December 2012 Issue
November 20, 2012

Health exchanges offer more options

Source: NYSUT United

As part of the Affordable Care Act, New York joins other states in implementing health exchanges for individuals without insurance and for small businesses effective Jan. 1, 2014. It is anticipated that the choices through the exchange will be more affordable than those currently offered and provide comprehensive benefits.

An individual health exchange is a web-based marketplace where people can easily compare health plan options and purchase coverage if they do not have insurance, or if their employer-sponsored insurance is unaffordable. Although most NYSUT local members have negotiated excellent health benefits, some members may not be eligible because their job may be part-time, seasonal or temporary. Others are eligible but may not be able to afford their share of the premium.

The individual exchange will offer four different coverage levels: platinum, gold, silver and bronze. Bronze plans will have more out-of-pocket costs, and platinum plans will have the least. Bronze plans will cover 60 percent of enrollee costs, silver 70 percent, gold 80 percent and platinum 90 percent.

Lower-income workers may be eligible for premium subsidies if their income is less than 400 percent of the federal poverty level ($92,200 for a family of four) if they purchase coverage through the exchange.

The employer exchange is called the Small Business Health Options Program (SHOP). Initially the SHOP program will only be available to small employers (50 or 100 workers). In 2017, larger groups may have the option to enroll.

Even with these potential new options, coverage for NYSUT members is determined by their collective bargaining agreement and is likely the best option. If you have any questions, please contact your NYSUT regional office.

— Susan Klug