In Practice: Health Exchange: A One-Month Checkup

Health Exchange: A One-Month Checkup - NYTimes.com

The Affordable Care Act's goal of providing health insurance for all Americans grew more complicated when governors of more than 30 states
opted not to create their own health care exchanges. That left the federal government responsible for enrolling a much larger portion of the population than it had expected, which is at least part of the reason for the troubled rollout of HealthCare.gov.

"It would be one thing if it was just a federal marketplace with federal plans and federal Medicaid rules, but it's not," said Elisabeth R. Benjamin, a vice president at the Community Service Society of New York that helps enrollees navigate the state exchange website. "That's a pretty big endeavor that you wouldn't really want to pull off in a year or 18 months, which is essentially what they had to do when it became clear that some of these states were opting out."

According to documents released by a House oversight committee, fewer than a dozen people were actually enrolled on Oct. 1, the opening day for HealthCare.gov. To meet the Obama administration's goal of seven million enrollees by March 31, it needs an average of more than 38,000 per day.

"The website right now is kind of give or take, you know?" said Steph Mulvey, a canvasser for the Texas Organizing Project, which aims to help people enroll. "Some people are going on at 3 a.m. and having luck. It's all about when you do it."

For more information on how the health care exchanges are performing, see these graphics from The New York Times:

• How HealthCare.gov Was Supposed to Work and How It Didn't

• State-by-State Premiums Under the Health Care Law

• Tracking the Progress of the Health Exchanges

• Why Some People Can't Keep Their Insurance Plans

How Much Will It Cost Me?

Subsidies you could be eligible for ...

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Your reduced monthly premium

offers additional state subsidies, so the amount you would pay could be lower.

Because the share of your income you would be paying is below a set cap, you will not be eligible for premium subsidies.

The maximum amount you would have to pay each year "out-of-pocket" for deductibles, copayments and services not covered by insurance can be no more than ...

Income

Your income is of the federal poverty level.

Because is expanding its Medicaid program to cover most people up to 138 percent of the federal poverty level, you and your family will likely be eligible for Medicaid.

Because your income is between one to four times the federal poverty level, you will be eligible for subsidies to help you pay the premium, as long as you don't qualify for Medicaid, Medicare or job-based coverage.

Because your income is less than 100 percent of the poverty level, you will not be eligible for premium subsidies.

is not expanding its Medicaid program, but you or some of your family members could still be eligible under your state's rules.

Children younger than age 19 at this income level are likely to be eligible for Medicaid or Children's Health Insurance Program coverage. To get the most accurate estimate for your family's premium, do not include eligible children in your list of family members needing coverage.

Because your income is greater than 400 percent of the poverty level, you will not be eligible for premium subsidies.

Your Coverage

Prices shown are for the second-cheapest "silver"-level plan that would cover your entire family. Silver plans are expected to cover about 70 percent of health care costs and may cover more for lower income people who are eligible for cost sharing subsidies.

Tobacco

In most states, insurers can add a tobacco surcharge of up to 50 percent of your premium before the tax credit. If you get a subsidy, it cannot be applied to the surcharge.

Other Coverage Options

Under the exchanges, silver plans are expected to cover about 70 percent of health care costs. More comprehensive gold plans are expected to cover 80 percent, and bronze plans are expected to cover 60 percent. An even less comprehensive catastrophic plan is available for people under 30 and people who would have to spend more than 8 percent of their income on a bronze plan.

Notes

Cost estimates are based on an analysis by the Department of Health and Human Services and the Kaiser Family Foundation of expected premiums in 2014. Actual premiums will vary by insurance company and by the degree of competition in the market.

Income is measured using modified adjusted gross income, which includes wages, salary, foreign income, interest, dividends, and Social Security, but not gifts, inheritance or survivors benefits.