||Blue Cross to Offer Marketplace Plans Statewide
When the federal health insurance marketplace opens Oct. 1, Blue Cross and Blue Shield of Louisiana will offer plan and network options across the state. Several major provisions of the Affordable Care Act (ACA), the healthcare reform law passed in 2010, go into effect this January. Most Americans will be required to have healthcare coverage or pay a fine. People who purchase their own insurance and do not get healthcare coverage through an employer or government program, such as Medicare, will be able to shop for plans in a health insurance marketplace, also called an exchange.
Blue Cross is one of four Louisiana health insurance companies that will sell products in the state’s marketplace. It is the only company that will offer plans from all four metal levels to residents in all areas of the state.
The plans offered through the marketplace will be categorized into four metal levels—bronze, silver, gold and platinum—according to the level of out-of-pocket costs the customer will pay for each. For each level, the insurance company pays a certain percentage of the healthcare costs, and the policyholder pays the rest. For a bronze plan, the lowest level, the insurance company would cover about 60 percent of healthcare costs, while the highest-level, platinum plan would cover about 90 percent of these costs.
The premiums for a bronze will be lower than plans from the higher metal levels. Buyers will also have options for silver plans, which cover 70 percent of healthcare costs, and gold plans that cover 80 percent. Within the marketplace, the federal government has designated the silver-level plans as the benchmark that set the standard for people’s purchasing options.
Metal levels do not affect the quality or amount of coverage—only what the policyholder pays. All plans, regardless of metal level, cover the 10 categories of “essential health benefits” that are required under the ACA. These benefits include core services such as hospitalization, maternity care and prescription drugs.
Advance premium tax credits, or “subsidies,” will be available for people buying insurance through the marketplace who earn between 100 and 400 percent of the Federal Poverty Level (FPL). Under current guidelines, 400 percent of the FPL is an annual income of $45,984 for a single adult living on his/her own and $94,224 for a family of four. Blue Cross estimates that 45 percent of its current customers have incomes in this range and could qualify for a subsidy.
People who purchase silver-level plans through the marketplace and have incomes below 250 percent of the Federal Poverty Level could also be eligible for reduced out-of-pocket costs, such as lower deductibles and copayments, in addition to premium payment assistance through subsidies.
Customers will be able to buy insurance through the online marketplace beginning Oct. 1, 2013. They can also purchase insurance and inquire about subsidies in person, working with a marketplace navigator, or a broker/insurance agent, or via telephone, either through the marketplace call center or a particular insurance carrier’s Customer Service unit. The marketplace will remain open through March 31, 2014.
The company recently added an online premium calculator to its healthcare reform website to help Louisianians estimate what they could pay for insurance next year. The calculator, online at www.bcbsla.com/whatyoupay, also shows whether someone might be eligible for a subsidy to help pay healthcare premiums.
People who have questions about applying for a subsidy or purchasing health insurance when the marketplace opens should contact their insurance agents for assistance. Thousands of Louisianians will be buying health insurance for the first time when the marketplace opens this fall. There are also people who will leave the small group insurance market and buy individual policies through the marketplace, or current individual customers who switch to new products. The majority of Blue Cross customers today get their insurance through employer groups, and as most group plans already meet ACA requirements, these customers will likely remain with the plans they have.
Also, Blue Cross has many “grandfathered” customers, meaning people bought their current plans before the ACA passed in March 2010 and have kept their policies active since. These customers will be able to keep their plans even if they do not meet all the new healthcare reform requirements. They also have the option to purchase a compliant plan through the marketplace.
For more information about the coming changes under the ACA and what the options are for healthcare coverage, shoppers are encouraged to visit the Blue Cross and Blue Shield of Louisiana healthcare reform site, www.bcbsla.com/reform.