What you need to know to sign up for Obamacare - The Buffalo News

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What you need to know to sign up for Obamacare

Repeated attempts by Congress and the Trump administration to weaken and repeal Obamacare have thrown its future in question.

But the Affordable Care Act is still around, and consumers can get health coverage through the state's health insurance exchange in a new open enrollment starting Wednesday.

"The Affordable Care Act is still the law of the land, and efforts to end it have continued to fail," said Leslie Moran, senior vice president of the New York Health Plan Association, which represents health insurance companies. "Health plans and the state are doing the work to show people that they still have options."

Open Enrollment, which extends through Jan. 31, is when you can sign up for private health insurance if you don't have coverage through an employer, Medicare, Medicaid or another type of insurance. Low-income individuals eligible for Medicaid, Child Health Plus or the Essential Plan can enroll in those programs anytime.

As of October, more than 4 million people statewide had obtained coverage on the state's exchange, including more than 192,000 Western New Yorkers have used the exchange to sign up for coverage, many of them benefiting from subsidies to defray costs, including 26,519 in the state's Essential Plan and 15,186 in qualified health plans.

Here's what you need to know:

What is the Affordable Care Act?

Also known as Obamacare, the law enacted in 2010 established exchanges in states through which consumers who don't get health insurance through work can shop for coverage.

The law continues to provide subsidies for individuals and families with income between 133 percent to 400 percent of the federal poverty level. It also bars insurers from refusing to cover pre-existing conditions, guarantees individuals the ability to renew coverage and requires everyone to have health insurance.

Tax credits for eligible people help pay monthly premiums.

Didn't President Trump end some Obamacare payments to insurers?

Trump ended payments to insurers that helped offset a requirement that the companies sell health plans with reduced copayments and deductibles. Under the law, insurers must continue to provide the discounts despite losing the cost-sharing reductions.

The loss of the cost-sharing reduction payments contributed to significant premium increases in Silver health plans, one of the tiers of plans available under Obamacare, and threatens the future of New York's Essential Plan. Consumers must purchase Silver plans to receive the subsidies for out-of-pocket expenses.

In New York, a large portion of the federal funds that would be used for tax credits and cost-sharing reductions go to support coverage in the Essential Plan.

If I sign up for health coverage, is it in jeopardy? 

Coverage appears safe for 2018, but the future of the Essential Plan and the Child Health Plus are unclear.

New York State lawmakers, including Gov. Andrew Cuomo, have demanded that federal lawmakers continue funding for both plans, setting up a potential battle over the programs.

Is there a penalty in the Affordable Care Act for not having health insurance?

Yes. The penalty in 2018 is $695 for each adult and $347.50 for each child without insurance. The amount is capped at $2,085 per family, or 2.5 percent of a family's income, whichever is higher.

How can I enroll?

The federal government shortened the open enrollment period for 2018 coverage for the states that use the federal marketplace for buying insurance. But New York state operates its own exchange, and is maintaining a longer open enrollment period from Nov. 1 to Jan. 31.

The Trump administration's moves to cut funding for marketing Obamacare plans and assisting people with enrollment did not impact New York because the state budgeted for those efforts.

Individuals can enroll or obtain assistance, including in-person help in their community, online at nystateofhealth.ny.gov or by calling 1-855-355-5777.

What is the Essential Plan?

The Affordable Care Act allowed states to establish a basic health program that provides a new option for individuals under age 65 with family incomes between 138 and 200 percent of the federal poverty level. That's basically people of modest income who make too much for Medicaid. For context, the federal poverty level is $24,600 in annual household income for a family of four.

New York is one of two states that developed basic health plans. The other is Minnesota. In New York, it is called the Essential Plan, and offers coverage with little cost-sharing and a premium of $0 to $20 a month for people with low incomes who don't qualify for Medicaid.

What does the Affordable Care Act cover?

Health plans compete on price, with different deductibles and copayments. But they must all cover at least 10 essential health benefits:

1. Outpatient services, including care at a doctor's office

2. Emergency services

3. Hospital care

4. Pregnant mother and baby care

5. Mental health and addiction treatment

6. Prescription drugs

7. Rehab and skill development services and devices for people with injuries and disabilities

8. Laboratory services

9. Prevention & wellness services, and long-term disease management

10. Dental and vision care for children

Private health plans for sale from insurance companies, known as qualified health plans, come in different tiers categorized as bronze, silver, gold or platinum.

What's the difference between the tiers?

In each tier, the individual or family buying the coverage is responsible for paying a different portion of the total average costs for the services that the plan covers. Bronze plans, for example, come with the lowest monthly premiums but the highest costs when you need care. Platinum, at the other extreme, come with the highest premiums but the lowest costs when you need care.

Which companies sell health plans on the state's exchange?

In Niagara, Erie, Chautauqua, Cattaraugus and Allegany counties, four insurers offer individual coverage in a qualified health plan on the exchange: BlueCross BlueShield of Western New York, Fidelis Care New York, Independent Health and Univera Healthcare.

In Orleans, Genesee and Wyoming counties, the four insurers are joined by MVP Health Plan.

Those are the same options as last year.

How much does coverage cost for a qualified health plan?

Premiums and fees vary depending on the tier and other benefits, such as dependent coverage. Some people will be eligible for subsidies to defray the cost of the listed premiums.

For example, Fidelis Care sells plans with dependent coverage to age 25 that range in cost in Erie County from $333 a month for Bronze and $408 for Silver to $483 for Gold and $576 for Platinum.

Silver and bronze plans have been the most popular choice for Fidelis, accounting for 80 percent of its Western region health exchange members. Despite uncertainty over the future of the Affordable Care Act, company officials anticipate a robust enrollment in New York.

"We don’t expect a fall off from sign ups, and we’re optimistic as we head into open enrollment," said Scott Averill, vice president of marketing.

What's the status of Child Health Plus?

Child Health Plus provides low-cost, government-sponsored health insurance to 9 million children in the United States, including 20,943 in Western New York.

Congress let funding for the program expire Oct. 1 and has yet to restore it. Without federal money, New York officials say the state would be left with a $1 billion budget hole, threatening coverage.

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