Avenue H is different than most of the other state exchanges in that its intended customers are solely small businesses with 50 or fewer employers. Avenue H connects small employers with health insurance brokers and carriers. Employers choose the amount they wish to contribute, and employees are free to select whatever health plan they like in the exchange. A 35 percent tax credit for health contributions encourages employer participation, and contributions from employees are pre-tax. Of course, per the ACA, groups cannot be turned down for health reasons.
Avenue H offers about 70 health insurance plans from the following three providers: Arches Mutual, SelectHealth, and United Healthcare. It also offers dental plans from seven providers: Alpha Dental, Delta Dental, DentalSelect, EMIHealth, Guardian, Premier Access, and SelectHealth; as well as Health Savings Account (HSA) plans from three carriers: HealthEquity, KeyBank, and Optum Bank.
Groups whose employers have signed up with Avenue H can start shopping immediately through a broker or direct from AvenueH.com after October 1, 2013. Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
Note: Individual Utah residents looking to purchase health insurance for themselves or their families outside of their employer can use the enrollment process at HealthCare.gov, the federal Health Insurance Marketplace, or, of course, purchase their own private insurance.
Six insurers operating in Utah have filed plans to offer on the federal Health Insurance Marketplace: Altius Health Plans, Arches Mutual, Bridgespan Health, Human Medical Plan of Utah, Molina Healthcare of Utah, and SelectHealth. Those six insurers have submitted 99 medical plans.
Per the Affordable Care Act, all plans have to offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Utah is also offering standalone dental and health savings accounts.
There are four basic plans available, all with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). The lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan is available for folks under the age of 30. This plan has a high deductible.
Parents living at or below 46 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), and pregnant women living at or below 139 percent of the FPL, can qualify for Medicaid in Utah, based on eligibility requirements that take effect January 1, 2014.
Additional federal financial protections will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to the silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
The monthly rates for a 40-year-old for a benchmark Silver Plan from insurers participating in Avenue H range from a low of $231 in Salt Lake County to a high of $369 for both Utah County and Salt Lake County.
Meanwhile, the monthly rates for a 40-year-old for a benchmark Silver Plan from Utah insurers participating in the federal Health Care Marketplace range from a low of $173 in Salt Lake County to a high of $286 in Cache County.
Individuals and families with incomes between 100 percent and 400 percent of the federal poverty level (and who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the cost of Bronze, Silver, Gold, and Platinum, and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.