Navigating through the Affordable Health Care Act And where to get some local help
Garth Olson | Staff writer NORTHWEST WISCONSIN - Passed in 2010, the Affordable Care Act, aka Obamacare, rolls out some big changes in health care in 2014. The new laws have implications for the already insured, as well, since it boosts coverage on many preventive care items without a co-pay. The Affordable Care Act also prevents insurers from turning away customers because they’re sick and does not allow insurers to cap the amount they will pay out.
Preventive services without co-pay Under the new laws, the following items would be covered by insurance without a co-pay: • Cancer screenings, such as mammograms and colonoscopies; • Vaccinations such as flu, mumps and measles; • Blood pressure screening; • Cholesterol screening; • Tobacco cessation counseling; • Birth control (challenged in court system); • Depression screening.
Fines for the uninsured In 2014, a $95 fine or 1 percent of income, whichever is more, will be added to an individual’s tax on their federal tax return. In 2016, the fine jumps to $695 per adult or 2.5 percent of income, whichever is more. Children are required to be insured and fines for families are capped in 2014 at $285 or $47.50 per uninsured child.
Purchasing health insurance – dos and don’ts First bit of advice – jumping on by yourself at the Marketplace or Exchange website at healthcare.gov may not be in your best interest. According to a recent webinar hosted by the University of Wisconsin-Extension, with participation from the Polk County Health Department and Mike Rust of ABC for Rural Health, individuals looking to purchase health care on the healthcare.gov website are advised to have the assistance of a certified application coordinator or of a navigator – or someone trained in the Affordable Care Act. The Marketplace or Exchange website sells plans until March 31; however, insurance on the website would need to be purchased by Dec. 15 to have it start by Jan. 1.
Where to find help from certified application counselors and/or certified insurance agents with the Affordable Care Act Polk County Health Department – Balsam Lake – Rita Bohn 715-485-8557. Amery Regional Medical Center – Deanne LaBlanc or Diana Martinson 715-268-8000. St. Croix Regional Medical Center – St. Croix Falls/Frederic and Unity clinics – Patty Turner 715-483-3221 (St. Croix Falls location).
Burnett County is politely referring everybody who calls to the healthcare.gov website. If someone needs access to a computer or Internet, they can use the one in the health department’s office, but no assistance is available. Referrals to help, however, are being made.
Burnett Medical Center does not directly provide assistance, according to marketing director Alyssa Ryan, but will provide direction in getting people to the healthcare.gov website, to the call center, to Tasha Hagberg, the ACA navigator for this area and to opportunities to learn more about signing up for coverage, such as public informational sessions held recently in Grantsburg and Webster.
Northwest Wisconsin Concentrated Employment Program, Inc. has been awarded $285,035 by the U. S. Department of Health and Human Services to help people in its coverage area - which includes Burnett County - to enroll for health insurance through exchanges to be established under the Affordable Healthcare Act. Contact information is available on their website at nwcep.org. In addition to certified application coordinators, individuals looking for help with the healthcare.gov website can also contact certified insurance agents with the Affordable Care Act – in Osceola for example, Central Bank Insurance and Noah Insurance provides assistance navigating through the registration and enrollment process online. Another source for general information regarding the new healthcare laws can be found at your local medical center as well as the website itself - healthcare.gov.
Insurance plans – and the Polk County healthcare wrinkle Insurance sold on the marketplaces comes in four levels: bronze, silver, gold and platinum. The plans DO NOT differ on what they cover but differ on the cost-sharing or how much you will pay for deductibles and copays. In Polk County, Wisconsin, as of Dec. 1, there is not a platinum plan available online at healthcare.gov and Polk County residents using the exchange have only two options – Medica and Health Traditions, however, Health Traditions’ providers are not local to Polk County.
If you don’t like the Obamacare website, you may purchase insurance other ways
The source of many late-night TV talk-show jokes, the federal healthcare website has been the source of a lot of frustration and anger. It seems, however, some of the glitches have been ironed out and despite some delays, the website is now working, despite stalling during heavy traffic times during the day. The website has a 24-hour call center at 800-318-2596 and for the hearing impaired 855-889-4325.
The advocacy group Families USA and USA TODAY reported that three-quarters of people buying insurance in the individual market are eligible for tax credits or subsidies because of their income levels. That includes individuals earning less than $46,000 and families of four earning less than $95,000. In order for individuals to receive such tax credits, they must purchase insurance through the exchange or the federal healthcare website – healthcare.gov. However, if your income is on the higher scale, healthcare insurance can be purchased outside of the federal website.
.Gov, .gov, .gov If we’re repeating the website healthcare.gov a lot, it’s for a good reason. Don’t be fooled by similar web addresses such as healthcare.com or healthcare.net – those are not the official federal healthcare plans eligible for potential tax credits.
Medicaid If you’re happy with your health-care coverage through your job or you purchased your own health insurance before the Affordable Care Act passed on March 23, 2010, you don’t need to worry about a lot of this. Low-income individuals and families can also look to see if they qualify for Medicaid, which has been broadened in some states. If you don’t qualify for Medicaid, you can still investigate public programs for kids at insurekidsnow.gov.
New for kids and women Insurers can no longer drop your coverage for arbitrary reasons or deny you coverage if you have a medical condition. Individuals paying higher premiums based on existing conditions may want to shop for a new health-care plan with their adviser/agent. Dental and vision coverage for kids are required in the marketplaces. Insurers can no longer charge higher prices for women and must cover pregnancy and childbirth as well as counseling for new moms. (With information from the Wall Street Journal).
Living in rural Wisconsin and smoking will cost you more Unfortunately, residents in Northwest Wisconsin will pay more in premiums than folks living just across the river in Minnesota. Wisconsinites living near major cities will likely have lower premiums than rural residents. According to the New York Times, Pima County in Arizona has the best health-care rates due to a flooded marketplace of competing insurers. For smokers, if you haven’t quit yet, you’ll save money on the exchanges if you’re smoke free for six months.
Obamacare obstructionists The Wall Street Journal reported that blue states, or states not run by mostly Republicans, typically have greater resources to support enrollment in the exchanges and have had less setbacks. To be fair to Republican-led states, many plans in the Marketplace limit the network of available doctors, so keeping your doctor under the new health-care laws is one of many concerns with Obamacare.
Too early to tell if marketplace concept will lower costs Unfortunately, large insurers like Cigna and UnitedHealth Group have opted out of many states’ exchanges. Aetna has backed out of seven exchanges it originally applied for based on cost models. If additional insurers opt into the exchanges in future years, government officials claim health-care prices should decline.
Advice is free; shop around “A lot of insurance agents have decided not to continue to work in the health insurance market,” Doug Willert of Noah Insurance said. “But I have stayed in health insurance for 14 years and we’re here, ready to help people. Agents get paid from the exchanges now, so why not sit with an agent/adviser when selecting health insurance.“
Next year – shorter open enrollment As of today, next year’s open enrollment for the exchanges runs only from Nov. 15- Dec. 7. For businesses with less than 25 employees, the Small Business Health Option Program, which features tax credits, must be purchased through a broker and the website for SHOP has been delayed
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