The Times West Virginian

West Virginia

September 29, 2013

Key questions answered about health care exchange

MORGANTOWN — Starting Tuesday, people in West Virginia who currently have no health insurance can sign up for coverage under a health care exchange — a state and federal partnership.

Coverage will kick in Jan. 1, 2014, and the U.S. Department of Health and Human Services predicts that six in 10 people will be able to find at least some level of coverage for $100 or less per month, after tax credits.

But low premiums have a

trade-off: They could lead to big out-of-pocket expenses later when medical bills exceed the amount that insurers consider reasonable.

Here’s some information to help you get started.

How many West Virginians lack health insurance?

An estimated 254,000 are uninsured, according to U.S. Census Bureau data. That’s nearly 14 percent of the population.

What is a health care exchange?

It’s created by the federal Affordable Care Act. The online marketplace allows for side-by-side comparison of coverage options before enrolling.

Who is selling it in West Virginia?

Highmark Blue Cross Blue Shield is offering 11 plans in the individual market and four plans in the small business marketplace. People can choose from four levels of coverage — bronze, silver, gold and platinum. The big difference is cost sharing. Bronze plans have the lowest premiums, while platinum have the highest. But low premiums could result in big bills later if your expenses exceed what’s considered reasonable.

How much will it cost?

A chart provided by the Obama administration gives two examples.

A 27-year-old man making $25,000 a year would, on average, pay a monthly premium of $342 for the midrange silver plan. After tax credits, that premium could drop to $145. If the person opted for the bronze plan, his cost would drop to $90.

For a family of four making $50,000, premiums on the midrange silver plan would average $1,237 a month before tax credits but drop to $282 with them. If the family went with the bronze plan, the cost would be $81 a month.

Why should I sign up?

If the government decides you can afford health insurance and you don’t have it by 2014, you may have to pay a fee. You also have to pay 100 percent of your medical bills on your own.

The fee is 1 percent of your yearly income, or $95 per person for the year, whichever is higher. For children, it’s $47.50 per child, up to $285 total.

The fee increases every year. In 2016, it will be 2.5 percent of income, or $695 per person, whichever is higher.

What if i am on Medicare?

Medicare beneficiaries don’t have to do anything differently.

What about Medicaid?

West Virginia is expanding Medicaid up to 138 percent of the federal poverty level on Jan. 1, so any resident who earns less than $15,800 and is younger than 65 will be eligible. That’s believed to be about 133,500 low-income residents.

How are my children affected?

Kids currently eligible for the federal Children’s Health Insurance Program will remain eligible through 2019. The Affordable Care Act includes more money to get people enrolled in both Medicaid and CHIP.

Can someone help me?

West Virginia will have navigators, independent counselors who work under federal grants to help you and your family find the best coverage plan. Many hospitals and health care facilities will have on-site navigators, and information about other places to find them will be coming out soon.

Where can I learn more?

Go to a county office of the Department of Health and Human Resources, or call 1-800-318-2596.

Health Insurance Marketplace:

West Virginians for Affordable Health Care: http://www.wvahc

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