In 2010, the federal healthcare law — the Affordable Care Act (ACA) — was passed, giving states the opportunity to build health insurance marketplaces called exchanges. Hawaii Health Connector is Hawaii’s exchange.
All plans must offer the following 10 essential services:
- physician office visits
- chronic disease management
- emergency care
- inpatient hospital care
- maternity care
- newborn care
- mental health services
- rehabilitative and habilitative care (including speech, occupational, and physical therapy)
- diagnostic laboratory services
- preventive care
- pediatric care
- substance abuse
There are four basic plans available through the exchange. These have varying coverage levels. They include:
- bronze (60 percent of expenses paid)
- silver (70 percent)
- gold (80 percent)
- platinum (90 percent)
Lower percentage plans will have lower premiums (the basic amount you must pay for coverage). The downside is higher out-of-pocket costs (including deductible, copays, and coinsurance).
Many people will want to know how much of a subsidy they qualify for, but the real question is, how much will you pay? Your ultimate decision should be based on your income versus how often you might need to use the coverage. In the case of a chronic illness with frequent doctor visits, for example, you might save more money in the long run by choosing more coverage. The silver plan is often the wisest economic choice.
The ACA protects against outrageous medical bills. As of 2015, it mandates a maximum annual out-of-pocket cost of $6,650 for individuals and $13,200 for families. This may reduce bankruptcy rates attributed to uncovered medical bills.
Depending on your income, you may qualify for financial aid to help offset the costs of coverage. This may come in the form of:
- Medicaid coverage
- tax credits
Adults living at or below 133 percent of the federal poverty level (FPL) may qualify for Medicaid. Pregnant women living at or below 208 percent of the FPL may also qualify. It’s important to differentiate between the FPL for the continental United States and the Hawaiian Islands. The FPL for 2015, according to the health insurance marketplace, is:
- $11,770 in individual annual wages
- $15,930 for families of two
- $24,250 for a family of four
- $40,890 for a family of eight
In Hawaii, the FPL is different because of the higher cost of living. These include:
- $13,550 for individuals
- $18,330 for families of two
- $27,890 for a family of four
- $47,010 for a family of eight
There are also two kinds of subsidies people may use for healthcare costs. Federal poverty levels from 2014 are used to calculate eligibility for subsidies in 2015. The first is a cost-sharing subsidy. This subsidy is for silver plans only and reduces the total out-of-pocket cost of a plan. People who have household incomes between 100 and 250 percent of the poverty level may be eligible.
The second type of subsidy is the premium tax credit. If your income is less than 400 percent of the federal poverty level but you do not qualify for Medicaid, you may qualify for this credit. This is a subsidy that would help pay for part of your insurance. On average, individuals who earn about $53,680 a year or less qualify. For a family of four, the eligible income level increases to about $109,720 or less.
The percentage of your costs that this subsidy would cover depends on income level and the cost of a second-tier silver plan where you live. This silver plan is used as a baseline because the ACA was designed so everyone could afford a silver plan, regardless of how expensive the healthcare rates may be where you live.
For example, if your income is $37,980 a year (283 percent of the poverty level), the most you’ll have to pay for a second-tier silver plan is about 9 percent of your income. This averages to about $3,420 a year, or $285 a month. You can choose a plan other than the second-tier silver plan and use your tax credit, but the subsidy amount will stay the same. This means a gold plan would cost you more, even if you use a subsidy to cover some of the cost.
The Kaiser Family Foundation has a free calculator that can also help you determine subsidies.
To learn more about Hawaii Health Connector, please visit http://www.hawaiihealthconnector.com. The website contains several tools to help individuals and small businesses make health insurance decisions. The site hosts its own health coverage eligibility screener, which helps customers find out if they might qualify for financial assistance for health insurance. The site also offers information for small business owners.
You can call 1-877-628-5076 as well. Call representatives are available in several languages, including:
There are also services available for people with hearing and speech impairments, or you can email firstname.lastname@example.org.
Open enrollment begins on October 1, 2015 and ends March 1, 2016. Your plan will be effective on January 1, 2016. Do your research before open enrollment to ensure you get the best plan for you and your family.