Healthcare Reform

Starting next year, the government will require nearly everyone to have health insurance or pay a tax penalty. This change is a result of healthcare reform. To help make coverage affordable, there will be a new Health Insurance Marketplace option for buying insurance. The Marketplace is a government-regulated online portal where you can compare plans and select coverage. You must buy insurance by March 31 in order to avoid the tax penalty.

This doesn’t mean that you have to buy insurance through the Marketplace. Riverside will still offer health coverage to full- and part-time team members. If you are not eligible for Riverside insurance, you may qualify for a subsidy on the Marketplace to discount your premiums and make coverage more affordable for you. Subsidies may also be available for some people who find that Riverside’s plans are not affordable for them. If you are eligible for Riverside insurance but the premium cost for you alone (and not any other members of your family) is more than 9.5 percent of your household income, you may qualify for a subsidy on the Marketplace.

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Who is likely to qualify for a subsidy
Health plans offered by Riverside will affect whether you can save on your premium through the Health Insurance Marketplace. In fact, three factors will determine whether you will be eligible for a discounted premium, or subsidy:

1. Does your employer offer you health insurance?

2. Is that insurance affordable for you?

3. What is your household size and income?

Use the chart below to get an idea whether you may qualify for a discounted premium, or subsidy:

Web decision tree

Will my premiums cost less on the Marketplace?
When you buy health insurance coverage in the Marketplace, you may qualify for tax credits (also called a subsidy) to help pay your premiums. Your income and family size determine if you qualify. You'll see the amount of savings you're eligible for when you fill out your Marketplace application. Prices shown for insurance plans will reflect the lower costs. These lower costs are possible because of a tax credit that can be applied immediately. You can get a rough estimate of costs and savings by using the Kaiser Family Foundation calculator.

One other thing to consider is that if you enroll in Riverside insurance, the company may pay a portion of your premium cost. By choosing the Marketplace, you will not be able to take advantage of this benefit.

Choosing the Marketplace can also affect your tax status. This is because the amount paid by Riverside and by team members toward their insurance premium is not subject to income tax. The insurance you buy through the Marketplace would be paid for on an after-tax basis.

Marketplace insurance options
The Marketplace will offer private insurance plans with four levels of coverage. The plans are coded as bronze, silver, gold and platinum, in order of least to most expensive. The main difference between the plans is cost sharing. Bronze plans cover 60 percent of expected medical costs; silver plans cover 70 percent; gold will cover 80 percent, and platinum will cover 90 percent.

All the plan categories offer the same set of essential health benefits. Things to consider when comparing plans include how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. Premiums are higher for plans that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold plan, you'll likely pay a higher premium, but you should have lower costs when you go to the doctor or use another medical service.

With a Bronze plan, you'll likely pay a lower premium, but you'll pay a higher share of costs when you get care. For a hospital stay that costs $10,000, for example, you will be responsible for paying $4,000 out of pocket.

In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.

Think about the health care needs of your household when considering which Marketplace insurance plan to buy.

The Marketplace also offers "catastrophic" plans to people under 30 years old and to some people with very low incomes.

Make sure providers of choice are in network
If you buy insurance on the Marketplace, make sure the physicians and facilities of your choice will be covered as in network by that plan. (If they are out of network, it will cost you more.) Remember that Riverside offers a 25 percent discount to all team members, their spouses and their dependents for eligible charges at RHS facilities.

Key dates to keep in mind with the Marketplace
There are three key dates:

  • Oct. 1, 2013: Marketplace open enrollment starts.
  • Jan. 1, 2014: Health coverage can start. (You must enroll by Dec. 15 for your coverage to take effect on Jan. 1, 2014.)
  • March 31, 2014: Marketplace open enrollment ends.

Penalty amounts
Under the law, nearly everyone must have health insurance for themselves and their dependents. The penalty for not enrolling in health insurance for 2014 is $95 per uninsured person, or 1 percent of household income (whichever is greater). The amount escalates each year to $695 in 2016.

Help enrolling in the Marketplace
Online questions and answers will be available at the Marketplace. You can also contact the government's toll-free call center at 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24/7.

You may also sign up for e-mail or text updates by clicking here.

Healthcare Navigator Heather Parsons can help enroll people in the Marketplace. She covers Hampton and Newport News. Call her at 757-275-0125.

Contact Enroll Virginia to be routed to a navigator for your area. Call 888-392-5132 or click here.

Carebridge offers all Riverside team members and their covered dependents general help accessing the Marketplace. Carebridge does not endorse or sell individual health insurance plans and will not provide personalized guidance on the selection of plans. Contact Carebridge by calling 1-800-437-0911.

Is the Marketplace open to me if I am not a citizen?
To be eligible for insurance through the Marketplace you must live in the United States, and you must be here legally. Click here to get a list of immigration statuses that qualify for Marketplace coverage.

Will the Marketplace affect people who have Medicare?
Medicare benefits will not change under the healthcare reform law. Medicare beneficiaries will still go to for their plans.

If I have a change in status, or a qualifying event, can I enroll in the Marketplace at times other than their open enrollment period?
You may qualify to enroll for Marketplace insurance at times other than open enrollment if you have a change in status known as a qualifying event. Examples would be moving to a new state, certain changes in income and getting married or divorced.

Riverside's 2014 insurance options
Click here to explore Riverside options. Open Enrollment, or the period where you can sign up for insurance, will take place Nov. 4-15.

Open Enrollment for the Marketplace starts Oct. 1 and concludes March 31, 2014.

Explore your options for discounted insurance on the Health Insurance Marketplace

Find out if you might get a subsidy, and how much it might be, using the online calculator offered by the Kaiser Family Foundation.

Low-income and disabled Virginians may qualify for Medicaid.

Marketplace questions answered. Click here.

Contact Enroll Virginia to be routed to a navigator for your area who can help you enroll in the Marketplace. Click here.


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