by Andrew Stein June 13, 2013 vtdigger.org More than 60 Vermonters gathered in a basement room at Waterbury’s Thatcher Brook Primary School on Wednesday to learn about the state’s new health insurance marketplace, Vermont Health Connect.PHOTO: Lindsey Tucker, deputy commissioner of the Department of Vermont Health Connect, addresses a crowd at a public forum Wednesday, June 13, 2013, at Thatcher Brook Primary School in Waterbury. Photo by Andrew Stein/VTDiggerLindsey Tucker, deputy commissioner of the Department of Vermont Health Connect, fielded questions about the Web-based market, which is slated to open Oct. 1. On Jan. 1, 2014, the more than 100,000 Vermonters buying insurance individually or through businesses with 50 or fewer full-time employees will be required to purchase coverage on the exchange.Sheila Rochefort and her family drove from East Montpelier and Stowe to learn how the new regulations surrounding the exchange would affect their business, Vermont Tire and Service.‘We need a navigator to come in and talk to our employees because offering insurance through the company they will receive no subsidies,’Rochefort said. ‘That seems really unfair to them. If they can get help paying their premiums, it would be unconscionable of us to actually deny them that opportunity.’But the Rocheforts aren’t entirely sure whether their business qualifies for the exchange or not because their 56 employees are right on the edge of eligibility for the small-group market, and large-group employers play by slightly different rules.Elizabeth Larimer (left) and Brenda Viens has questions about how the new health insurance exchange would affect their businesses. Photo by Andrew Stein/VTDiggerBrenda Viens is a bookkeeper for her son’s business, Viens Plumbing and Heating, LLC, in Fayston. Elizabeth Larimer, who does the accounting for Viens’nephew’s Richmond business, Russ/Wood Decorating, joined her.‘I’m concerned,’Larimer said. ‘It’s going to be a lot of change coming.’Viens, with more-than 45 years of accounting experience, said she is worried that learning curve for understanding the health care reform initiatives is very steep.‘If we can’t learn it in 24 hours, how are other people going to learn it in 24 hours?’she quipped.But all and all, Viens said, the challenge does not appear to be insurmountable. People simply need more information.Tucker told the group gathered in Waterbury that was why she was there.Using this power point presentation, she and a team of state officials waded through the ins and outs of the exchange.‘We are the government, and we’re here to help you,’she said.The questions and the answersThe Vermonters at the Waterbury public forum asked a range of questions. Here is an edited version of some of those questions and Tucker’s responses.For more public forum dates, see this calendar.Why are MVP and Blue Cross Blue Shield Vermont the only health insurance options on the exchange? How come there are only two health insurance companies and not Cigna and Aetna and other companies?Today, in our individual and small group market, we have two carriers: We have MVP and we have Blue Cross. Cigna is here in Vermont, but only in the large group market, and the exchange is only for individuals and small groups, defined as businesses with 50 or fewer full-time employees.Wasn’t there another company that applied for insurance status? The Vermont Health CO-OP? What happened to them?They applied for licensure through the Department of Financial Regulation, and they were denied and there’s currently talk about the possibility of an appeal. One of the reasons in the department’s report is that their premiums were higher. (For more on this issue, read here.How will the in-person guidance of navigators and brokers differ?They are very similar. The navigator program will have state and federal funding, so it will be free for Vermonters to use. The navigators will be certified, they will have 24 hours of training to sit down and help you. The broker community has a lot of expertise, and so an employer who has a relationship with a broker who knows the employer’s business and employees may wish to work with a broker. Brokers will charge a state-set fee, which will be finalized in the next few weeks.As a small business owner, can I have a navigator come into my business to discuss insurance options with all of my employees individually?Yes, and open enrollment starts Oct. 1, and it lasts six months until the end of March.Are the premiums the same for small businesses?Yes.If you’re a family, but you have adult children under the age of 26, do you apply as a family or do your older children apply individually? How do you access the subsidies to lower health insurance costs?Eligibility for federal and state subsidies is based on household income. So, if you in your household have one tax return or two different tax returns, your eligibility