good evening welcome to ask the experts i'm very happy tonight to be introducing marc larsen who is the commissioner from the department of vermont help access affectionately welcomed the department administers vermont's public health care programs and is responsible for the development and implementation of the vermont health insurance exchange and green mountain care which is for months universal health care program so mark comes with a background from the legislature having served on the house health care committee and house appropriations committee so we're really happy to have you here and a timely timely  which is a new way for vermonters to be able to access health insurance plans and to be able to compare them side by side and be able to pick the plan that's right for them it is a combination of variety of different ways to get help either through our website as we see on the screen here through a call center where the miners can call and get answers to their questions or apply for coverage or through a variety of people who can sit down with you in the community and help you through the information and generally it's about trying to make sure that people have access easy access to health coverage that works for them and fits their budget and access to financial help if they qualify to be able to make their premiums that out of pocket expenses more affordable so part of the idea i think originally was kind of on that expedia over you have flights where you can say i'm i want to go from here to here and here all the options are that there's a choice you have it is very much like that it's an online marketplace where all the complicated choices about different options which vary based on somebody's age somebody who's income somebody is in employer employment status  own health connect provides a simple way for somebody to see that as options to know what they are they qualify for and to be able to compare them side by side historically it's been very hard for people to actually look at plans in comparison apples to apples and so the idea is to take some of the guesswork out and make it easier in real time to pick a plan that works best for you so when people talk about the exchange this is not health connect and the exchange where they synonymous so the federal health care law gave states the choice to either have their own exchange which ours is vermont health connect or to have the federal government established an exchange for the state and so there is a federal health care exchange for those states that haven't got on their own path to do their own exchange and we're not connected to that when people here in the news the issues about the federal health exchange that's a different issue vermont health connect it is not the federal exchange and now we're experiencing very different things that the federal exchange and i think it reinforces the choice for us to develop our own exchange our own marketplace and really to being control of our own fate so who needs to sign up for th so vermont health connect is a way of accessing health coverage for two primary groups of people those who work for small businesses fifty full time employees or less or individuals who don't have access to insurance at work who are purchasing on their own for themselves or their family those two groups of people can access insurance coverage through vermont health connect so it accesses both public and private plans  and for those employers it's fifty full time which is thirty at full time is defined as thirty hours per week and it does not include seasonal or part time staff so if you're fifty and full time employees or decision yes about what you're going to offer so five a typical small employer with twenty employees and i have not offered insurance before what does that mean to me so the first important question for any employer whether they've offered it in the past or not is do i want to offer in the future and so that is the first big question for those who haven't offered in the past they might find it easier to offer coverage through vermont health connect than they have in the past because it's easier to compare the plans it's easier to set up an account and to and rolled employees for those who have offered in the past they might want to continue there are a lot of reasons why employers offer health insurance or they might want to rethink this year whether that's the best option for them and primarily that's because historically folks who are buying insurance on their own pay the highest premiums and often struggle to find the best plan even the small group market a lot of small businesses have found it hard to take advantage of the larger pool the larger groups of people that big employers have in order to get the best plans and get the best prices and to vermont health connected individuals and small businesses get to p together to be able to get the benefits of pricing options that large employers have typically had so historically a small business might now that if they're if they didn't offer insurance to their employees their employees were going to have a hard time finding good coverage and being able to afford it through them and help connect they could now that even if they don't offer coverage their employees can have access to the information about plans as well as financial help to help pay for those plans so one of the important provisions of the affordable care act is financial help to the form of tax credit that can be applied directly to your premiums that allow those who qualify to pay their premium as a percentage of their income that's going to make plans on remote health connect much more affordable to many vermonters who are purchasing coverage on their own and that spend some employers might find that their employees actually do better off as individuals compared to what they as the employer can offer in terms of assistance to help somebody afford a plan i also wanted to be sure that we talked about who this does not apply to thank you a couple of important groups of people that it does not apply to for minors who have medicare coverage for those who are sixty five years or older or are disabled on medicare or might help connect does not impact their medicare coverage they'll continue to have those that federal benefit their continued to access it the way that they have in the past including supplemental plans a lot of people on medicare are purchased supplemental plans and they would continue to access those supplemental plans like they do today on the other end children who are on doctor dinosaur or vermont for months public health care programs like medicaid medicaid will continue as it has been in the past and children and dr dinosaur will continue to see their who has children her own doctor and i am sorry but i don't have health insurance myself then i would sign up just for myself you could purchase a plan in fact when you go through vermont health connect and you apply you can put your whole family and you can see that my child qualifies for dr dinosaur i can enroll them in dr dinosaur and i qualify for a private hand plan through blue cross or n d p i can pick the one that i want and enroll in that so the whole family can find the plan that works for them all through the mud health clinic so what what's the schedule like we you know we hear a lot in the news and like october first everybody has to sign up there have been some computer challenges and now i think the conversation is so what are the deadlines and how is that looking could you just speak to that absolutely so october first part of the open enrollment period