FOX 8 Special Report: Shopping for Your Health, Part 1 - FOX 8, WVUE,, weather, app, news, saints

FOX 8 Special Report: Shopping for Your Health, Part 1

NEW ORLEANS - Hundreds of thousands of Louisiana residents are without health insurance, and seconds after midnight Monday they can begin shopping the so-called "health insurance marketplace," also known as the insurance exchange.

Keina Willis of Jefferson Parish does not have medical coverage, and she faces a mountain of hospital bills from a westbank hospital.

"I owe $60,000, and I'm like, 'ok.' I don't know what else to say," said Willis, as she fought back tears while discussing her situation.

Trey Roberts also has no insurance.

"At this point, it hasn't really affected me," he said. "I'm relatively healthy and still relatively young. My occasional visit to the hospital - like an injury from playing sports - I go to the emergency room and just pay out of pocket for whatever care or whatever prescriptions that I need."

The federal Department of Health and Human Services estimates that 20 percent or 794,805 Louisianans are uninsured. State health officials believe the number is between 16 percent to 17 percent.

The Oct. 1 opening of the health insurance marketplace comes just three months before most Americans will be required to have health insurance as part of the "individual mandate" included in the health care reform law upheld by the U.S. Supreme Court. Coverage purchased through the marketplace begins Jan. 1, 2014.

The State of Louisiana opted out of setting up its own insurance marketplace, so the federal government is in charge of the marketplace for the state. Four Louisiana insurers are participating in the marketplace: Blue Cross & Blue Shield, Humana, the Louisiana Health Cooperative, and Vantage Health.  Blue Cross & Blue Shield and Louisiana Health Cooperative will offer coverage statewide; Vantage Health and Humana will not cover every zip code in the state, according state insurance department officials.

"It may be only four companies, but they are four big companies," said Walter Lane, Ph.D., a UNO economist considered an expert in healthcare economics. "Obviously, they think that they're going to be able to make money, or they wouldn't be getting into the business. None of these are doing this for pure charity causes."

The feds say the Louisiana insurance marketplace will offer the uninsured a slew of choices.

"There are four companies offering plans, but those companies have many different plans, and there will be about 40 that will meet the federally mandated, [or] what's called 'essential health benefits' criteria," said Louisiana Insurance Commissioner Jim Donelon.

Marketplace plans fall into four categories: Bronze, which covers 60 percent of health care services; Silver, which covers 70 percent; Gold, which covers 80 percent; and Platinum, which covers 90 percent of out-of-pocket medical expenses. Deductibles and premiums are affected by the plans chosen and where the enrollees live.

"The higher you go, Platinum, the more expensive, but the smaller co-pay required; the lower you go, the less expensive, but a higher co-pay," Donelon said.

According to the Kaiser Family Foundation, a non-profit that studies health care issues, the average monthly premium for an individual in Louisiana is $206. Under employer-based plans, on average an employee's annual contribution is $1,217 or $101.41 monthly. For a family of four in Louisiana, the annual premium is estimated to be $4,416.

The federal government released a report last week in advance of the marketplace opening, which said, on average, a 27-year-old living in New Orleans who purchases the lowest Bronze plan would have a monthly premium of $170. If the 27-year-old's annual salary is $25,000 and he or she chooses the lowest Bronze plan, with a premium subsidy thrown in, the monthly premium drops to $74, according to the Department of Health and Human Services.  

For a family of four in New Orleans earning $50,000 a year, the monthly premium for the Silver plan would be $875, but drops to $282 if the family qualifies for a premium tax credit.  

All plans offered through the insurance marketplace must offer certain benefits: inpatient and outpatient care, trips to the emergency room, preventive and wellness care, maternity and newborn care, mental health and substance abuse treatment, contraceptives, prescription drugs, rehab services, laboratory tests and pediatric care.

"It's vital, from a public health standpoint, we want the general public to have access to preventive care, to primary care," said Mollye Demosthenidy, J.D., MHA., of Tulane University's School of Public Health.

Under the law, women will no longer be charged more than men for health insurance.

"Women now have access to free preventive services that they might not have been able to access before," said Demosthenidy.

The state is not expanding eligibility for its Medicaid Program - something all states have been encouraged to do under health care reform.

"It's not that we're abandoning the uninsured, we're actually working very hard to make sure that the uninsured continue to receive health care services. We've invested a lot of resources in our public-private partnerships to allow those uninsured to get the same level of care that currently privately insured individuals get," said Kathy Kliebert, Secretary of Louisiana's Department of Health and Hospitals.  

DHH said the state's partnership in New Orleans with Louisiana Children's Medical Center has resulted in an increased capacity for beds on a daily basis, the reopening of operating rooms that had been closed, an increase in surgeries, a reduction in emergency room saturation from 96-percent to five percent or less, and additional acute and ER beds are to be added to the LSU Interim Hospital this fall.

Kliebert said the expansion of the state's Medicaid Program would come with a hefty price tag.

"We feel very strongly that it will cost us anywhere from up to $60 million in the current fiscal year if we were to expand to over $1.7 billion dollars over a 10 year period now there are other estimates of course that make those estimates lower," said Kliebert.

She said a large chunk of the state's population is already on Medicaid.

"It would actually put over 41-percent of our population on the Medicaid rolls, a lot of people don't realize that we already have 29-percent of our population on Medicaid," stated Kliebert.

The federal government said it would cover the full bill for states expanding their Medicaid rolls for the first three years, then phases down to 90 percent.

The health insurance marketplace is not for everyone. If you have Medicaid insurance, Medicare, or are part of the Children's Health Insurance Program known as CHIP, TRICARE for current service members and military retirees, their families and survivors, or an affordable individual or employer-based insurance plan that you like you do not need to do anything in the marketplace, according to

Also, illegal immigrants cannot participate in the marketplace.

Some health care reforms have been in place for months. Young adults can remain on their parents' insurance until age 26; barriers to coverage due to pre-existing medical conditions no longer exist for children up to age 19, and will no longer exist for adults come Jan. 1 and lifetime maximums are a thing of the past.

"The things that have already gone into effect are the elimination of pre-existing condition exclusions. Well, that's a very costly thing for insurance companies," said Lane.

"The industry, the companies have said we should anticipate a 30 percent to 40 percent cost increase in the next year as this goes into effect," said Donelon.

Open enrollment through the insurance marketplace ends March 31, 2014.  You can apply online, by mail, or in person with the help of a so-called "navigators" or trained helpers.

For more information, click here or call (800) 318-2596.

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