Obamacare in Idaho: Credits, Penalties and Deadlines

The realities of how Gem State is handling the Affordable Care Act


There's a reason that David Chase didn't use the word "Obamacare" Jan. 8 while detailing the ins and outs of the Idaho Health Insurance Exchange: His audience couldn't have cared less about the politics surrounding the Affordable Care Act.

But just to make certain that he's sensitive to his audience, Chase said he usually takes the political temperature of the room.

"I come right out and ask people if they prefer to call it the 'Affordable Care Act' or 'Obamacare,'" Chase told Boise Weekly. "I'm perfectly OK with either."

But on this particular day, Chase sat in front of a group of Idahoans who were rich in diversity but unified in their interest--they were looking to save some money while securing health care.

"Let's face it: The name of it is the Affordable Care Act," he said, with particular emphasis on affordable. "People want to know if they can get a decent policy for a good deal."

And while not everyone is finding those cost savings, Chase--a so-called "in-person assister" from Boise-based Mountain States Group--said some have had better luck than others in keeping some money in their pocket.

"I've seen people save $200 or $300 a month, just by canceling their current policy and signing up for a plan that's similar to the one they just canceled," said Chase. "The big difference is, they're getting a subsidy to help pay for that coverage."

And those rebates--a lynchpin of the ACA--was a main topic of conversation as Chase facilitated the latest in a string of workshops held at the Collister Branch of the Boise Public Library.

Chase pointed to a chart (see it in the upper right column) that outlined who qualifies for those rebates under the new law.

"And those credits range anywhere to 2 [percent] to 9.5 percent of your income," said Chase.

Currently, the Idaho exchange includes health care coverage from four carriers--Blue Cross of Idaho, BridgeSpan, PacificSource and SelectHealth--and each provides plans in four categories: platinum, gold, silver and bronze. Simply put, the bronze plans cost a lot less but has high deductibles and co-pays. Conversely, platinum plans cost more but have very low deductibles and co-pays. Chase said bronze plans cover approximately 60 percent of what an insured person might normally pay for health care in a year; the remaining 40 percent would be the approximate out-of-pocket expenses that a patient would incur through doctor visits, treatments and prescriptions.

"That's about a 60/40 ratio," he said. "Silver is 70/30; gold is 80/20; platinum is 90/10."

And that's when Chase gave his first "inside tip" to the attendees who were still doing some comparative shopping on the exchange.

"Take a good look at those plans in the silver category. That's where the screaming deals are," he advised, getting everyone's attention. "We've seen some deals that were only about $10 or $20 a month after the subsidy. "

In Idaho, the four approved carriers offer a total of 43 different plans through the exchange: 14 bronze plans, 15 silver, 11 gold and two platinum.

But no matter what the plan--from bronze to platinum--every new policy offered through the exchange includes what the ACA mandates to be "essential health benefits": chronic disease management, emergency services, hospitalization, lab services, maternity and newborn care, mental health and substance abuse services, outpatient services, pediatric care (including vision and dental), prescription drugs, preventive and wellness services, and rehabilitation services and devices.

As for additional benefits, it still takes consumers a fair amount of research and more than a few phone calls to figure out what's covered and what's not. For example, alternative medicine--including acupuncture, chiropractic care, massage therapy and other homeopathic treatments. According to the National Institutes of Health, about four in 10 American adults are using some form of alternative medicine.

Section 2706 of the 2,400-page ACA requires that insurance companies "shall not discriminate" against any state-licensed health care provider. But that doesn't mean that insurance carriers in Idaho are required to include alternative treatments as part of the "essential health benefits" even if the services are provided by state-licensed providers.

"I'm a yoga teacher," said Naomi Jones, who is also the founder of the Idaho Health and Yoga Awareness organization. "I was told recently by a specialist who works for the International Association of Yoga Therapists that if a doctor prescribes yoga, chiropractic services or acupuncture, you can get a reimbursement through your insurance company."

Chase paused before he answered.

"It's possible," he said.

Boise Weekly contacted the Your Health Idaho call center to find out who did and who didn't, but we were ultimately directed elsewhere.

"What you need to do is call the individual insurance carriers to verify if their plans include alternative services," said Ian, a Your Health Idaho customer service rep.

And when BW contacted each of the approved carriers in the exchange, we got a mixed bag of answers.

"None of our plans through the exchange include acupuncture but, yes, some plans include chiropractic service," said a representative from Blue Cross of Idaho. "And I guess it would depend if there was a massage therapist affiliated with the chiropractor's office if we were to pay for massage."

A customer service representative from PacificSource told BW that all of the plans they offered through the exchange would include coverage for alternative care, including acupuncture and chiropractic services but not massage therapy. And representatives from BridgeSpan and Select Health said some of their plans included coverage for chiropractic services, but not acupuncture or massage.

George Meintel, a 60-year-old salmon fisherman who splits his time between Alaska and Idaho, said his reason for attending David Chase's presentation came down to how much money he might be able to save if he were to cancel his current policy and secure new coverage through the exchange.

"I pay through the nose. It's ridiculous," he said. "That's why I'm interested in the 'affordable' part of the Affordable Care Act."

But he'll need to shake a leg. If Meintel were to secure new coverage this week, it wouldn't be effective until March 1 (any policy purchased after the 15th of the month has to wait a month and a half before it's in effect). Additionally, this year's cutoff for signing up through the exchange is March 31.

"And after the end of March, you won't be able to purchase through the exchange until the next period opens in October," said Chase. "And you better keep in mind that you will be penalized if you don't have insurance coverage for three months or more. In the first year, the penalty is $95 per person ($47.50 for children) or 1 percent of your income, whichever is higher. In year two, it doubles. By year three, it's $600 per person ($300 per child) or 2.5 percent of your income. Let's face it; they want people to pay that money to get health insurance, not to pay penalties."

As BW was going to press, approximately 19,922 Idahoans had signed up for coverage through the exchange. Idaho is aiming to have at least 40,000 enrolled in 2014.