Karen Tuttle, Administrator for Jefferson Surgical Clinic is one of many people in our area dealing with challenges that healthcare exchange options are presenting.
Tuttle explains, "As an employer you look at the cost benefit analysis of offering group health insurance sponsored by the employer, versus facilitating our employees transition to the exchange in order to purchase their own insurance."
Burman Clark, Muneris President helps J.S.C. and others navigate the options that are out there.
Clark says, "The perception for the last three years that we have heard about Obamacare has been that Obamacare was going to help everybody and quite frankly it is a very select group of people."
2 main questions can help clear up confusion -
1. Do I have affordable health insurance through my job?
2. If married do I have affordable health insurance through my spouse's employer?
* If you answered yes to either question then you likely are not eligible for any subsidy or tax credits offered through the health care exchanges. Clark says it is similar to paying "retail price" for coverage.
* If your answer is no to both questions then you are eligible for a subsidy or tax credit. Clark says think of it as paying "wholesale" price for coverage. In the Roanoke Valley there are forty eight exchange options to choose from.
Jefferson Surgical Clinic will continue to offer group coverage for employees but is also faced with the challenge of helping patients navigate the new options that are available.
Tuttle says, "It is such a politically charged and controversial subject that none of us whether we are a provider, or a patient, or business owner knows what the exchange is really going to hold for us come January 1st.
There are also public and private exchange options available. They are both the same plans with the same benefits but the public exchange is the only place that offers a subsidy and income is a factor.
There are a couple of instances when even if you have health insurance through your job you could be eligible for a subsidy -
1. The 9.5% affordability test- if you pay more than 9.5% of your total household income for insurance through your employer you are eligible for a subsidy through the exchange program.
2. The 60% rule - if your plan does not pay 60 percent of the cost of ten essential benefits such as preventive care and prescription drugs then you would also be eligible for a credit through the exchange program.
Find more information about the options that are available www.Healthcare.gov