is based on that number or those numbers. Your young adult could apply with your family or on his or her own.Are members of the same family stuck with the same plan or can they access different plans?That’s something we are finalizing right now. We are working to determine how we can give Vermonters the most options possible and stick within the federal system. We will have that information by the end of the month.Who will police this eligibility?The federal government. Health and Human Services has created something called the federal hub. What this does is aggregates data and information from Homeland Security and the IRS and is tax-based. It’s your tax return that they base this information on. Whether your income goes up or down in the course of the year, it will all get trued up in the end through the IRS. We are hooked up to the federal hub, and we are a vehicle for Vermonters to be able to access coverage and subsidies.If your employer is from another state, can you continue to get insurance from them?You can continue to do that. If your plan is coming from Connecticut, it can continue to come from Connecticut. That Connecticut company has the option to offer you insurance through Vermont Health Connect, but they don’t have to.What will happen to the state-subsidized Catamount and VHAP health insurance programs?Beginning Jan. 1, 2014, those programs will go away. Folks who are eligible for Medicaid (earning up to 133 percent of the federal poverty line) and folks who are eligible for the exchange will go onto the exchange. There will be lots of notices coming over the summer.My son owns his own business, but he is on a Catamount plan. So, come Jan. 1, 2014, he will most likely have to buy insurance on the exchange?That’s right, and he would most likely be eligible for a subsidy.What are the main differences between the plans?The difference between the plans is how you pay for them. Some of them will have lower premiums and higher co-pays and some of them will have higher premiums and lower co-pays. There are four levels. Bronze is the lowest actuarial level, which means the least amount is covered by the plan. So, your premiums here would be low, but your out-of-pocket costs would be higher, so your deductible and copays would be higher. There’s a cap on both out-of-pocket costs and deductibles. At the high end, the platinum end, the premiums are going to be the highest, but the copays and deductibles will be the lowest.How do I pick a plan for my employees?If you are a small business owner, there are two options for you coming into the exchange. The first is to choose one carrier and pick a level or a dollar amount for your employees to buy up or buy down. Employees can say, ‘Here’s how much money my employer is giving me, this seems like a good plan.’Or they could say, ‘I really want to buy platinum.’The exchange will let you as the employer know what the employee has picked, so that you can deduct the appropriate amount from their paycheck. We will aggregate that information for you. The other option is a full-choice option ‘not limiting employees to just one insurer.Does the employer have to pay a portion of the employee’s insurance?No, and if there’s no employer support, an employee is eligible for subsidies.If employers are offering to pay a portion, how does that work? Is it pre-taxed?It’s pre-taxed just the way it is today.What businesses are eligible for the exchange?As you think about eligibility as a small business for the exchange, it’s 50 full-time employees or fewer, full-time being defined as 30 hours or more a week. As an employer, if you offer coverage to one of your full time employees, you have to offer coverage to all of them. You have to treat your full-timers equally. But you have a choice about your part-timers. You can offer them coverage or not.Is there a penalty for employers who don’t provide health insurance coverage?If you are a small employer, the employer assessment will still apply to you if you do not offer coverage or do not offer adequate coverage. However, there is a new federal assessment on large employers, and large employers are defined as 50 or more employees.If you are a larger employer and you do not offer coverage, there is a penalty that can be assessed on you; or if you’re an employer who offers coverage, but some of your employees find it unaffordable. If the premiums are higher than 9.5 percent of income, it’s unaffordable, and you may have a penalty assessed on you by the feds. There is no federal penalty for small employers.Will school districts that are self-insured be exempt?If you have more than 50 employees, you are not eligible for the exchange. If you have 50 or fewer, then you have to come into the exchange. There are associations that will need to break up and separate the small groups from the large groups. And the small groups have to come into the exchange.