Many questions surround Affordable Care Act, state-specific insurance exchanges

DES MOINES - One night earlier this month, the AARP hosted a conference call with Iowa Insurance Commissioner Nick Gerhart.

More than 8,000 people joined.

Such is the state of uncertainty surrounding the Affordable Care Act and the launch of state-specific insurance exchanges that go live on Oct. 1. There are a lot of questions and, while there are answers, sometimes they are hard to find, or hard to understand.

Oftentimes, the answer has to be prefaced with a disclaimer, like the one Gerhart gave several times during the hourlong conference call: “This gets very confusing.” His other frequently-used disclaimer was “It depends on your specific circumstance, but in general …”

The federal law requires that nearly everyone carry health insurance either through work or purchase it themselves.

State officials estimate anywhere from less than 100,000 to 350,000 or more people will sign up for plans through the exchange, also called the marketplace, before they are required to take effect on Jan. 1, 2014.

“Thing is, this is new for everyone,” said Tom Alger, spokesman for the Iowa Insurance Division. “We don't know how it's going to work out until we get there.”

What's an exchange?

The Affordable Care Act requires states to set up insurance exchanges where companies could offer insurance plans to consumers. Plans offered on the exchange must meet certain federal coverage requirements - for example, people cannot be denied because of pre-existing conditions.

Where is this exchange?

The starting point is the federal government website, www.HealthCare.gov. Drop-down menus will help you navigate through the process in order to compare health care offerings for your circumstances. The insurance policies being offered in California or Texas, for example, will be different than the ones being offered in Iowa. There are even differences in policy options depending on what part of the state you live in.

I thought Iowa was doing its own thing. Why am I going to a federal government website?

States had the option of going three ways in setting up their exchanges: a state-run exchange, a federal-run exchange or a state-federal partnership. Iowa chose the partnership model. So while the insurance plans are run through the Iowa Insurance Division, the federal government is maintaining the exchange web portal.

Can I see the companies and plans involved in Iowa's insurance exchange?

Final policies and prices have not yet been released, but will be posted on the exchange no later than Oct. 1.

Six companies will offer insurance on the Iowa health care exchange. Two companies, Coventry Health Care and CoOportunity Health are offering policies statewide. Four other companies are offering policies in specific regions. Those companies are: Avera Health Plans, Gunderson Health Plan, Sanford Health and Health Alliance Midwest.

Will the policy prices on the exchange be lower than what's available now?

A lot of that depends on the specific circumstances of the individual. The Affordable Care Act put in place minimum coverage requirements that all insurance plans will have to offer eventually. These may or may not be different than the current plan an individual has, so costs would reflect that.

So it will be “affordable?” Like it says in the name, right?

Affordable is a subjective term, and lawmakers determined that insurance which costs up to 9.5 percent of annual income is considered “affordable.”

The law allows for subsidies on a sliding scale for people who make up to 400 percent of the federal poverty level, or roughly $94,000 a year for a family of four.

What's this I hear about different types of plan categories?

The ACA separates plans into four categories based on how much your premium will cost and what your out-of-pocket costs will come to. Premiums are the monthly fees now typically paid by you and/or your employer. Out-of-pocket costs are items not covered by your plan.

The categories are platinum, gold, silver and bronze. These categories aren't related to the quality or coverage of insurance, just how much you can expect to pay in premiums and out-of-pocket costs, which are typically inversely expensive. Plans with higher premiums typically have lower out-of-pocket costs and vice versa.

In the ACA model, platinum plans have the highest premiums and cover 90 percent or more of expenses, gold plans are the second-highest and cover 80 percent, silver covers 70 percent and has the third-highest premiums, while bronze plans have the lowest premiums and cover roughly 60 percent.

So someone who expects to have a lot of doctor visits and/or regular prescriptions would likely want a platinum or gold plan, while someone with less-frequent doctor visits may want to choose a silver or bronze plan.

Who else can help me choose my plan?

Three Iowa agencies - Genesis Health System, Visiting Nursing Services of Iowa and Planned Parenthood - are designated “navigator” agencies in the state. They have staff trained on how to help people use the exchanges.

By law and rule they are prohibited from having conflicts of interest, meaning they can't have financial relationships with the companies selling the insurance policies.

Are there other information resources out there?

In addition to the www.healthcare.gov website and the navigators, there's a 24-7 hotline at 1-800-318-2596 or (TTY: 1-855-889-4325). In addition, by going to the https://www.healthcare.gov/contact-us/ address, consumers can get involved in real-time, online chats or get directed to state-specific help.

The Iowa Insurance Division also is hosting more than 20 town-hall meetings in various locations around the state to give people information about the Affordable Care Act and the changes that come with it. The listing can be found at the agency's website here: http://www.iid.state.ia.us/