The Shumlin Administration has taken the first step to design the specific health care benefit packages that will be available in Vermont through the new marketplace exchange beginning in 2014.
Consumers will have a range of options with different deductible levels, co-payment requirements and caps on out of pocket expenses.
While some states are still struggling with the basic details of creating a consumer exchange, Vermont has made a lot of progress and the Green Mountain Care Board is now ready to consider the basic outline of benefit packages that will be available to all individuals and small businesses in January of 2014.
Under the Affordable Care Act, there are four levels of coverage; platinum, gold, silver and bronze. The benefit package is the same in each category but the cost sharing requirements are very different and this factor will largely influence the cost of the policy.
For example, the annual deductible in the platinum plan is $250 – in the bronze plan it’s almost $2,000. The cap for out of pocket medical expenses in the platinum plan is roughly $1,000 – in the bronze plan it’s just over $6,000.
The cost of a trip to the emergency room is capped at $100 under the platinum plan – it’s $350 under the bronze plan. The cost of these services under the gold and silver plans fall between these two extremes.
Robin Lunge is the director of Health Care Reform for the Shumlin Administration.
"What we’re trying to do is balance diverse needs of consumers and diverse desires of consumers by having a range of choices from what some people may feel like is inadequate to what some people may feel like is too rich," said Lunge. " And so really give the range and then the consumer can find something that’s right for him or her."
Federal subsidies will be available for individuals and families with incomes up to 400% of the federal poverty level. That’s roughly $45,000 a year for an individual and $92,000 for a family of 4.
Let’s say you’re an individual with a $30,000 salary and your employer doesn’t offer health insurance. Under the exchange, you would be expected to pay roughly $2,400 for the middle range policy known as the "silver" option – federal subsidies would pay the rest.
Lunge says the federal subsidies are a critical way to make coverage more affordable.
"There are some affordability options in the federal law as well through the premium tax credits that should make insurance much more affordable for folks."
The Green Mountain Care Board will now study the cost sharing plan developed by the Shumlin Administration and it will seek public comments as part of that review.