What Does it Mean to You?
The Affordable Care Act was signed by the President in 2010, and many aspects of federal health care reform have since been rolled out to GIC members:
Preventive Care Covered with No Cost Sharing: As of July 1, 2011, preventive services, such as mammograms, scheduled immunizations, routine physical and OB/GYN visits, and cholesterol screenings for adults are no longer subject to a copay or to the calendar year deductible. This benefit was expanded with additional women’s preventive care effective July 1, 2013. Medicare members received similar benefit enhancements.
Dependent Coverage Expanded to Age 26: Prior to July 1, 2011, dependents who were full-time students were covered to age 26, and dependents were covered up to two-years after loss of IRS coverage, or age 26, whichever came first. Now, GIC members can keep their children, stepchildren, adopted and foster children on their GIC health plan up to the age of 26, regardless of IRS dependent status.
Summary of Benefits and Coverage (SBC): Last spring GIC health plans distributed to members enrolled in their plans a new document required by federal health care reform that provides the plan’s benefits and cost-sharing requirements in a standardized format. Each year, members will receive an updated SBC and new employees will receive notice of where these can be viewed and printed: www.mass.gov/gic/sbc.
Marketplace Notice/Notice of Exchange: In October, all employees received a Marketplace Notice, also known as a Notice of Exchange, from their benefits office. New employees must also receive this notice from their employer. The Notice describes the availability of coverage through the Health Insurance Marketplace, which in Massachusetts is the Mass Health Connector.
So Should I Purchase Health Insurance Through the Marketplace?
Most GIC members enjoy more comprehensive benefits by remaining in their GIC health plan. If you are eligible for GIC health insurance coverage as an employee, you are not eligible for subsidies through the Connector, unless GIC coverage is not “affordable.” For these purposes, affordable means the individual premium for the least expensive plan for which the employee is eligible costs more than 9.5% of the individual’s household income.
Although GIC members can enroll in unsubsidized Connector coverage, they will lose the employer contribution to the GIC plan (75% or 80% for state employees and 80%, 85% or 90% for state retirees; and different percentages for municipal enrollees). They will also lose the tax benefit of paying for health insurance on a pre-tax basis. This adds about 44% to the cost for the typical employee. The bottom line: a Connector plan will be more expensive than staying with a GIC plan.
There are three exceptions to the above:
- If you are very low income and live outside of Massachusetts (and therefore not eligible for one of the GIC’s less expensive plans), you may benefit by enrolling through your state’s Marketplace. Visit the federal website to be directed to your state’s options or call 1-800-318-2596.
- If you are Medicaid eligible, you may benefit by applying for Mass Health, either to enroll in MassHealth, or to get a premium voucher from MassHealth to pay for part of your GIC premiums: MassHealth; 1-800-841-2900.
- If you are on COBRA/Deferred Retirement, or if you are a low income retiree who is not Medicare eligible and not eligible for insurance through another employer, Connector plans available to you may be less expensive than the full-cost or retiree premium share of GIC plans. Check the Connector’s website to assess your options.
Note that Connector subsidies are not available to those on Medicare and a GIC Medicare plan will provide the best value for Medicare retirees.
What Will Change in 2014?
More people will receive tax credits and subsidies to pay for insurance through the Marketplaces as Medicaid eligibility expands. Note that as of press time, some states, including Maine and New Hampshire, have decided against Medicaid expansion. In general, however, the following chart indicates income levels at which people are eligible for Medicaid or Connector subsidies:
|Family size||Eligible for Medicaid (annual income)||Eligible for a subsidy (annual income)|
|1||Up to $14,856||$11,170 to $44,680|
|2||Up to $20,123||$15,130 to $60,520|
|3||Up to $25,390||$19,090 to $76,360|
|4||Up to $30,657||$23,050 to $92,200|
Source: Federal poverty guidelines for 2012-2013.
Even with this expansion, most GIC members will enjoy better benefits and lower costs by remaining in their GIC plan. If you do meet the expanded definition of Medicaid, contact MassHealth as noted above.
Some of the changes that go into effect nationwide in 2014 have been previously in place for Massachusetts residents, such as the need to get health insurance. Guaranteed coverage without regard to preexisting illness will be a new benefit for other private sector employees, but members of GIC plans have never been denied coverage for preexisting illness, nor have they been charged higher amounts for coverage.
The GIC will be subject to some ACA fees, but the state as a whole will simultaneously benefit from Medicaid and Connector subsidies. The GIC directly received money from the Early Retiree Reinsurance Program, which we have used to pay claims. Additionally, ACA-connected efforts should help the GIC and our plans improve care coordination and financial accountability for health care providers.
New standards for essential health benefits will go into effect July 1, 2014, and the GIC, our consultant, and plans are currently evaluating a few ancillary benefits such as prosthetic wigs that may need to change from dollar limit benefits to limits on frequency, such as once per year. Additionally, new out-of-pocket maximums will go into effect. These changes will be determined and communicated to you by the beginning of Annual Enrollment.
The bottom line: for most GIC members, benefits have improved as the result of the Affordable Care Act.
This information provided by the Group Insurance Commission.