Although some insurance company executives say they are now using analytics, others say they’re still on the fence about it or only beginning to explore its possibilities.
June 22--Blue Cross Blue Shield of North Carolina has unveiled an online tool, called Blue Map, to help North Carolinians navigate through potential changes to their health care coverage.
The tool is available at www.bcbsnc.com/BlueMap. The insurer said about 1.2 million residents could benefit from the tool as the October open-enrollment period for insurance plans nears.
Among the regulatory issues described on the website are new health plans featuring essential benefits, eligibility to keep current plans, premium tax credits and cost-sharing reductions.
The map is aimed at people who may be purchasing health insurance for the first time. One recent trend has been more employers, particularly small businesses, opting not to provide health-insurance coverage for employees to reduce expenses.
Another key factor: Families USA said in April that 869,000 North Carolinians, including about 176,000 in the Triad and Northwest North Carolina, would be eligible for tax credits as part of participating in federal insurance exchanges created through the Affordable Care Act.
The tax credits will be available to uninsured individuals and families who have incomes between 138 percent and 400 percent of the federal poverty level standards. For individuals, the current income range is $15,860 to $45,960; for a family of four, the current range is $32,500 to $94,200.
"Blue Map is designed to help individuals buying their own health insurance (to) understand their options with a clear and concise summary personalized to their coverage needs," states Michael Parkerson, vice president of marketing for Blue Cross. "There are numerous changes associated with the Affordable Care Act, and Blue Cross wants individuals to be ready to make an informed decision."
The Blue Map tool asks users a few questions and applies the responses to provide a customized summary of information for individuals under the age of 65 to make an informed decision about coverage in 2014. The tool will indicate for current Blue Cross customers whether their current plan is eligible to maintain grandfather status.
The insurance exchanges will be subsidized by the federal government and operated by state governments. They will go into effect Jan. 1. The tax credits would pay a sizable portion of their premium costs, according to Families USA. People with pre-existing conditions are eligible.
The state marketplace will be available online and by phone. The process for applying is expected to begin in October, about when employers will begin enrolling workers in their 2014 health plans.
Also eligible are employees who pay more than 9.5 percent of their wages to participate in an employer's health plan, and whose employer's plan pays less than 60 percent of the cost of covered benefits.
"The tax credit subsidies are a game-changer," said Ron Pollack, executive director of Families USA.
"'They will make health coverage affordable for huge numbers of uninsured families who would have been priced out of the health coverage and care they need."
The size of the tax credit depends on income level: The lower the income, the larger the tax credit.
For example, a family of four with a household income of $47,100 would not be required to pay more than 6.3 percent of its income toward the "silver" plan -- about $247 a month -- and would be eligible for a $9,530 tax credit. For individuals making the maximum income of $45,960 for eligibility, they would pay no more than 9.5 percent of their income to premium costs and would receive a $630 tax credit.
The federal law does not require employers to offer coverage. However, employers with 50 or more workers who don't offer coverage will be required to pay $2,000 for each full-time employee for its entire full-time workforce. The fee begins if at least one employee enrolls in a plan through an exchange and receives a federal subsidy.
What makes the insurance marketplace and tax credits a political football is that the federal law was created with the expectation that individuals and families below 138 percent of poverty level would be covered by Medicaid through state expansions of that program, and thus not eligible for the tax credit.
Gov. Pat McCrory and the General Assembly have decided against expanding North Carolina'sMedicaid program because of their concerns about its operation and efficiency.
Families USA said that "states that refuse to expand Medicaid, despite the generous federal support offered, will be condemning their most vulnerable residents to remain in the ranks of the uninsured."
(c)2013 Winston-Salem Journal (Winston Salem, N.C.)
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