Qualifying Central New Yorkers will be able to sign up for new low-cost health insurance starting Nov. 1.
The Essential Plan is an extension of theAffordable Care Act and will cover people who have enrolled starting January first. Any working person who makes under $24,000 qualifies. With the plan, people would receive free insurance from one of the major carriers that covers all essential health benefits.
According to a release by ACR Health, the 10 categories the coverage must include in accordance with the Affordable Care Act Legislation are:
- Ambulatory patient services, such as doctor’s visits and outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavior health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive wellness services and chronic disease management
- Pediatric services, including oral and vision care
Copays will be low, and there is no deductible, according to Assistant Directory of Support at ACR Health Services Steve Wood.
Those who qualify will either pay about $20 a month or nothing at all depending on income, though the cost does increase for those who have multi-member households. The demographics that could benefit the most are low-wage workers and older adults, according to Wood.
“People over the age of 19 who are working in retail, who are maybe working in a restaurant or places like that, that just aren’t earning a lot, so I think this is a great plan for younger people,” Wood said. “But also we have a lot of people who might be 62, who are retiring and collecting a pension that’s not a lot of money; they’re not qualified for Medicare yet.”
Wood said the plan might also be an affordable option for people who are self-employed.
“Self-employed individuals – we’ll look what your business losses are and what your income losses are, and we’ll count that. That brings a lot of self-employed [rates] down” Wood said.
Since the implementation of Obamacare, Wood said he has seen people helped immensely by these low-cost insurance plans.
“For the two and a half years we’ve been doing this, we’ve had people come in with significant, with really profound chronic illness – people with cancer who have not been able to get treated, people with diabetes who can’t get their insulin, people with HIV, all kinds of stuff,” Wood said. “And [we have been] able to get them insurance and get them primary care but also to get them specialists and get their medication.”
However, positive benefits are not only limited to those who major have chronic illness, Wood said.
“Quite of people have come in who have had a profound change in their health because of this,” Wood said. You know, you can finally go to the doctor, you can finally go to the dentist, or get glasses.”
For more information, you can call ACR Health navigators at 1-800-475-2430 to make an appointment, or e-mail navigator@ACRhealth.org.
Important dates for 2016 Health Insurance enrollment:
(source: ACR Health release)
- November 1, 2015: Open Enrollment starts – first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
- December 10, 2015: last day to enroll in or change plans for new coverage to start January 1, 2016.
- January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
- January 15, 2016b: Last day to enroll in or change plans for new coverage to start February 1, 2016.
- January 31, 2016: Open Enrollment ends. Enrollments or changes between January 16 and January 32 take effect March 1, 2016. If you don’t enroll in a 2016 health insurance policy by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a special enrollment period.
*If you can afford health insurance but choose not to buy it, you must have a health coverage exemption or pay a fee.
If you didn’t have coverage in 2015, you pay the higher of these two amounts:
- 2% of yearly household income – Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty. The maximum penalty is the national average premium for a Bronzeplan.
- $325 per person for the year ($162.50 per child under 18) – the maximum penalty per family using this method is $975
