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The Real Deal: Healthcare Exchanges

ALBANY – In just a matter of months, healthcare exchanges will be open for business here in New York. The exchanges were mandated by the federal government under the Affordable Healthcare Act. Insurers have already submitted their plans to the state for approval and are expecting to hear back by late July on whether the products they’ll offer in the exchange market are adequate. 

Depending on where you work, you may be forced to join a healthcare exchange if you need insurance.  Employers with less than 50 full-time employees will now be able to transition employees to an exchange instead of offering traditional coverage.  In most cases, employers will still contribute to the cost of healthcare.  Essentially, if you choose or are forced into a healthcare exchange, you will go online, put in your coverage wants and needs and “the exchange will spit out information to you to show you the number of health plans available to you that might fit your needs and you'll be able to shop and compare individual options on that basis,” says Bob Hinckley, Chief Strategy Officer at CDPHP.  Chances are though, you won’t get any better of a price on premiums, “a consumer will see more benefits on the exchange then they did in years past... I'm not so sure they're going to see lower costs,” according to Hinckley.

Basically, the exchanges will make it a bit easier for the employers but consumers will have to do a lot more work.  “The employer could say, you're going to get $250 a week, here is access to the portal, here is access to the different plans...pick the plan that's right for you and your family, here's how much we will contribute, you contribute all or the rest,” says Keith Dolan.  Dolan is a broker with Rose & Kiernan Inc. in East Greenbush and has been spending the last several months counseling businesses on the Affordable Healthcare Law changes.  Many small local businesses are deciding right now, if they will offer insurance at all and if they do whether it will be a traditional option or through one of the exchanges. 

If you are not offered insurance through your work and/or you decide not to buy into an exchange, starting next year you will be penalized financially by the federal government.  In 2014, the penalty is $95/adult, $47.50/child.  In 2015, the penalty jumps to $325/adult, $163.50/child.  In 2016 and beyond the penalty will be $695/adult and $347.50/child.  The fines, in some cases can be cheaper than the insurance and that may cause a problem down the road.  “Our concern still remains that the young invincibles, those 28,29,30 year olds who don't have real health needs, won't join, instead will opt to pay the penalty,” says Hinckley which would cause an unbalanced risk pool that could drive up prices. 

Employers will have to inform employees before open enrollment what kind of plan they are offering.  They will also be obligated to help walk you through the process.  The open enrollment period for the exchanges will begin in October. 

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