Paul Szmal: It's 8.15, FLX Morning, Friday. We've got partial computer repair underway here. We can't do our interview though, that's good. We have Autumn White with us from Finger Lakes Community Health. She is a financial advocate who can help you make the right choice in healthcare. Good morning, it's great to have you here.
Autumn White: Good morning, Ted. Thank you for having me.
Paul Szmal: So, let's talk, before we talk about the exciting changes in the Essential Plan, remind people what this is. This is New York State's offering under the Affordable Care Act, correct?
Autumn White: Correct. The New York State of Health Marketplace started because of the Affordable Care Act. The Essential Plan has been around since 2016, and they've just expanded it to cover more people.
Paul Szmal: So, let's talk about these changes. So, one of the things is the income level has gone up considerably, so now people, you know, for a long time people would say, well, I probably don't qualify, but you need to take another look.
Autumn White: Exactly. They've raised the limits for the Essential Plan from 200% of the poverty level up to 250, so it's helping a lot more people. And so, the first check is always whether you can get affordable care through your employer. So, what does the state consider to be affordable, and then if you don't qualify that, then we can get into the Essential Plan.
Paul Szmal: Exactly. This year, 2024, affordable is 8.5% of your gross household income. So, we would take into account spouse's income and look at the employer prices for an individual, for a spouse, and for a family. So, usually the employee coverage might be affordable, but not when you go to add a spouse or family. So, we could do the Essential Plan for the spouse, maybe Child Health Plus for the children.
Autumn White: So, before we get into some of these, the coverages and the changes, explain, figure like Community Health has several trained patient navigators, because a lot of people, you know, we're already a couple minutes in and their heads are spinning and they're going this income, that income. So, explain how those navigators can help people make the right choice.
Paul Szmal: There's actually a difference between patient navigator and health insurance navigator. So, as a health insurance navigator, we sit down with people and go over their financial information to see about coverage, and then a patient navigator helps with other sorts of things at the health center to help get appointments set up and interpretation, things like that, through Finger Lakes Community Health's sites, locations.
Autumn White: So, let's talk about... That's a little different.
Paul Szmal: Okay, let's talk about the coverage under the Essential Plan, because this is very comprehensive. I mean, you get a lot of coverage with this plan.
Autumn White: You do. It's the 10 essential health benefits plus vision and dental, and there are no co-pays for vision, dental, preventative care, and starting in January, no co-pays for diabetic care.
Paul Szmal: Wow. Yeah, and there's no premium or deductible with the Essential Plan.
Autumn White: Wait, no premium?
Paul Szmal: No premium.
Autumn White: Wow. So, if someone doesn't go to the doctor one month, they pay absolutely nothing.
Paul Szmal: Wow, that's fantastic. Yep, it's been great, and expanding it to the 250% of the poverty level, they've just opened it up to so many more people. But above that, if somebody is above the 250 and still can't get affordable insurance through their employer, we do still have the Qualified Health Plans with premium tax credits that people can apply for.
Autumn White: Yeah, now explain how some of those work. How does that work?
Paul Szmal: Those we do at open enrollment or within 60 days of losing other coverage. We, again, would look at their financial information for the year. The tax credits are based on their taxable income for the entire calendar year, and then we would show them the options for high deductible, medium deductible. We've got the bronze, silver, gold, and platinum levels with different price points and different companies that work with us. MVP, Excellus, and Fidelis are the biggest ones in the area.
Autumn White: Now, a couple of things for younger people. You can be on your parent's plan up to age 26. So after that, explain the options for someone who's just turned 27 and can't be on their parent's plan anymore.
Paul Szmal: Yep. At that point, we would base it just on that individual's income, since they're no longer independent. And if they can't get insurance through their own employer, and they're no longer able to get it through their parent's employer, we would screen them for Medicaid, the Essential Plan, or one of these Qualified Health Plans with tax credits.
Autumn White: And then let's talk about Child Health Plus for the younger kids in the family.
Paul Szmal: Yes. A lot of people don't realize that they can get Child Health Plus even if a family plan is available through their job. Everyone who's not a public employee, so only people who can get NYSHIP, the New York State Health Insurance Plan, they're the only ones who are not eligible for Child Health Plus. Everyone else can see if it might save them money, and it usually does. That one also has no deductible, and there are no co-pays. Maybe a premium, if there is a free category. And then if they're over that, there's a 15-category, a $30-a-month category. So there's subsidized levels for the Child Health Plus as well.
Autumn White: So I think a lot of people are hearing this and going, wow, I think I can afford this. And maybe for people who haven't had any option, now they have one. What's the best way to get a hold of a healthcare navigator at Finger Lakes Community Health? And then what information should you have when you come to your appointment?
Paul Szmal: The best way to schedule an appointment is by calling 315-531-9102. We also have the 211 helpline out of Bath that does some scheduling for in-person appointments at 1-800-346-2211. They would want to bring everyone's Social Security numbers and birthdates and proof of income, such as the most recent four weeks of pay stubs or their tax return if they're self-employed.
Autumn White: So once again, with these changes in the income level, a family of four can earn up to $78,000 per year and qualify under the Essential Plan. That's gone up considerably. And the percentage of your gross income has changed as well. So you can check first to see if you qualify for your Employer's Plan. But for many people who don't, or not that qualify, but who earn more money, can get on the Essential Plan. It's a pretty good deal.
Paul Szmal: Exactly. All right, Autumn White, who is one of the financial advocates at Finger Lakes Community Health, which operates, is it eight or nine? I lose track.
Autumn White: Eight or nine health centers now. I think it's eight. I'm remote. I'm not in the community, so I'm not located at any of the centers. I think there are eight of them. Go to localcommunityhealth.com and you'll find one near you. I'm a patient of the one here in Geneva.
Paul Szmal: Autumn, thanks for being on with us. And this is just terrific news, and it's going to help a lot of people. So thanks for sharing it with us.
Autumn White: Thank you for having me. Bye.
