Monday, Sep 01, 2014
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How to get started on health insurance exchanges


Published:   |   Updated: September 1, 2013 at 05:05 PM

Starting Oct. 1, health insurance marketplaces or exchanges are going to enroll those who want to buy health care coverage for next year as part of the Affordable Care Act but don't get insurance through their employers.

For Highlands County residents, the choice of insurance companies offering insurance policies may be limited.

According to the Florida Office of Insurance Regulation, one insurer has been approved for Highlands as of July 31. Their web site shows the company has filed a request to offer 31 plans locally, from four coverage categories, based on the level of benefits offered and the cost.

More details will soon be shared with the public, said the agency's deputy director of communications Amy Bogner.

Every county has at least one insurer, and 10 companies have been approved as of July 31 to do business on the state's health exchange, which the federal government is running.

Lack of options among companies available means less competition and, perhaps, less competitive rates, but Florida CHAIN'S Executive Director Laura Goodhue said people will still have several plans to choose from even if one company is offering plans within a local area.

Plus, private insurance can still be obtained without going through the exchange, Goodhue added. Florida CHAIN is a health advocacy group.

As the deadline to enroll approaches, advisors or "navigators" will help get the word out about the exchange and enroll people by fanning through neighborhoods and schools.

In Highlands County, Central Florida Healthcare in Avon Park has received $180,000 from the U.S. Department of Health and Human Services to hire advocates to help people understand their coverage options.

"Staff recruitment and training is underway in order to comply with the enrollment set to commence October 1, 2013," said Gregory Okwengu, with Central Florida Healthcare. "As details unfold, the community will be advised."

The navigators will help residents understand their coverage options not just through the exchange but through Medicaid and the CHIP program.

According to the U.S. Census Bureau, 29 percent of Highlands County residents are uninsured.

How many obtain insurance through the exchanges remain to be seen but about seven readers who responded to a Highlands Today Facebook query said they didn't plan to buy a policy because they could not afford it.

Goodhue said people shouldn't forget that subsidies are being offered to reduce the cost of coverage.

A million Floridians also will be able to claim an exemption from paying a penalty for not carrying insurance due to economic hardship, she added.

Highlands Today has compiled an informational Q&A on health insurance exchanges, what plans consumers can expect, income levels for subsidies and credits, and who can request an exemption from buying health insurance.

This does not explore the pros and cons of the exchanges and the law that puts them into place or people's support or opposition to the Affordable Care Act. Most of the information has been obtained through the exchange, wwww.healthcare.gov

Q: Is a health insurance marketplace or exchange like a one-stop shop for buying health insurance?

A: Yes. Consumers can go to a website, www.healthcare.gov, to find a side-by-side comparison of options.

They'll fill out an application and see all of the health plans available in their area.

They'll also be able to find out if they can get subsidies and tax credits on premiums, co-payments and out-of-pocket maximums for private insurance plans.

While certain low-income consumers also will find out if they qualify for free or low-cost coverage through expanded Medicaid or the Children's Health Insurance Program instead of private insurance, Florida is one of a few states that has not expanded its Medicaid option, so that benefit is not available to eligible Floridians.

Q: When does open enrollment start?

A: Open enrollment is expected to start Oct. 1. Coverage starts Jan. 1.

Q: Are there any savings on premiums for enrollees?

A: Yes, based on income and family size. Health insurance companies offering coverage through the marketplace must lower the amount subscribers pay if they meet the following income criteria.

Up to $28,725 for individuals

Up to $38,775 for a family of 2

Up to $48,825 for a family of 3

Up to $58,875 for a family of 4

Up to $68,925 for a family of 5

Up to $78,975 for a family of 6

Up to $89,025 for a family of 7

Up to $99,075 for a family of 8

The subsidy benefits will be obtained through the exchanges when people apply for health insurance and will be reflected in the premiums.

To be eligible for a subsidy, a person cannot be eligible for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). The federal government will pay the subsidy amount directly to the insurance company.

To qualify for tax credits available under the health-care overhaul, residents must get their insurance on the government exchange (healthcare.gov).

Q: Can I get an estimate of my costs and savings before enrollment begins Oct. 1?

A: Yes. Those interested can get a rough estimate of costs and savings by using the Kaiser Family Foundation calculator at http://kff.org/interactive/subsidy-calculator/.

Q: Florida is not expanding its Medicaid program in 2014. Where does that leave eligible low-income individuals?

A: It depends. They can buy insurance through the health exchange but won't be eligible for a subsidy if they qualify for Medicaid.

But since Florida has opted not to expand its Medicaid, it means those who qualify under the new income requirements can get an exemption from buying health coverage and won't have to pay any penalty if they don't want to carry coverage.

The federal government has set this income threshold: Consumers whose income is more than about $11,500 a year as a single person (about $23,500 for a family of four, or 100 percent of the federal poverty level), will be able to buy health insurance in the marketplace and get lower costs based on household size and income.

Those who make less than that will be able to get insurance in the marketplace - but not the subsidy.

Q: Starting in 2014, can health insurance plans refuse to cover me or charge me more because I have a pre-existing health condition?

A: No.

Q: Can I buy just "catastrophic" insurance?

A: Yes. People under 30 and some people with limited incomes may buy what is called a "catastrophic" health plan, which protects plan holders from very high medical costs.

Q. I'm a part-time worker and my employer doesn't offer health insurance to part-timers. Can I use the marketplace?

A: Yes.

Q: What is the penalty I'll have to pay if I don't get medical insurance coverage or don't qualify for an exemption from the coverage requirement?

A: The fee in 2014 is 1 percent of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5 percent of income or $695 per person, whichever is higher.

In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.

Q: Who doesn't have to pay the fee?

Uninsured people won't have to pay a fee if they:

Are uninsured for less than three months of the year

Are found to have very low income and coverage is considered unaffordable

Are not required to file a tax return because their income is too low

Would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility

Are a member of a federally recognized Indian tribe

Participate in a health care sharing ministry

Are a member of a recognized religious sect with religious objections to health insurance

Q: What kinds of health insurance don't qualify as coverage?

A: Health plans that don't meet minimum essential coverage don't qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:

Coverage only for vision care or dental care

Workers' compensation

Coverage only for a specific disease or condition

Plans that offer only discounts on medical services

Q: What kind of plans will be offered?

A: There will be four types of plans - bronze, silver, gold and platinum - with varying benefits and premiums, with bronze being the leanest and platinum having the best benefits.

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