What's going on in Germantown?

Obamacare opens for business

Posted: Sunday, September 29, 2013 12:30 am

By Kyle Adams Columbia-Greene Media

Oct. 1 will mark the first major implementation of the Affordable Care Act in New York State as New York State of Health, “the official health plan marketplace of New York State,” opens for business.

The marketplace aims to provide New Yorkers with “quality, low-cost” health plans as well as tax credits to those who qualify.

“Essentially, we’re a one-stop shopping experience and we’re the only place to get financial assistance to reduce the cost of coverage,” said Kyle Kotary, director of External Affairs, Outreach and Marketing for the New York State of Health. “We encourage all New Yorkers to go to the New York State of Health website. It’s the only place where you can see if you qualify for a health plan, for payment assistance and be able to see what’s available.”

The program is expected to enroll more than 1 million New Yorkers and Governor Andrew Cuomo has estimated that it could save those who enter up to 53 percent in health care costs.

The open enrollment period beginning Oct. 1 will include a marketplace for individuals and families and a small business marketplace. Those interested can apply online (at, by phone (toll-free at 1-855-355-5777) or in-person with a designated local “navigator.”

In Columbia and Greene counties, the Columbia County Healthcare Consortium has been designated as the official local navigator. Senior Program Director Lisa Thomas said the consortium will place trained navigators in community organizations and facilities, like libraries, doctor’s offices and churches.

“Wherever we can go so that we can reach as many people as possible and make it convenient for them,” she said.

For information about where to contact an in-person navigator, contact the consortium at 518-822-8820.

The open enrollment period beginning Oct. 1 will end March 31, 2014. After that, enrollment will not open again until January 2015, and anyone without insurance by that time may face a federal penalty. Plans purchased through the marketplace can start as soon as Jan. 1, 2014.

Those who currently have insurance that they are happy with can keep it — there is no mandate to switch to a new plan through the exchange. But anyone is welcome to browse, for free, to see if they qualify for cheaper coverage, said Kotary.

A person living alone and earning less than $45,960 a year may be eligible for financial assistance, as will a family of four with a combined income of $94,200. The assistance, in the form of tax credits, will be highly flexible, said Thomas, to accommodate irregular incomes. It could be spread out to help a person make payments through low-income periods throughout the year, she said.

The small business marketplace will offer a similar service for small businesses. They’ll be able to compare and enroll in plans, as well as receive tax credits if they meet certain criteria.

“Employers will be able to make it easy for their employees to choose from a wide array of plans at different levels,” said Kotary.

Employees will be able to choose how to prioritize their search for coverage: by specific provider, by a selection of providers, by coverage level, or any plan at any level. Employers can then choose from three contribution models: paying an uncapped percentage, paying a percentage capped at a dollar amount, or simply giving the employees a certain amount to shop the marketplace on their own.

A small business with fewer than 25 full-time equivalent employees that provides health insurance and pays an average annual wage of less than $50,000 may qualify for the Small Business Health Care Tax Credit, which could be up to 50 percent of their share of employee premiums (35 percent for non-profits).

“For small businesses that are already offering insurance, they should see savings,” said Thomas. “They’re expecting that overall costs for small businesses will be reduced by 5 percent.”

A mandate to require coverage has been put off until the start of 2015, so those not currently providing insurance will not be forced to immediately.

All the certified health care plans in the marketplace (having been approved by the New York State Department of Financial Services and the New York State Department of Health) must offer 10 essential health benefits: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

Further, preventive measures, such as regular physicals and mammograms, will be free under the certified plans in the marketplace.

Plans will be arranged into four tiers: bronze, silver, platinum and gold, reflecting how much the plans cover versus out-of-pocket expense.

Columbia Memorial Hospital spokesman Bill Van Slyke said health professionals have some concerns that the lower tiers could result in out-of-pocket expenses that may prevent people from seeking treatments they consider unaffordable.

“If that prospective patient doesn’t have the means to pay that deductible and therefore doesn’t go to get the care he or she needs, that’s a problem for everybody,” he said. “By the time they do show up, if they put something off, they’re much sicker and they demand many more resources to take care of. And that becomes a problem for all of us because then it become more expensive. So that’s something that we need to keep an eye on.”

Overall, he said, the hospital is expecting the program to result in more insured people in New York, “and that’s a good thing.”

“That enables these folks to have better access to care and allows us to be reimbursed for the care that we deliver,” he said.

In Greene and Columbia counties, certified health plans are provided by CDPHP, Empire Blue Cross Blue Shield, Fidelis Care, Health Republic, HealthNow (BlueShield of Northeastern New York), MVP, and Today’s Options/American Progressive (Greene County only) in the individual marketplace. In the small business marketplace, certified plans are offered by CDPHP, Health Republic, HealthNow (BlueShield of Northeastern New York) and MVP.

“This is an historic launch,” said Kotary. “It means that people are going to have peace of mind that they’re prepared for life’s events. As we like to say, a broken arm shouldn’t break the bank.”


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