was sort of the the marketplace opened the marketplace stays open through march the end of march two thousand and fourteen so people can purchase coverage through remodels connect starting in october all the way through march  however for those who have coverage that ends in december obviously they want to enroll in a plan that will start january first and a lot of  calendar year plans if you have coverage that and december thirty first october and november are times that you can go on the web say to call up the call center down with a navigator a broker to be able to review the plans start your application figure out what your plan works best for you in december there you want to make sure that you've selected your plan and you've paid your premium for january so that you'll be enrolled by january first so there's a time in october november for all that comparison and plan selection that people want to do the important part if you're looking for coverage for january first is to make sure that you've completed those decisions and paid glitches but right now on the website if you go in you can register and people have been registering and completing the registration but they can't actually pay that right so well well if someone's completed the registration will they get a bill or you know how that works so the plan is that it after you've selected your plan you will receive an invoice which indicates that the plan that you selected means that your first premium for january is x amount of dollars it will calculate if you're an individual who qualifies for financial help what that financial help is in your invoice would reflect only what you o and then you would need to pay about that bill again by mid december in order to have coverage for january starting in november their website also will have the opportunity to will so you can get the invoice you can pay online or you can pay by check if that's what's most comfortable to you about people that don't use computers or don't like  great questions so that again there are multiple options there's the online resources there's also a call center and the call center number is eight five five eight nine nine nine six zero zero you can call and do everything that you can on the web site on by telephone with the assistance of somebody who can walk you through the information or the application until you can call the call center or again right at the top of our website here if you  to sit down with somebody in person and there are two resources one we call navigators we've contracted with eighteen different from our organizations who have a history of helping people with health care health care coverage who can sit down with you in person it's a free service they can also help you with the application if you want them to do that or we have also trained brokers in how to use promote health connect a lot of small businesses have used brokers in the past and so do they can continue to access their broker and their broker can also sit down and walk them through the process in person and help them with an application some people like paper and you can actually get a copy of paper application if that's how you want to submit your plan as well what about what about the financial assistance so when you first look at that chart and i got in there on line and said oh you know my daughter who's thirty for example and she's a farmer and the the out of pocket expenses seem really high deductibles seem really high but is there an income sensitizes portion there is so for those who don't get insurance through work there is financial help available and in two forms for many vermonters here is income meets a certain threshold and it's technically four hundred  percent of the federal poverty level guidelines and what that means in practice is a family of four whose income is about ninety six thousand per year or less can qualify to pay their premium as a percentage of their income and it's on a sliding scale so that percentage is smaller as somebody income is lower and it's higher as their their income gets higher and secondly other people w qualified to have their out of pocket expenses limited as a form of financial help what that means is that your deductibles would be lower or you're out of pocket maximum would be lower based on whether you qualify the nice thing is that as you submit your application there's a link here that says are you looking for coverage for yourself or your family as you start your application there it's going to ask you all the questions to figure out what you qualify for it will then tell you your options and when you get to the point of looking at the plan side by side it will show you what those plans are in terms of premiums and out of pocket expenses based on what you qualify for so you don't have to go through all the calculations it's just going to show you on the screen what plans are available to you and then you can pick the one that fits best might be able to say that you know part of what makes the comparisons possible is that all the planned cover the same ten essential elements which includes hospital coverage the ability to go to your doctor  problems preventative services prescription drugs something that's new in the plans compared to the past individual small group market plans pediatric dental and vision are included in the plans and so all the plans cover the same package of services where they differ is in the premium and how much you might pay if you have to pay pay or you have a deductible and how much you're out of pocket maximum might mean different people like different plans and again there's a variety of them available  we hear on the news every day about the exchange glitches and could you just give us the update on where we're at in vermont right now with vermont health connect so today as we sit here vermonters have been using vermont health connect some have been using it just to gather information others have been starting applications and choosing their plans the challenge that we faced is that too many vermonters have experienced errors as they've been trying to go through the process and what we've been doing is making sure that we identify why those errors are occurring and eliminate the cause of them so that as people go through their application more of the miners are getting through with each passing week and that's what we want to see is that the ability for reminders to consistently be able to submit successful applications after using the resource of the website to compare plans and that's the progress that we want to make sure is happening and then the next step in november is making sure that when voters are ready to pay that function is there so that they can finish their application and roll in their plan so we spoke earlier and you mentioned kind of that the tooth actors about the success of this one of them certainly is the technical part is there a lot of experts working on and the other is the people  part signing up than a lot of us many people i've talked with are waiting to see and kind of wait and see how it goes and maybe at what point do we all just jump and i think maybe we're just waiting for that headline that says ok you can sign have now could you just talk about that in terms of the numbers of vermonters that are eligible for those kind of you know so there's a period now of the next eight weeks or so so we know that there are about seventy thousand boners between the individual market in the small group market who have coverage that and to some at the end of december and so that those are the ones that we want to make sure are