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What you need to know for 01/20/2017

Health insurance exchange set to open

Health insurance exchange set to open

In two days, one of the most tangible realizations of the Obama administration’s health care law wil

In two days, one of the most tangible realizations of the Obama administration’s health care law will be upon us, and many still have questions.

That’s good, according to local health experts. State-run health exchanges open Tuesday across the country, and that will be the soonest anyone can get answers beyond the hypothetical.

“Nothing like this has ever been done before at this kind of level,” said Bob Hinckley, chief strategy officer at CDPHP. “So to think it’s going to go off without any bumps along the way is not reasonable. There will be issues, and next week we can start sorting them out.”

Getting started

Visit: New York’s official health plan marketplace: www.nystateofhealth.ny.gov.

Call: New York’s marketplace Customer Service Center at 1-855-355-5777, or send questions about the implementation process in New York state to exchange@health.state.ny.us.

How much: Find out with this online calculator, a collaboration between the Kaiser Family Foundation and NPR: http://kff.org/interactive/subsidy-calculator/.

Eligibility: To see if you qualify for tax credits, visit http://bit.ly/1fHn1jd.

Coverage won’t go into effect until Jan. 1, but an estimated 2.7 million uninsured New Yorkers and those who are unsatisfied with their employer-based coverage can begin shopping Tuesday for insurance plans on the New York exchange, called NY State of Health. The online marketplace will offer 16 health plans and 10 dental plans, including Capital Region-based plans from CDPHP, MVP Health Care and BlueShield of Northeastern New York.

The Sunday Gazette asked health experts to offer their best advice to individuals who are planning to check out the health exchange Tuesday. Here’s what they said:

Take your time

Tuesday, Oct. 1, isn’t a magic date, said Hinckley. The most important thing potential enrollees should keep in mind is not to rush the process. Yes, the exchange opens Tuesday, but you have 90 days to find the right plan for yourself or your family.

“I would recommend they use that time to do some research, look at the various plans and make their decision on a number of factors beside price alone,” said Hinckley.

A major point of the exchange is the opportunity for people to comparison-shop for health insurance just as they might comparison-shop for furniture, cellphones and even colleges. The exchanges are set up in a way that no longer allows health plans to hide behind the fine print. Individuals can compare coverage options side-by-side, with information about prices and benefits in plain, simple language.

“People should use the next 90 days to become an educated consumer,” said Paul Larrabee, a spokesman for the New York State Conference of Blue Cross and Blue Shield Plans.

New York is known for having some of the highest health insurance premiums in the country. So while many enrollees will be shopping based on price, Larrabee said no one should shop based on price alone.

“They need to ask important questions,” he said. “ ‘Is my doctor going to be a part of the plan I’m considering? How easy is it going to be for me to access health services that my family needs?’ Everybody is so different, so each individual has to make a decision based on what’s right for their circumstance, which could very well include their budget but also the size of their family, the region in which they live, whether or not preventive care is important to them or whether or not a plan offers the right kind of specialty care.”

Ask questions

Hinckley said he hopes people use the first week of the exchange just to look around and get a feel for what’s out there. If they have questions, they should call up individual health plans and ask.

Even though CDPHP has used the past year and a half to prepare for the exchange, it still expects to treat the first year of the exchange as a learning curve.

“People know us,” he said. “We are going to be offering the same service, the same quality we always have. But that’s not to say that next year we might not do something different. Our philosophy on this has been to be in the exchange and use this first year to make the necessary changes to really compete hard for business in the coming years. And I think everybody’s going to be learning along with us, the state included.”

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