Health Insurance Marketplace in Alabama
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Alabama has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Alabama’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)?
Ascension Health is the nation’s largest Catholic and nonprofit health system. The Ascension Health Navigator project will assist consumers (individuals and small employers) in understanding new programs, taking advantage of consumer protections, and navigating the health insurance system to find the most affordable coverage that meets their needs.
AIDS Alabama devotes its energy and resources statewide to helping people with HIV/AIDS live healthy, independent lives and works to prevent the spread of HIV. AIDS Alabama Navigators will conduct community-wide educational events and presentations in an effort to educate Alabamians on the Federally-facilitated Marketplace. The project will focus on those newly-eligible for health insurance, especially reaching out to lower and middle-income populations.
Samford University, located just outside of Birmingham, Alabama will work with existing networks through its pharmacy, nursing, and education and professional studies schools to facilitate enrollment of individuals. The existing networks of schools and churches will reach a diverse community in the rural and metropolitan communities of Northern Alabama.
The Service Center of Catholic Social Services provides essential services and skills training in Mobile County since 1953. The Service Center’s Affordable Health Insurance Selection Program will provide enrollment assistance to low-income, under-insured, uninsured and vulnerable participants living in Mobile County, Alabama.
Tombigbee Healthcare Authority (THA) will place Navigators in 18 counties in the Alabama Delta Region to help consumers understand the new federal Marketplace coverage options and find the most affordable coverage that meets their health care needs. To achieve this goal, THA will develop a contractual agreement with its existing Delta Rural Access Program (DRAP) partners to expand their program focus. THA and these partnering agencies have been providing the Delta Region counties access to primary and preventive health care services, education and resources for more than nine years through outreach efforts in schools, churches, community centers, homes, and other community outlets.
Who you can contact for more help?
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in Alabama
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- University Of Alabama At Birmingham AL – Health Care Innovation Award
- TransforMED AL – Health Care Innovation Award
- University of Alabama Hospital Birmingham, AL – BPCI Initiative: Model 2
- d/b/a Amedisys Home Health Irondale, AL – BPCI Initiative: Model 3
- Amedisys Home Health Lakeshore of Birmingham Birmingham, AL – BPCI Initiative: Model 3
- d/b/a Amedisys Home Health Brent, AL – BPCI Initiative: Model 3
- d/b/a Amedisys Home Health Blountsville, AL – BPCI Initiative: Model 3
- d/b/a Amedisys Home Health of Walker Jasper, AL – BPCI Initiative: Model 3
- Top of Alabama Regional Council of Governments in Huntsville Huntsville, AL – Community-based Care Transition Program
- Southern Alabama Regional Council on Aging (SARCOA) Dothan, AL – Community-based Care Transition Program
- Franklin Primary Health Center, Inc. Aiello/Buskey Medical Center Prichard, AL – Community-based Care Transition Program
- Franklin Primary Health Center, Inc. Gilbertown Medical Center Gilbertown, AL – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Franklin Primary Health Center, Inc. Maysville Medical Center Mobile, AL – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Franklin Primary Health Center, Inc. Springhill Health Center Mobile, AL – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Hale County Health Center Greensboro, AL – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Southeast Alabama Rural Health Associates – Clayton Family Health Center Clayton, AL – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Southeast Alabama Rural Health Associates – Slocomb Family Health Center Slocomb, AL – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- UAB Obstetrics Complication Clinic (OBCC) Birmingham, AL – Strong Start for Mothers and Newborns Initiative
- Eastern Health Clinic Birmingham, AL – Strong Start for Mothers and Newborns Initiative
- USA Women’s and Children’s Hospital Mobile, AL – Strong Start for Mothers and Newborns Initiative
- Western Health Clinic Birmingham, AL – Strong Start for Mothers and Newborns Initiative
- West End Health Clinic Birmingham, AL – Strong Start for Mothers and Newborns Initiative
- Cox St. Clinic Mobile, AL – Strong Start for Mothers and Newborns Initiative
Establishing the Exchange in Alabama
Despite previously supporting Alabama’s implementation of a state-based health insurance exchange, Governor Robert Bentley (R) announced on November 13, 2012, the state will default to a federally-facilitated exchange.1
Prior to the decision, Governor Bentley issued Executive Order 17 which created the Alabama Health Insurance Exchange Study Commission to recommend how Alabama should establish a health insurance exchange.2 The Governor appointed an Executive Director of the Alabama Health Insurance Exchange to work with stakeholders and other state agencies on implementing the recommendations of the Commission.3After meeting for three months, the 15-member Health Insurance Exchange Study Commission released final recommendations in late November 2011 to the Governor and Legislature endorsing the establishment of the “Alabama Health Insurance Marketplace.”4 Additional recommendations included, establishing a new quasi-public authority to operate the exchange, following a free market facilitator model, establishing one administrative entity to oversee both the individual and small business exchanges while keeping the risk-pools for both separate, and funding the exchange through fees on all products sold in the individual and small group markets inside and outside the exchange.5
