embroiled in a dispute with Central Maine HealthCare over whether Anthem would be allowed to exclude Central Maine hospitals in its insurance network. If approved by the state Bureau of Insurance, Central Maine HealthCare officials argue the plan could limit choices for central Maine customers on the exchange.
However, Hurd said he expects that more insurance companies will offer plans on the exchanges in future years.
Harvard Pilgrim insurance is not participating in Maine's exchange for 2014, but a spokeswoman told the Portland Press Herald in an email that the company intends to offer plans on the exchange in future years.
"Long term, we plan to participate in Maine's public exchange," Joan Fallon wrote in an email, though she didn't say when.
Kevin Lewis, CEO of Maine Community Health Options, said he expects there will be "healthy competition" in future years on the exchanges, as more companies attempt to capture new customers coming into the health care system.
Lewis said interest in Maine Community Health Options is strong, but there's no way to know how many will sign up in the first year. He said the company is conservatively estimating 15,000 will sign up with Maine Community Health Options, but it is "preparing for swings on either side" of that prediction.
The state's decision not to expand Medicaid to 60,000 residents could also drive more people to the exchanges, Lewis said.
But he said he's concerned that those who would have qualified for Medicaid under the expansion will not be able to afford insurance on the exchanges, even with a subsidy.
Joe Lawlor can be contacted at 791-6376 or at: