eHealth Obamacare Countdown: Your Third Step to Get Ready for Health Reform This Year

eHealth Obamacare Countdown: Your Third Step to Get Ready for Health Reform 
This Year 
MOUNTAIN VIEW, CA -- (Marketwired) -- 07/15/13 --  Today eHealth,
Inc. (NASDAQ: EHTH) (www.ehealthinsurance.com), parent company of
eHealthInsurance, the Nation's first and largest private online
health insurance exchange, published the third step in its six step
guide to help consumers prepare for health care reform and this
year's new open enrollment period, which begins October 1, 2013.  
Beginning in 2014, individuals and families who do not have major
medical health insurance that meets minimum federal standards may be
subject to a tax penalty, which has been dubbed "the mandate tax."
The new open enrollment period will be the first opportunity
consumers will have to research new health insurance plans, compare
benefits and prices and enroll. But you cannot be an effective
shopper if you don't understand what you're shopping for. 
In Step One of this six step process, eHealth described when an
individual or family that already had health insurance might be
required to enroll in a new plan. In Step 2, eHealth explained the
mandate tax and subsidies made available by the Affordable Care Act
(ACA) and designed to help make insurance more affordable. Now, in
Step Three, eHealth examines the benefit levels and overall structure
of the new, reformed health insurance plans that will be made
available for 2014, and explains the Bronze, Silver, Gold and
Platinum level "actuarial values." 
Step 3: July 2013: Get to know the features of America's new health
insurance plans - Starting January 1, 2014, the way health insurance
benefits are structured will be changed forever. To shop smart,
consumers need to understand what benefits every plan they enroll in
must have in order to help them avoid the mandate tax.  
What's covered? Each new health insurance plan will cover at least 10
health benefits deemed to be essential under the Affordable Care Act.
Before the ACA became law, eHealth built its own list of eight
"essential" benefits and tracked the percentage of plans that covered
them. 
This table breaks down the new list, the old list, and how often the
new benefits would be covered: 


 
                                                                            
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  ACA 10 Essential    % of Qualified        eHealth's     % of Plans Sold by
  Health Benefits     Plans Covering     "Comprehensive"    eHealth in 2012 
                           EHBs         Benefits in 2012       Covering     
                                                            "Comprehensive" 
                                                               Benefits     
----------------------------------------------------------------------------
     Laboratory                         Laboratory and           99.2%      
     services;                               X-Ray                          
-------------------                    -------------------------------------
Emergency services;                    Emergency Services        99.7%      
-------------------                    -------------------------------------
Prescription drugs;                    Prescription Drugs        88.1%      
-------------------                    -------------------------------------
  Mental health &                         Chiropractic           70.9%      
   substance use                                                            
 disorder services;                                                         
-------------------                    -------------------------------------
   Maternity and           100%            Maternity;            18.9%      
   newborn care;                                                            
-------------------                    -------------------------------------
Pediatric services,                      Well Baby care          87.1%      
 including oral and                                                         
    vision care;                                                            
-------------------                    -------------------------------------
 Rehabilitative and                          OB/GYN              90.5%      
    habilitative                                                            
    services and                                                            
      devices;                                                              
-------------------                    -------------------------------------
 Ambulatory patient                      Periodic Exams           88%       
     services;                                                              
-------------------                                                         
   Preventive and                                                           
 wellness services                                                          
and chronic disease                                                         
    management;                                                             
-------------------                                                         
  Hospitalization;                                                          
----------------------------------------------------------------------------

 
How much is covered? All new reformed plans will have a "metallic"
benefit level designed to allow consumers to make more informed
decisions when comparing plans. 
The metallic benefit levels start at a minimum of 60% and go up to
90% of the plan's "actuarial value." The actuarial value is equal to
the percentage of total average costs for covered benefits that a
plan will pay.  
A plan with a 60% actuarial value would pay for an average of 60% of
all covered medical costs and the customer would be responsible for
40% of covered medical costs. Insurers may also offer
catastrophic-only plans to eligible individuals, which would have
higher cost-sharing than the standard metallic plans. 
These are the metallic designations: 


 
                                                                           
---------------------------------------------------------------------------
         Metallic Designation                    Actuarial Value           
---------------------------------------------------------------------------
          Catastrophic Plans                         ≤ 60%             
---------------------------------------------------------------------------
                Bronze                                 60%                 
---------------------------------------------------------------------------
                Silver                                 70%                 
---------------------------------------------------------------------------
                 Gold                                  80%                 
---------------------------------------------------------------------------
               Platinum                                90%                 
---------------------------------------------------------------------------

