Published December 05. 2012 4:00AM
Experts at forum answer questions about first-ever state-sponsored insurance marketplace
New London - As the state prepares to launch its first-ever health insurance exchange, future customers had a chance Tuesday to learn, among other things, the types of plans that will be offered, how much insurance will cost and how consumers will access the exchange.
"Our vision for the exchange is to take something complicated and confusing and make it easy and understandable," said Kevin Counihan, chief executive officer of the state-sponsored Connecticut Health Insurance Exchange, during a "Healthy Chat" event at Mitchell College attended by about 75 people. "We want to make it simple for people to shop and compare."
The exchange is being set up as an online shopping center for health insurance that will begin enrolling customers in October for plans that will start providing coverage in January 2014. The exchange is being created as the state's response to the federal Affordable Care Act. Along with about 15 other states, Connecticut is opting to build its own rather than default to a federally-created exchange.
The main purpose, Counihan said, will be to provide affordable insurance to the approximately 9.6 percent of state residents who are uninsured. Others, including small businesses and self-employed residents such as Kate Davis of Madison, now paying high rates for inadequate coverage, also will be able to access the exchange.
"We just saw our plan go up $100 a month, and we're already paying 30 percent of our income for insurance," said Davis, who was pleased to learn she may be able to find a better plan on the exchange.
She said she "pays through the nose" for a plan that doesn't even cover routine mammograms, even though she's a breast cancer survivor.
Counihan explained that rates for insurance in the exchange will determined as a percentage of income, with subsidies provided to those with low incomes. The maximum monthly premiums would not exceed 9 percent of monthly income, or about $432 per month for a family of four with an income that's 200 percent of the federal poverty level - about $46,100. There will be four tiers for each plan offered, from the most expensive "platinum" plan that covers 90 percent of health care costs, to the "bronze" plan that covers 60 percent but has the lowest premiums.
There also will be maximum deductible of $2,000 for an individual, $4,000 for a family, and maximum out-of-pocket costs of $5,000 for an individual and $10,000 for a family, he said.
Dr. Stephen Smith, a primary care physician at the Community Health Center, said he is "excited about the exchange, but also apprehensive," because of concerns about affordability. He gave the example of two of his diabetic patients who now have "crappy" insurance that doesn't cover the insulin they need. His patients can't afford to pay for it themselves, he said.
Grant Ritter, one of panelists Tuesday and a member of the board of directors of the exchange, said those with very low incomes will pay only 3 percent of their incomes toward insurance.
"Crappy insurance is more or less going to die," he said. "All the new policies will at least be at the bronze level."
Smith, however, said he didn't think these two patients could afford to pay 30 percent or 40 percent of the cost of their insulin. Later in the forum, he urged Counihan and others from the exchange to use their leverage with insurance companies in the exchange to bring costs down and improve coverage, particularly for specialist care.
"Be the Sears or the Target or the Wal-Mart and get some cojones and start negotiating," he said.
Others, including dental hygienist Beverly Whitford of Old Mystic, said the exchange should ensure that plans cover more than the most basic services, including dental care, nutrition counseling and alternative medicine.
Separate dental coverage will be offered through the exchange, and all the plans will be required to include pediatric dental care, Counihan said.
Tuesday's event was one in a series of forums the exchange is hosting around the state this month. Another series will be offered next year, he said.