It’s finally here. Come hell or government shutdown, Tuesday, October 1 is opening day for Obamacare’s central feature: the health-insurance exchanges.
These online marketplaces will allow individuals and small businesses to comparison-shop for health plans from a variety of carriers. Business owners in many states finally will get a chance to see their coverage options and premiums under the new health-care law.
The nationwide rollout of these state- and federally-run exchanges is a complicated affair and nobody--not even health-care reform’s staunchest defenders--expects everything to go smoothly. Fortunately, there’s time for the exchanges to find their footing. As for you, we’ve put together a helpful list of FAQs to help you figure out what, if anything, you need to do. And remember: whatever happens over the next few days, there’s no reason for panic. At least not yet.
1. Do I Need To Care?
In general, only businesses with 50 or fewer full-time-equivalent employees will be able to purchase health insurance through the new exchanges. (Note: For companies of this size, providing employees with healthcare is entirely optional; only businesses with more than 50 full-time employees will be affected by the employer mandate. And that’s not slated to go into effect until 2015.)
2. What's this notification requirement I keep hearing about?
By October 1, the Affordable Care Act calls for all businesses with at least one employee and $500,000 in annual revenues to give employees a written notice informing them: (1) that the health exchanges are open, and (2) that, even if they have coverage through work, they may be able to get insurance more cheaply in the exchange. For help, check out the Department of Labor's sample employer notice. Missed the deadline? No problem. In this year of health-care reform mulligans, the U.S. Department of Labor has announced that there will be no penalties for failing to make the notification on time.
3. Where do I find my state's exchange?
If you’ve missed the catchy ads, you can be forgiven for not knowing the URL, or even the official name, of your state’s exchange. To make things extra-confusing, some states are running their own exchanges, while many more--36 of them--have passed all or part of the job to the federal government. Fortunately, there is an easy-to-use search tool at Health.gov. Just select your state and you’ll find a link to either or your state-run exchange or to the federal exchange, where you can start examining your options.
4. What will my options look like?
Employers and benefits experts around the country are warning that many plans offered through exchanges will offer narrower networks of doctors and hospitals than their “regular,” non-exchange plans. Insurers say that these narrower networks let them better control costs, and thus keep premiums down. But it may mean that employees lose access to favorite doctors and other specialists.
In states including California, Illinois, Indiana, Kentucky, and Tennessee, insurers have cut major medical centers out of their exchange-based plans. Blue Shield of California, for example, will restrict exchange members to about 50 percent of its regular physician network statewide.
In many states, the choice of insurers will also be limited: in California, neither Aetna, United HealthCare, nor Anthem Blue Cross will offer products in the state’s SHOP exchange. In some states, there may be only one or two carriers offering small-group coverage--and in Washington state, it’s appears that there will be no small-business plans available in 2014, and Maryland's exchange will not open until January 1.
5. Now what?
In most states, you should be able to at least see what your company’s coverage options are. If you like what you see, you’ll have to enroll by mail or fax; the online option will not be available until November 1 (yes, another delay). Individual states may also have delays in processing applications online, or may require you to work through an actual human advisor. And be warned: some of the state-exchange sites seem to have been designed with inscrutability as a goal (I'm looking at you, Vermont.)
If you can’t find the answers you need--or someone to talk to--right away, well... just keep trying. If email doesn’t work, try calling. I’ve also had success reaching state exchange officials via Twitter. Or go to https://localhelp.healthcare.gov to find official ACA “navigators” and other advisors in your area who can help you figure things out. If you’ve already been working with a licensed broker or agent, you can continue using them to buy insurance in the SHOP; the premiums you pay will be the same.
Once again: don’t panic. You have until December 15 to sign up for plans that start coverage on January 1, and until March 31 to enroll for plan year 2014. After that, though, you’ll have to wait until October to sign up for coverage starting in 2015. Good luck!
How are you faring on the first day of Obamacare? Leave your comments and stories below.