The Arrival of the New Health Insurance Marketplace

  By: Shannon Charles, guest blogger

For millions of Americans today, the idea of acquiring adequate healthcare coverage seems farfetched. With the uninsured rate gradually increasing for adults between the ages of 26-64, does this really provide much hope for the future? Next month, the new Health Insurance Marketplace  will be introduced as a solution to help the uninsured, but before we address this topic, let us examine the past. In March 2010, President Barack Obama signed the health reform, the Patient Protection and Affordable Care Act (ACA), into law. The main goals of the ACA were to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. The ACA has come under some harsh criticism from those who believe that it will lead to higher healthcare costs, slower job growth, and rising numbers of part-time workers.

October 1, 2013 marks the beginning of open enrollment in the new Health Insurance Marketplace. The Marketplace is a new way to find affordable health coverage that meets your needs. Our main goal as health advocates is to provide assistance to help people select the right health coverage option for themselves and their families. The ACA has outlined three opportunities for consumer assistance which include the following:

·      Patient Navigators

·      Certified Application Counselors (CACs)

·      General education and outreach

Patient navigators educate consumers on health coverage options and assist with eligibility, enrollment, and health plan selection. The navigators are put in place to focus on our low-income, disadvantaged, and hard-to-reach populations. In Florida alone, 2.7 million individuals remain uninsured. In regards to our CACs, these individuals are required to provide information about a full range of Qualified Health Plan (QHP) options. Additionally, they help facilitate enrollment in QHP, Medicaid or Children’s Health Insurance Programs (CHIP). They are also expected to comply with privacy and security standards and disclose conflicts of interest. Although both group’s roles are similar, the two groups differ when considering the fact that the work done by CACs is strictly on a voluntary basis. Patient navigators are compensated through funds provided by the federal government. As of August 15, 2013, the federal government decided which organizations would receive funding to work in the community as navigators.

            The creation of the new Health Insurance Marketplace addresses many important issues that Americans have faced for several years. For instance, most Medicare Prescription Drug Plans have a coverage gap commonly referred to as the “donut hole.” This means there's a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. The new Health Insurance Marketplace has worked to eliminate the “donut hole” to allow seniors to purchase name brand medications at lower costs. Another issue tackled is the idea of pre-existing conditions. In the past, health plans were able to deny individuals access to health coverage or raise costs because of a pre-existing health condition. Starting in 2014, health insurance plans are no longer allowed to discriminate against these individuals. The new Health Insurance Marketplace has even made strides to eliminate the gender bias; women are no longer being charged more for health coverage than men. These are only some of the issues addressed in the new Health Insurance Marketplace. Last week I had the pleasure of attending an insightful forum on the ACA, hosted by United Way, that shed some light on several topics. The challenges we currently face include: few people understand ACA, there are limited resources for one-on-one assistance, and general education and outreach. As consumers we must make efforts to become more knowledgeable about the marketplace to help inform others.

            One of the particularly fascinating additions to the Health Insurance Marketplace is the Small Business Health Options Program (SHOP), which is a new program that simplifies the process of buying health insurance for small businesses. For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time equivalent employees (FTEs). The advantages of this program include:

·      You control the coverage you offer and how much you pay toward employee premiums.

·      You can compare health plans online on an apples-to-apples basis, which helps you make a decision that's right for your business.

·      You may qualify for a small business health care tax credit worth up to 50% of your premium costs. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit.

The SHOP will be very important to businesses as we near the arrival of the new Health Insurance Marketplace. It is very encouraging to see steps being made to solve the healthcare crisis in the United States. Many individuals have been affected by inflated healthcare costs because of a variety of issues that I mentioned earlier, such as: pre-existing conditions, gender bias, and the coverage gap. As the unemployment rate continues to decrease, we will see more individuals being able to join the workforce and select health coverage through their employers. For those individuals who are uninsured due to their unemployed status, it becomes extremely difficult to maintain monthly payments for even the most minimal health plans. It is imperative that we monitor the unemployment rates in the United States because it goes hand-in-hand with access to adequate health coverage, since most individuals acquire insurance through their employers. Hopefully we will see some significant change in the years to come. 

              Considering how much there is still to learn, Catalyst Miami will be hosting a forum in partnership with Florida Blue Foundation on October 4, 2013 from 8am-12pm. The event is titled: Affordable Care: How to get it and how to share it. Stay tuned as we send out more information on this event. If you have any questions, please reach out.