Posted tagged ‘Essential Health Benefits’

Vermont Health Connect – be ready for a new way to pay for Health Insurance in 2014!

May 10, 2013

A new post based on my work with both the Medicaid and Exchange Advisory Board and The Green Mountain Care Board Advisory Committee:  Clarifying what’s next in Health Insurance for Vermont Residents.

VHC Logosizedforwebsite
Starting October 2013, all Vermonters who pay for Health Insurance themselves, Vermonters who don’t have Health Insurance, those who have Medicaid, Dr. Dynasaur, Catamount or Vermont Health Access Program (VHAP), and all Vermonters who work for a company that employs less than 50 people, can buy Health Insurance or sign up for Medicaid, etc. from Vermont Health Connect.

On October 1, 2013 the Vermont Health Connect (VHC) website will be ready for you! (If you don’t use the internet, no worries.  A call center and in person Navigators are also being set up.)

The first question VHC will ask, either on the website, or in person:  “Do you have health insurance though an employer?”

If you answer “No”, there is a second question:  “How old are you?”

If you are 65 or older, VHC will say:  “You are covered by Medicare.”  From the website, you will be able to click on a button and go to the Medicare application page.

If you are 64 or younger VHC will ask:  “How many people in your household?”

The website or Navigator will then tell you:  “If your household income is below a (it will spell out the specific amount based on your household size), you may qualify for a tax credit in 2014.”   Those with household incomes up to 400% of the Federal Poverty Level may qualify.

Some samples of who will qualify for the tax credits:  A single person making less than $45,960; a couple making less than $62,040; a family of four making less than $94,200. (These are based on 2013 estimates and may change slightly for 2014.)  How much you make is listed on your taxes as your modified adjusted gross income, this is the figure Vermont will use.

Starting May 15th, you can go to http://www.vermonthealthconnect.gov and see your tax credit/subsidy estimate on the website.  By the end of May Vermont Health Connect will also have a FaceBook page.

On top of the Vermont State tax credits, there will be some federal subsidies for out of pocket expenses for households making less than 250% of the federal poverty level.

Note: Tax Credits will be available for any person buying their own insurance whose household income is below 400% of the federal poverty level – but not for those who get insurance through their work.

By following website prompts, you will be directed to a page where you can compare Health Insurance plans.  After you input your modified adjusted gross income, the website will figure in the tax credits, and let you know your monthly bill for each plan. When you are ready, you can then choose and purchase your own health insurance.

THE PLANS
All plans offer 10 categories of essential health benefits (see next paragraph) and the following applies:  Any person up to age 26 can be on their parents’ plan.  Preventive care does not have any co-pays.  There will be tax credits and out of pocket limits as noted above.

Essential Health Benefits:  Ambulatory patient services, emergency services, prescription drugs, rehab and chronic disease management, hospitalization, maternity & newborn care, mental health & substance abuse, lab work, preventive wellness and pediatric health including dental and vision.

There are four types of Qualified Health Plans (QHP):  Bronze, Silver, Gold, Platinum.  The higher monthly premium you pay, the more is covered and the less you spend on your own out of pocket costs and co-pays.

On the website you will be able to compare plans side by side and evaluate what is best for you and your family.

Because all plans will have the same benefits, the important choice is how you want to pay for health care. Whether you pay more up-front in premiums and less in out-of-pocket costs, or the reverse, it’s up to you.

For example, if you choose a platinum plan, your monthly premiums will be higher, but what you pay in out of pocket costs will be lower – about ten percent of the actual cost of the visit or procedure. If you choose a bronze plan, you will have lower monthly premiums, but what you pay out of pocket will be higher – about 40 percent of the actual cost of the visit or procedure.

BROKERS & NAVIGATORS
There will be a lot of resources available to assist you with your health insurance purchase either by internet, phone or in person. If you have purchased health insurance through a broker in the past, he or she will still be able to assist you. In addition, “Navigators” will be trained and available to help you figure out which plan is best for you, and to help you enroll. There will also be a Vermont Health Connect call center to help you use the website and understand health insurance options.

ENROLLMENT
You have from 10.1.2013 until  3.31.2014 to enroll in this plan.  If you don’t, there will be a tax penalty!

If you have questions now, please email: vthealthconnect@state.vt.us   You can also sign up for the Vermont Health Connect newsletter at:  http://www.VermontHealthConnect.gov  (Click on:  “Information for You” on the left hand side, then click on “email updates”.)