The new online health insurance marketplace was dogged with technical glitches this week, but for Alaskans who managed to log on, they got the first glimpse at the plans now available to everyone.
The Affordable Care Act, America's new health care law, requires that everyone carry health insurance or face fines. In Alaska, two companies are offering a menu of plans for uninsured people. Consumers can qualify for federal subsidies to cut the costs of the plans. Premera Blue Cross Blue Shield of Alaska and Moda Health of Portland, Ore., have signed on to participate in Alaska's marketplace.
People interested in enrolling or looking at their options may go directly to healthcare.gov, or use one of a suite of helping services provided by federally funded "navigators," certified counselors or private brokers.
Consumers can expect at least 34 plans, according to health officials. People need to sign up by Dec. 15 for their coverage to start by Jan. 1. The sign-up deadline to avoid penalties is March 31.
Because of technical problems with the site, some navigators and certified counselors, trained to help individuals with the marketplace, say they are pushing back meetings with potential enrollees until the registration process is working more smoothly.
"We're going to let this phase out for a few weeks before we inconvenience anyone," said Cherise Fowler, an outreach and enrollment coordinator with the Alaska Primary Care Association.
HIGH COSTS IN ALASKA
For the first time, because of the Affordable Care Act, health insurance companies cannot refuse to insure someone based on a preexisting condition. Also, all plans must cover 10 "essential health benefits" like emergency services, maternity and newborn care, and mental health and substance abuse disorder services, including behavioral health treatment.
Because of this quality requirement, it's likely marketplace plans will be a bit more costly than some current private and employer-based plans, according to Joshua Weinstein, employee benefits consultant with Northrim Benefits Group, the parent company of Enroll Alaska, which helps people apply for insurance. Alaskans will also experience some of the highest premiums in the U.S. because of the state's remoteness and high health care costs.
Households that make between 100 and 400 percent of the federal poverty level for Alaska may qualify for a federal subsidy or tax credit. The federal subsidy is like a coupon the consumer can use to lower the prices of plans. It's a tax credit, but it's received immediately.
The tax credit is "basically just a sliding scale based on income," Weinstein said.
The marketplace is targeted at people who do not have insurance through their employers. There are nearly 140,000 uninsured Alaskans. People with insurance through an employer can access the marketplace only if the cost of their insurance is more than 9.5 percent of their income. If a household earns more than four times the poverty level, it must pay the entire premium cost.
"The law is really trying to focus on people who are uninsured and don't have a place to go," Weinstein said. The Affordable Care Act was signed into law in 2010.
People with Medicare aren't required to make any changes. Alaska Natives and Native Americans, who have access to free health care, can apply for insurance through the marketplace to cover things like glasses, hearing aids and travel for treatment. Alaska Nativeswho don't apply for insurance must apply for a one-time, lifetime exemption from the individual insurance mandate.
LIKE BUYING PLANE TICKET
Once a person logs into healthcare.gov, they enter household and income information. The user then sees the prices of plans with the appropriate subsidy deducted. This process has been compared to buying a plane ticket on Expedia.
Plans are arranged like Olympic medals from bronze to silver to gold. Unlike other states, the Alaska marketplace will not offer platinum plans. Platinum plans offer the greatest amount of coverage and lowest deductible at the highest cost.
"We're already very concerned about affordability for our customers," said Premera spokesman Eric Earling.
The bronze plans, with the lowest monthly costs, or premiums, have the highest deductibles (a consumer's upfront cost before insurance pays). As plan premiums climb, deductibles drop. As a consumer's income climbs, federal subsidies to offset premiums drop as well.
With a mid-range silver plan offered through Premera Blue Cross Blue Shield of Alaska, for example, the consumer pays about 30 percent of medical costs and the insurer covers 70 percent, with a maximum annual out-of-pocket cost of $4,500 for an individual and $9,000 for a family.
For a family of four with two 40-year-old adults, such a plan costs $1,296 a month. In the marketplace, a family will pay this entire cost if its income exceeds four times the poverty level for a household of four, or $117,760.
But, if the household income is at 100 percent of poverty level -- $29,440 -- the family will pay only $49 a month, and receive a $1,247 federal tax credit. This credit can be put toward a bronze plan, where the family will pay a lower premium, or a gold plan, where the family will pay a higher premium for more coverage.
Age and whether a person smokes will also affect premium costs.
"It's all very complicated," Weinstein said.
Reach Tegan Hanlon at firstname.lastname@example.org or 257-4589.