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HEALTHCARE Q & A

How would a new health insurance pool work?

Details on who would be eligible under House and Senate proposals; plus questions about shopping the 'exchange,' understanding bronze and platinum plans, and more.

January 11, 2010|By Kim Geiger

Reporting from Washington — I hear the healthcare bill will create an immediate insurance pool for people who can't get insurance. How will this work and who will be eligible?

Both the House and Senate bills would provide $5 billion to create a temporary insurance pool until an insurance exchange is up and running. Under the House bill, this program would be available to people who have a preexisting condition or have been uninsured for at least six months. Under the Senate bill, individuals would have to meet both requirements to be eligible. The House pool would open immediately and the Senate pool would open within 90 days of the bill's enactment. Both pools would set limits on the premiums and cost-sharing that individuals would have to pay.

How will an insurance exchange work?

An insurance exchange is a marketplace -- a website, for example -- where consumers can choose from a range of plans that meet minimum standards set by the government. The Senate bill proposes to create state-based exchanges, while the House bill would create one national exchange. Consumers who don't get health insurance through their employer or a government insurance program would be eligible to shop on the exchange for plans. Low- and middle-income people who shop on the exchange would be eligible for government subsidies to help them buy their insurance plan.

What is the difference between a bronze plan and a platinum plan?

Both the House and Senate bills would create categories of benefit packages that could be offered on the exchange. Under the Senate bill, there are four categories: bronze, silver, gold and platinum. Under the House version, there are three categories: basic, enhanced and premium. The bronze and basic plans would offer the lowest premiums and restricted benefits, while the platinum and premium plans would be more expensive but would cover more, as well as offer such extras as dental and vision coverage.

I'm young and rarely go to the doctor. What are my options if I don't think I need a bronze or basic plan?

The Senate bill creates an additional category called a catastrophic plan, which would be available to people age 30 and younger. The plan would likely have lower monthly costs and would cover up to three visits to a primary-care doctor.

kim.geiger@latimes.com

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