In May 2012, the Governor threatened to veto a bill establishing a state exchange, which passed in the House, if it cleared the Senate before the Supreme Court ruled on the constitutionality of the Affordable Care Act (ACA). The bill failed at the close of the 2012 legislative session, as did a similar bill in 2011.6
Governor Bentley signed into law a measure in May 2012, prohibiting health plans operating within an Alabama exchange from offering abortion services except in cases of life endangerment, rape, or incest.7
Information Technology (IT): In February 2012, the Office of the Alabama Health Insurance Exchange, within the Department of Insurance, released a Request for Information on the IT systems necessary to develop the state’s exchange.8 The state anticipated leveraging existing technology infrastructure to build components of the exchange related to screening, applications, and eligibility determinations. In June 2012, the Department released a Request for Proposals soliciting a subcontractor to build an eligibility and enrollment system capable of making determinations for the state’s Exchange, Medicaid, and the Children’s Health Insurance Program (CHIP); however, the award was put on hold until after the November elections.9 Alabama was also participating in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use.10
Alabama is focusing on a significant Medicaid eligibility system upgrade. The state received CMS approval for an enhanced federal match to assist in financing IT upgrades of the state’s Medicaid eligibility and enrollment system.11 The Alabama Medicaid Agency released a Request for Proposals earlier this year soliciting subcontractors to implement the new system which will meet future exchange interoperability standards.12 Work on the Medicaid eligibility system was anticipated to begin in April 2012.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Alabama has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Alabama 320 Plan PPO.
The Alabama Department of Insurance received a federal Exchange Planning grant of approximately $1 million in 2010. In November 2011, the Department was awarded an $8.6 million federal Level One Establishment grant to support contracts and activities around exchange implementation.13
Alabama, along with nine other states, received technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance included help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.14
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Alabama is not participating in Medicaid expansion.
The federal government will assume full responsibility for running a health insurance exchange in Alabama beginning in 2014.
Additional information about Alabama’s health insurance exchange efforts can be found at:
1. Office of the Governor Press Release. Governor Bentley Announces Alabama will Not Set Up State Insurance Exchange. November 13, 2012.http://governor.alabama.gov/news/news_detail.aspx?ID=7251
2. Executive Order 17 issued on June 2, 2011. http://governor.alabama.gov/news/news_detail.aspx?ID=5164
3. Press Office Release Governor Bentley. “Alabama Health Insurance Exchange Study Commission Holds Organizational Meeting.” September 16, 2011.http://governor.alabama.gov/news/news_detail.aspx?ID=5603
4. Alabama Health Insurance Exchange Study Commission Recommendations. Alabama Department of Insurance. November 2011. http://www.governor.alabama.gov/pdfs/HIXStudyCommissionReport.pdf
5. Alabama Exchange Planning Grant, Quarter 2 Report. (1/1/2011-3/31/2011)http://www.aldoi.gov/PDF/Consumers/SQReport.pdf
6. King, Samuel. “Governor promises veto of insurance exchange bill.” WFSA.com. May 12, 2012.http://www.wsfa.com/story/18075972/governor-promises-veto-of-insurance-exchange-bill
7. SB 10. 2012 Regular Session. Enrolled Copy. http://www.openbama.org/bills/1059/SB10-enr.pdf
8. Request for Information. Department of Insurance. Office of the Alabama Health Insurance Exchange. February 23, 2012. http://www.aldoi.gov/PDF/Consumers/RFI-Alabama-HIX-14.pdf
9.Request for Proposal for the Alabama Health Insurance Exchange System. Department of Insurance- Office of the Alabama Health Insurance Exchange. June 7, 2012.http://www.aldoi.gov/PDF/Consumers/FINAL-Alabama-HIX-RFP-v47_acceptedchange.pdf
10. Enroll UX 2014 website. http://www.ux2014.org/
11. Performing Under Pressure: Annual Findings of a 50-state survey of Eligibility, Enrollment, Renewal, and cost-sharing policies in Medicaid and CHIP. January 2012. Kaiser Family Foundation. http://www.kff.org/medicaid/upload/8272.pdf
12. Request for Proposal for the Medicaid Eligibility Determination System. Alabama Medicaid Agency. January 5, 2012.http://medicaid.alabama.gov/documents/2.0_Newsroom/2.4_Procurement/2.4_Med_Elig_Deter_Sys_RFP_Updated_1-5-12.pdf
13. Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List. http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html(Accessed December 1, 2011).
14. Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011. http://www.rwjf.org/coverage/product.jsp?id=72289
Also of interest
Provided by the Henry J. Kaiser Family Foundation