finding a plan that works for them and enrolling in that plan by january first that they don't experience any gap in coverage about fifty thousand of those get insurance through and about twenty thousand get insurance as an individual and so we're certainly working with our navigators and brokers and other resources to make sure that those for minors who have coverage that ends this december kno one that they have a choice to make and then secondly know that schedule that we talked about where you get a job or november you have time to review the options consider which plan works best for you but then by december want to start making your final decisions and paying for that january premium so that in january you don't have any cap so the key thing here as look at your health insurance if it expires and december thirty first then you are one of them yeah the person who needs to sign up or work with your employer to get signed up because the risk is if that deadline passes then you may find yourself without coverage that's right that's right and as we talked about the open enrollment period goes through march so the door doesn't close to january first on being able to purchase a plan but it some point you wouldn't be able to have a plan to cover you in january you would be able to start in february and that's what people want to avoid again is any gap between the end of their current plan and the beginning of next did ask for questions on an email i emailed a few people and said what questions do you have and one of them was what happens if the number of people signing up on the exchange falls short of the target so if seventy thousand people are supposed to sign up but half do then then what happens most of the first thing that we do is we monitor every day how many people are starting their applications getting through their application  paying their premium and getting rolled in the plan that they've selected so we'll be monitoring on a regular basis to make sure that people are getting their way through the steps if we see that there's a certain group where people aren't getting through the first thing that will do is make sure that we're doing additional outreach to make to try to remind people of the important choices that they have to make and to that might mean doing outreach to employers doing outreach to for example it some individuals and be happy and catamount today will need to make a new a new selection about which plan that they want to be on next year if we see those numbers not keeping pace will do outreach to those specific individuals and to our first effort is a is trying to reach out to people to make sure that they know the schedule and they know an important choice has to be made this fall so i don't want to ask about the happen catamount well what happens those programs actually go away with the exchange they do yes so the complicated thing is that there are changes to the eligibility for medicaid and so a lot of in and then other people will qualify for a blue cross or an m v p plan with the financial help that we've talked about tonight we're going to identify all the people who we as we understand will move from the happen catamount into medicaid and we'll help them with that transition for those who need to pick a private plan will continue to send written information about the choices that are available to them in the timeline that they have for picking and they'll have to go either online or through our call center or work with somebody in person to help pick the specific plan that they think works best for them and we'll be making sure that we do a lot of outreach to them to make sure that nobody else with a crack so if i if i have the have path is medicaid then do those individuals need to do something if i pay some information that we have right now from their application for we know that they would qualify next year to remain in medicaid we're we're just going to help people move right into that program and they're not going to have to make any choice for those who would qualify for a private plan will let them know specifically that that's a choice that they're going to have to make and then try to make sure that there's as many resources as possible to get online by phone or in person to help them make that choice for those who move from the have to or catamount to medicaid they're actually going to see more expansive coverage and no premium so a lot of them will benefit from the transition also for those individuals who've been purchasing insurance in the private market out on their own  many of those are going to qualify for financial help and will see their premiums become more affordable through remote health connect so perhaps we should have started the program with like affordable care with a whole big vision here it is affordable care and occasionally people and i know i have family members who look at it and say oh this feel like affordable care could could you just speak to that  i think the challenge is has always been that health insurance is very expensive and even with efforts in vermont to make it more affordable that's always a relative term and it isn't an expense that many vermonters struggle with what we're trying to do is make sure that more vermonters can pick a plan that is relatively affordable to them partly that's by making sure that they have access to financial help partly that's by making sure that some of the advantages that large businesses had in having a larger pool of people to share risk with his experience by people in the individual group market ultimately though in turn is a challenge for a lot of people and even with the financial help available through the month of connect we know that that will continue to be a challenge that's why even though vermont health connect and the affordable care act are important steps forward we know that it doesn't get us to the to the place where all the miners are covered where we maximize the opportunity to control costs of health care we make it more fair and equitable in terms of how we pay for it and we're actually seeing improvements in vermonters health because of it that's why we have a plan to health connected up and running to move forward to a day where we actually have a universal and more integrated health system where every vermont resident is covered as a part of being a vermonter and people have to weigh about these complicated options and which one do i qualify for and does my work offer it doesn't not while right help connect makes things better it doesn't get us to where we really want to go long term that's where we have more work left to do there's always work left to do and i just want to say how much we appreciate the work that you're doing thank you it's important work and i do think that sometimes we lose fact of the matter that we're really trying to just make sure that people do have health coverage and that they that they participate much like you know i say to my thirty something children are required to have car insurance and you pay for that and so having a bigger pool with all of us in it about health insurance is just going to make it better for everybody that's right that's right so thank you so much you're think we perhaps should say again that there are different ways to access the information yeah can i go through them again sure the website is here w w w dot vermont health connect dot gov  center is it five five feet nine nine nine six zero zero or if you're looking for help in person again that information is available either on the call center or on the website and you can access that information about