2013-09-12 / Front Page

Residents learn about health-care reform

Director of state exchange speaks at public forum on prices of health insurance
By Margo Sullivan

Christine Ferguson addresses a crowd of 50 residents last week at Central Baptist Church. Ferguson, a Jamestown resident and director of the state’s exchange on health care, spoke about health insurance. 
Photo by Margo Sullivan Christine Ferguson addresses a crowd of 50 residents last week at Central Baptist Church. Ferguson, a Jamestown resident and director of the state’s exchange on health care, spoke about health insurance. Photo by Margo Sullivan At a forum last week at the Central Baptist Church, residents heard about the changes coming to health insurance from Jamestowner Christine Ferguson.

Ferguson is director of Health- Source RI, the state exchange where individuals and small businesses can buy an insurance plan. She has been traveling to Rhode Island communities with a Power- Point presentation titled, “Making Insurance Affordable and Accessible for Rhode Islanders.”

Her goal, she told the audience of some 50 people, was to “shed some light on how health insurance works.”

Ferguson brought rate sheets comparing the various plans by benefits and costs, the latter including monthly premiums, co-payments, co-insurance and maximum out-of-pocket annual expense. The information represented a “partial summary,” according to the fine print.

Ferguson said some specifics, such as rates for dental plans, are not yet available.

In a nutshell, individuals and families will be able to choose among 11 or 12 plans. Neighborhood Health Plan of Rhode Island is the provider for two. Blue Cross Blue Shield of Rhode Island is the provider for the others.

The 12th plan, the catastrophic plan, is typically available only to individuals under 30 but some exceptions apply to the rule.

Small-business owners and their employees will have 16 plans to consider. Two are from Neighborhood Health Plan of Rhode Island, five are from United Health Care, and the rest are from Blue Cross Blue Shield. Other providers are expected to offer health care in Rhode Island in 2015, she said. The small-business plans are more expensive than the options for individuals and families, she indicated, but added HealthSource RI will provide special services that will help reduce the work of administering the plans.

Small-business owners will have a new option: full employee choice. It will allow workers to choose any of the 16 available plans. The way it works, she said, is the employer makes the contribution and the employee picks up the difference in the premium, if there is any. Or the company can continue buying one plan for all its employees.

Currently, Ferguson said, 100 percent of businesses with more than 50 employees offer health insurance. Half the companies with fewer than 50 workers include a health plan among the employee benefits, she said.

“Rhode Island will be one of the only states to offer full employee choice,” she said.

The call center will be open next week for any small-business owner or employee with questions. In the meantime, people can call 222-5192 with their inquiries. In a few weeks, it will be possible to register online at HealthSourceRI. com. However, people can wait to sign up. The plans don’t start until January.

“This really isn’t that complicated,” she said.

Health-care reform will mean older people pay more for insurance because that’s the way the law is written, Ferguson said. Gender and pre-existing conditions are no longer factors.

The prototype compares the monthly premiums for a 21-yearold and a 45-year-old. For the 21-year-old, the range goes from a low of $150 for the catastrophic plan to a high of $282. For the 44-year-old, the lowest premium is $240 and the highest is $408.

However, the premiums “are not always the most important thing.” To understand the entire cost, look at the co-insurance, annual maximum out-of-pocket expenses and co-payments, she said.

Ferguson says these new rates offer an opportunity to have a discussion about health care.

According to the rate sheets, people in their late 50s and 60s who buy their own health insurance will see monthly insurance costs soar. When the Affordable Health Care Act takes effect in January, costs can be as high as $719 for a 58-year-old, and up to $847 for someone who is 64 years old. Those numbers are according to HealthSource RI’s chart of individual premiums.

Small-business plans cost even more, with several priced at more than $1,000 for the monthly premium for workers 60 and older.

The cost of hiring older workers will increase, she said.

Several residents who are some small-business owners expressed astonishment to find out their premiums are about to triple.

One resident noted the new law has effectively scuttled all incentives for people to lead healthy lifestyles, saying the reverse course is exactly contrary to previous efforts by insurance companies to promote healthy choices.

“Boy, this is a tough crowd,” Ferguson said. She suggested Jamestown residents must be healthier than their counterparts in Wickford. She presented the same program there, and found most people thought their premiums were going down.

She also noted a tax credit, which is applied immediately to reduce the premium, will help low-income people, although there will be no relief for people earning over $100,000 a year. Families with more than three children will only be charged for the first three youngsters, and state programs to help children will also continue.

People with pre-existing conditions will benefit from the changes, while people who are healthy will have to pay more, she said.

The penalty for dropping coverage is $95 in the first year of health-care reform, she said.

Ferguson, who said she negotiated the new rates with the insurance companies, said if people want better rates, they will have to complain and demand changes.

“If you don’t like it, we want to hear from you,” she said. “I want you to call the call center on Sept. 16 and scream.”

Ferguson said the rates will continue to be negotiated. “That’s my job. I take what you tell me and turn around and go back to the carriers.”

But Jamestown resident John Kalooski said he doubted complaints would have an impact.

“The insurance companies are going to be lobbying our politicians,” he said. Kalooski predicted the winners in these negotiations would be “who’s got the most money.”

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