 
How will cost-sharing work? Out-of-pocket costs like coinsurance,
co-pays and deductibles will also be limited under the law. For those
whose incomes are below 400% of the Federal Poverty Level (FPL), the
ACA limits their cost-sharing with subsidies that cap their
out-of-pocket costs.  
The ACA restricts the out-of-pocket limit on all plans to the amount
allowed for health plans with Health Savings Accounts (HSAs): $6,250
for an individual and $12,500 for a family in 2013. These numbers may
seem high, but if your income is at or below 400% of FPL then your
out-of-pocket liability is capped. Cost-sharing that exceeds the
limits set for your household income are subsidized at the levels
outlined in this chart:  


 
                                                                           
---------------------------------------------------------------------------
  2013* Federal Poverty Level Income  *Reduction in Out-of-Pocket Liability
---------------------------------------------------------------------------
             100-200% FPL                 Two-thirds of the HSA maximum    
---------------------------------------------------------------------------
-- Individual Income: $11,490 to      -- Max Out of Pocket: $2,083         
$22,980                                                                    
-- Family of Four Income: $23,550 to  -- Max Out of Pocket: $4,167         
$47,100                                                                    
---------------------------------------------------------------------------
             200-300% FPL                  One-half of the HSA maximum     
---------------------------------------------------------------------------
-- Individual Income: $22,981 to      -- Max Out of Pocket: $3,125         
$34,470                                                                    
-- Family of Four Income: $34,470 to  -- Max Out of Pocket: $6,250         
$70,650                                                                    
---------------------------------------------------------------------------
             300-400% FPL                  One-third of the HSA maximum    
---------------------------------------------------------------------------
-- Individual Income: $34,470 to      -- Max Out of Pocket: $4,167         
$45,960                                                                    
-- Family of Four Income: $70,651 to  -- Max Out of Pocket: $8,334         
$94,200                                                                    
---------------------------------------------------------------------------
*This table uses 2013 HSA limits and FPL income levels because 2014 data is
not yet available. These rules do not go into effect until 2014, at which  
point these levels and limits will increase.                               
---------------------------------------------------------------------------

 
These reductions in out-of-pocket liability will be achieved in new
plans through a variety of cost-sharing methods, including co-pays,
deductibles, and coinsurance. As such, two plans with the 60% bronze
"actuarial value" may have the same out-of-pocket limit, but be
structured differently.  
The following is an example created by Aon Hewitt for the Kaiser
Family Foundation in their April 2012 report on Patient Cost-Sharing
Under the Affordable Care Act: 


 
                                                                            
----------------------------------------------------------------------------
     Tier     Actuarial Value   Deductible     Coinsurance    Out-of-Pocket 
                                                                  Limit     
----------------------------------------------------------------------------
Bronze 1      60%             $4,375         20%            $6,350          
----------------------------------------------------------------------------
Bronze 2      60%             $3,475         40%            $6,350          
----------------------------------------------------------------------------
Silver 1      70%             $2,050         20%            $6,350          
----------------------------------------------------------------------------
Silver 2      70%             $650           40%            $6,350          
----------------------------------------------------------------------------

 
Additional Consumer Resources:  


 
--  Follow eHealthInsurance's consumer blog, Get Smart - Get Covered
--  Browse our answers to real-life health insurance questions on Yahoo
    Answers
--  Follow eHealthInsurance on Facebook and Twitter

  
About eHealth
 eHealth, Inc. (NASDAQ: EHTH) is the parent company of
eHealthInsurance, America's first and largest private health
insurance exchange where individuals, families and small businesses
can compare health insurance products from leading insurers side by
side and purchase and enroll in coverage online. eHealthInsurance
offers thousands of individual, family and small business health
plans underwritten by more than 180 of the nation's leading health
insurance companies. eHealthInsurance is licensed to sell health
insurance in all 50 states and the District of Columbia. Through the
company's eHealthTechnology solution (www.eHealthTechnology.com),
eHealth is also a leading provider of health insurance exchange
technology. eHealthTechnology's exchange platform provides a suite of
hosted e-commerce solutions that enable health plan providers,
resellers and government entities to market and distribute products
online. eHealth, Inc. also provides powerful online and
pharmacy-based tools to help seniors navigate Medicare health
insurance options, choose the right plan and enroll in select plans
online through its wholly-owned subsidiary, PlanPrescriber.com
(www.planprescriber.com) and through its Medicare website
www.eHealthMedicare.com.  
For more health insurance news and information, visit the
eHealthInsurance consumer blog: Get Smart - Get Covered. 
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For media inquiries, please contact:  
Sande Drew
eHealth, Inc.
(916) 207-7674
sande.drew@ehealth.com 
Kris Kraves
Cogenta Communications
(805) 527-7733 - direct
kris@cogentacom.com