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Tue, Feb. 25

Blue Cross Blue Shield representative explains Affordable Care Act

Williams residents asked questions, expressed concerns and learned more about the Affordable Care Act (ACA) at an information session Sept. 26.

Terry Rulon, business development executive for Blue Cross Blue Shield of Arizona, gave the presentation put on by the Williams-Grand Canyon Chamber of Commerce. Rulon started the presentation by telling the audience of about 15 people: "I know that healthcare reform is a very emotional topic for a lot of people. I claim no personal responsibility or accolades for what we're about to talk about."

Rulon outlined the following information:

Congress passed the ACA commonly referred to as Obamacare, in March 2010.

The law requires most people ages 18 and older to have health insurance by March 31, 2014. Those who do not have coverage at that time will face a tax penalty. In 2014, that penalty will be $95 for an individual or $285 for a family, or 1 percent of the individual or family income, whichever is more. The penalties will increase in the following years.

Open enrollment through the Health Insurance Marketplace, at, started yesterday and continues through March 31, 2014. There, people can buy plans for individuals, families and small groups. Coverage can begin as early as Jan. 1, 2014.

Plans purchased before March 23, 2010 will likely be exempt from changes associated with the ACA.

The requirement to obtain health insurance has some exceptions, including some for Native American tribal members, undocumented immigrants, people with certain religious beliefs, people in jail and people with financial hardships.

People who earn below 400 percent of the federal poverty level and do not have coverage through their jobs can qualify for a tax credit for their insurance. For an individual, the income level to qualify for a subsidy is between $11,490 and $45,960.

People who want to apply for a tax credit for their health insurance must buy coverage through the Health Insurance Marketplace.

Those who do not qualify for a subsidy can be insured through their employer, a private insurance company, an independent broker or the marketplace.

Four different tiers of health coverage will be available under the ACA: bronze, silver, gold and platinum. Each plan will pay different amounts toward healthcare expenses (bronze about 60 percent, silver about 70 percent, gold about 80 percent and platinum about 90 percent). Bronze plans will have the lowest monthly premiums and Platinum plans will have the highest.

"Most people today have plans that are either bronze or less expensive, so that gives you an idea of the enrichment of the benefits," Rulon said.

Under the new law, health insurance premiums will depend on age, geographic area and tobacco use instead of preexisting conditions.

All new plans must include essential health benefits, including ambulatory and emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care.

The maximum out of pocket costs will be about $6,350 for individuals and $12,700 for families, including deductibles and co-payments.

At the end of the workshop, Bria Sherinian, a health benefits advocate for North Country HealthCare, said the center will put on enrollment workshops for the new marketplace in the coming months.

"Don't be scared of this," Sherinian said. "Every single person I think is confused."

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