I’ve heard that some parts of the new Affordable Care Act take effect Oct. 1, but I’ve also heard Jan. 1 is an important date. What’s up?
On. Oct. 1, thousands of previously uninsured people will be able to purchase subsidized health insurance in new online marketplaces called health insurance exchanges.
The first wave of open enrollment for individuals, families and small businesses starts Oct. 1 and lasts until March 31, 2014. Once open enrollment ends, however, you won’t be able to purchase health insurance through the exchange until the next enrollment period in October 2014.
Coverage starts as early as Jan. 1, 2014.
If I have health insurance already do I need to do anything?
No. A majority of the population will not be affected by the exchange, because most people already have insurance purchased through their employers.
Medicare is also unaffected by the exchange, and open enrollment for that program starts on Oct. 15.
Where will I be able to buy insurance?
During open enrollment, you can go online to Washington’s health insurance exchange, called the Healthplanfinder, at www.WAHealthplanfinder.org. If you don’t have access to a home computer, in-person assisters (read on) can go through the application process with you. You can also call 1-855-923-4633 to apply by phone.
How many plans are there for me to choose from?
Cowlitz County residents can choose from a range of 34 health plans offered by four insurance companies, including Community Health Essentials, Kaiser Foundation Health Plan of the Northwest, LifeWise Health Plan of Washington and Premera Blue Cross.
What must the plans offered through these exchanges offer?
All health plans cover basic medical needs:
- Doctor visits and hospital stays
- Maternity, pediatric and newborn care
- Prescription drugs
- Preventive care, such as vaccinations or cancer screenings
- Mental health services
- Management for chronic diseases, such as asthma or diabetes
What if I’ve been denied before?
Insurance companies can no longer deny people who have pre-existing health conditions. Companies cannot refuse to cover treatment.
What are these plans going to cost me?
As with any insurance plan, premiums and out-of-pocket costs vary depending on age, by county and smoking habits and other health risks. Actual marketplace prices won’t be available until the exchange opens.
The amount you pay in premiums and out-of-pocket costs also depends on the insurance plans, which are categorized into “metal levels” — Bronze, Silver and Gold. Bronze plans are kind of budget options, with lower monthly premium payments but which require consumers to pay 40 percent of out-of-pocket costs, including co-pays. Gold plans are the high-end options, with higher premiums but only 20 percent out-of-pocket costs.
Cowlitz County residents won’t have access to Platinum plans, which have the lowest out-of-pocket costs and highest premiums, because insurers didn’t offer any.
Kaiser will offer a “Catastrophic” plan — available to people 30 years old and younger — that covers emergency medical costs, three primary care visits a year and free preventive care visits.
Why are plans offered through the exchange expected to be cheaper or better than those I can find shopping around on my own, or are they?
For many state health exchanges, the cost of insurance plans may not be different than those purchased outside the exchange, according to the independent nonprofit Pew Charitable Trusts.
In comparison to previous insurance plans, however, the projected cost of new plans in the exchange were lower for the amount of coverage, reported Kaiser Family Foundation, a nonprofit health policy organization independent of Kaiser Permanente.
All plans in the exchange first had to be approved by Washington state Insurance Commissioner Mike Kreidler to ensure that plans meet the requirements of the Affordable Care Act. Kreidler capped annual out-of-pocket costs at $6,350 for individuals and $12,700 for families.
If you buy through the exchange, you could qualify for tax credits if:
- Your income is less than 400 percent of the federal poverty level
- Your plan at work covers less than 60 percent of your medical expenses
- Your medical costs exceed 9.5 percent of your household income.
Are there any projected prices?
Yes. Under the Group Health Bronze plan, for example, a single 21-year-old making $28,725 a year would pay a $172 monthly premium and get an annual tax credit of $388, according to the Washington state Office of the Insurance Commissioner.
For a 40-year-old with one child and a household income of $62,040 (400 percent of the federal poverty level) a Group Health Bronze plan premium would cost $330 and would not receive subsidies.
A wider range of prices and plans will be available Tuesday, but cost savings estimates can be calculated using the Kaiser Family Foundation calendar available at www.healthcare.gov. A full list of insurance rates are also available on the state insurance commissioner’s website at www.insurance.wa.gov.
What if the cost of plans offered through the exchange are still too high for me? What are my options?
You may be eligible for Medicaid. In Washington, the Legislature has expanded Medicaid coverage to childless adults between 19 and 65 years old, opening coverage in the exchange’s first year to around 250,000 people who weren’t eligible previously.
To qualify, you would need to earn up to 138 percent of the federal poverty level or have an annual income of less than $15,856 if you’re single, according to the state Health Care Authority. A family of four would qualify if their household income is less than $32,499.
Medicare coverage is not included in the exchange.
What if I don’t have insurance by Jan. 1? Will I be penalized?
If you don’t have insurance in 2014, you incur a fee of 1 percent of your yearly income or $95 per person. The fee increases yearly, and in 2016 the charge is 2.5 percent of your income or $695 per person. The charge depends on which fine is higher.
If your kids are uninsured in 2014, you’ll be charged $47.50 per child with a maximum fee of $285.
You likely won’t be refused medical services, but you may be expected to pay the total cost of services depending on the provider.
I’ve never bought insurance before. Can I get help choosing the right plan for me?
Yes. You can get in-person assistance from the Cowlitz Family Health Center, which is one of the main organizations in the state helping people navigate the new online marketplace.
In Cowlitz County, you can also get help at the Lower Columbia Community Action Program, Love Overwhelming, Community House, Drug Abuse Prevention Center, Cowlitz County Guidance Association and PeaceHealth St. John Medical Center, the Kelso Emergency Support Center and Agency on Aging and Disabilities of Southwest Washington in Kelso.
In Lewis County, the Valley View Health Centers in Toledo and Winlock also provide in-person assistance.
You can also get help by calling the toll-free Customer Support Center weekdays between 7:30 a.m. to 8 p.m. at 1-855-923-4633. Assistance is available in 175 languages.
You can email the exchange at firstname.lastname@example.org.
What if I don’t have a checking account?
You can still be eligible for health care coverage even without a traditional bank account. The Obama Administration recently ruled that insurance companies will be required to accept nontraditional payment methods, including prepaid debit cards, cashier’s checks and money orders.
Is there any sign that politicians in Washington and Oregon are trying to set up roadblocks to implement the Affordable Care Act, as they are in some other states?
No. In fact, Washington and Oregon are two of the states leading the changes with the Affordable Care Act and are part of 17 states that are running their own exchange market.
In Washington, former Gov. Chris Gregoire established an 11-member board to run the exchange separately from the state. The exchange will be required to be self-sustaining starting in 2015.