With new health care requirements right around the corner, many people will be trying to sort through what they need to do. On October 1st, state insurance exchanges will open. In a three part series, Katie Gibas will show us some of the hard decisions people will be making. In part one, we'll take a look at different types of insurance plans and what happens if you go uncovered.
NEW YORK STATE -- If you're confused about what's going on with health care, you're not alone. A Washington Post-ABC News poll says 60 percent of those surveyed say they don't understand the changes. So let's break it down.
First, will you be forced to get insurance? No. But if you don't, you will have to pay a penalty. At first, that fine will be relatively low. For a single person, it will cost $95. For a family, $285. But again, that's the beginning. Those fines will increase substantially every year for several years. You'd pay that fine on your 2014 tax bill, so not this April, but next April.
But advocates note that beyond penalties, having no insurance carries risks.
"The number one cause of bankruptcy in America is health care. And it's because people just don't realize how much it costs to go to the emergency room or to bring their baby to the emergency room. For example, a woman who's having a baby, those medical expenses can run $10,000 to $15,000. Something as simple as a sprained ankle, if you go to an emergency room, that could run $1,000 or $2,000," said Arthur Vercillo, the Excellus BCBS Regional President.
If you would rather pay the penalty, that's fine. If you think you might want to get insurance, the state insurance exchange, called NY State of Health, opens October 1st. It's an online site where you can compare plan coverage and prices.
"Any New Yorker can come to the marketplace and see what they're eligible for. For those that have insurance right now through their employer, the marketplace may not be someplace where they would buy coverage. But for anyone who is currently uninsured or is paying far too much for the insurance that they have. The marketplace might be able to give them much more affordable options. It's the only place where New Yorkers will be able to access financial assistance to help pay for the cost of coverage and reduce their expenses related to health insurance," said Sherry Tomasky, the NY State of Health Stakeholder Engagement Director.
There will be a number of plans from several different insurance companies. They range in price. Some for just one person could start around $100 per month. Prices range based on whether you choose a co-pay plan or a deductible plan.
Co-pay plans mean you pay a certain amount every time you go to the doctor, such as $15 for a primary care visit and $30 for a specialist. Preventive care, such as a physical or an annual ob-gyn appointment would be free. Those monthly rates will be higher.
A deductible option means you pay less per month, but have a higher bill when you do get care.
"If they're a family that spends more time just on preventative services and they don't expect significant out of pocket expense, a co-pay plan might not be the way to go. They might want to go to a high deductible health plan to keep their premium down. That happens today. It's the same type of conversation that individuals and employers make today," said Todd Muscatello, the Excellus BCBS Sales VP.
Every plan has to meet certain coverage requirements. And every one has had to get approval from New York State before being allowed on the exchange.
You'll have to pay a monthly premium for the insurance. But many people will be able to get back some of that money in the form of a tax credit at income tax time. You won't get that money until April 2015.
If you choose not to get health insurance, you'll be paying a penalty while you file your return. That, again, would be in April 2015.
For a more in-depth discussion of the New York State of Health exchange tune to channel 1020 for YNN Health Reporter Marcie Fraser's extended interview.
NY State of Health website:
National Health Exchange website:
To estimate your tax credit and premium, click the link below, scroll down to "downloads" and click "Tax Credit and Premium Rate Estimator":