Eldon woman has insurance for first time under Obamacare
Long in the works and much debated, the Patient Protection and Affordable Care Act (ACA) - known colloquially as "Obamacare" - along with its tax credits and penalties for non-insurance is slated to go into effect next week as the end of the open enrollment period comes on Monday, March 31.
Horror stories about loss of policies, increasing rather than decreasing rates and the implications for the federal budget, the economy and the health care industry have all been topics of interest in the national news since the act was passed in March 2010 - not to mention the many stories dedicated to the travails of the healthcare.gov website, lagging numbers of newly-insured through the program and religious questions over requirements for birth control.
It has been a long road, but for better or worse, the core of the ACA - mandated health insurance for individuals and families - will take effect with penalties for non-insurance on April 1.
For one lake area woman at least, April 1 will mark a new day in health care and financial security - at least for the immediate future.
Eldon resident Bonnie Massey has never had health insurance before, but was recently able to sign up for a plan through the Missouri Health Insurance Exchange with help from outreach specialists at an enrollment day held by Primarus at the Eldon Community Center.
Signing up for insurance through the marketplace, a website that opened October 2013 where you can compare and buy insurance plans, was easy with a certified enrollment specialist, she says.
Reviewing the plans online beforehand, Bonnie had an idea of what she wanted going in. The 61-year-old widow picked a basic plan to cover her until she hits 65 and is eligible for Medicare.
The specialists helped Bonnie make sure she got what she wanted, and that everything was lined out for coverage to begin April 1, and she has already made her first insurance payment which came later in the mail.
Even when she and her late husband were working and living in Georgia, Bonnie has never had health insurance before because premiums have always been too expensive, she says. Bonnie has both diabetes and thyroid problems.
Tight finances continued after Bonnie's husband, who worked construction, passed away in 2004. She worked another three to four years before being laid off when her job went overseas to China. A year later, her unemployment ran out.
Then in her mid-50s, Bonnie decided to make the move to Missouri where she could live with family and largely support herself on her widow's pension.
"I am on a fixed income - it's definitely fixed and not by me," she says. "It's really kind of scary when you don't have insurance. One trip to the hospital can wipe you out, so this is a good thing for me."
With her purchase, Bonnie joined the more than 54,000 Missourians estimated to have enrolled in Missouri Health Insurance Marketplace plans as of March 4, according to Cover Missouri. This coalition of organizations within the health care field was formed through the Missouri Foundation for Health which has an overall mission to achieve improvements in the health of Missouri’s citizens, particularly underserved populations.
While Bonnie Massey has signed up for "Obamacare", she like many other Americans is still unsure of the system overall.
"I did not think it was a good idea when they started it basically because of the way he [President Obama] did it. He just shoved it through," she said. "I thought that probably it wasn't going to work very well, and I'm still not convinced it will. But it's available, so I'm going to take advantage of it. I'm not sure if it will work in the long term though."
Melissa Magana was not the outreach and enrollment specialist who helped Bonnie Massey, but she has worked with many others in the region over the last few months to get them signed up for insurance through the Missouri Health Insurance Marketplace.
While she is one of 15 certified application counselors with Katy Trail Community Health based in Sedalia, Magana is the sole full time specialist for the organization which has satellite clinics in Versailles and Warsaw.
On an individual level, she says many people have been scared about how getting health insurance will impact their finances - scared that it will mean having to cut their grocery bill or cable bill.
"People are coming in expecting horrible plans and horrible prices, but I tell them, it's not that the insurance market has changed - it's still expensive - the savings comes from the premium tax credit," says Magana. "They're so surprised that the plans they're getting are not what the news has been saying."
In addition to the tax credit on monthly premiums, cost sharing reductions to help pay out-of-pocket costs may also be available depending on income.
Magana encourages people currently without insurance due to affordability to attend an enrollment event or contact an enrollment specialist to get their "real numbers."
"We're really trying to get people to give it a chance. We say, don't assume you can't afford it. Come in and do an application and get real numbers so you can make an educated decision for your family," she says. "There's no obligation to buy anything. You don't have to pay the counselors. You're not losing anything but two hours of your time. And in return you're getting real numbers - what it truly means for you and your family."
According to Magana, she hasn't had a single person say they couldn't afford health insurance once they saw what their price was after the the counselors calculated their tax credit.
The credit can be taken upfront or at the end of the year with their taxes. Most people who qualify take it upfront, she says, to be able to make the payments on the monthly premiums. This allows insurance companies to automatically send a portion of the bill to the individual and a portion to the government based on the income qualifications set during the application process.
In addition to income, the premiums also depend on the type of plan being purchased. Silver plans under the ACA is considered middle of the road and works best with the income tax credit, according to Magana. That's where she starts people on the application process, but they also look at Bronze and Gold level plans to find the right mix to suit the needs of the individual or family.
A lot of people come in saying they're going to pay the fine for being uninsured, says Magana, but leave astonished at how affordable it is. She has seen monthly premiums that range from zero and 67 cents to $200 and up to around $400. At the same time, she's seen deductibles range from zero to $7,000-$8,000.
"A variety of plans are offered," Magana says. "My favorite part is where we're able to compare plans. We really are comparing apples to apples. You can see the plans side by side."
With such a new system and with the website still having difficulties, Magana recommends you make an appointment with a certified counselor for help in applying for health insurance through the marketplace. They attend training sessions every week to know the quirks and bumps in the system. Here are some more tips from Magana for getting enrolled.
1. Bring 2012 and 2013 income tax statements. As long as you haven't changed jobs, this paperwork is useful for estimating 2014 income. And remember Obamacare goes by income tax, so a "family" is not necessarily who lives in the household but how you do your taxes. So dependents listed on your income tax statement impact your qualification level for the premium tax credit.
2. Bring proof of current income. Once in a while - sometimes when there's a big difference in income from last year to this year - the system might ask for proof of current income. If you have it on hand, the counselors can go ahead and get it loaded into the system to process the application faster. Otherwise, you will have to mail in certain pages of the application along with the proof at a later date.
3. Bring actual Social Security cards. The application requires ID verification. The application must match exactly your name as it appears on your Social Security card for the system to recognize it. Along the same lines, naturalized citizens should also bring their citizenship certificate, and immigrants should bring their permanent resident cards or work permits.
4. Bring information about your health care needs. Having a list of the medications you're on and what doctor you go to or want to go to can make a big difference in what plan you ultimately choose. Try to think generally as well about your level of health and the pros and cons of high premium/low deductible plans versus low premium/high deductible plans.
Enrollment events and help
Melissa Magana and other certified enrollment counselors will be available at an enrollment event in Morgan County this weekend.
Katy Trail Health Prairie Hills Clinic, 112 N. Hwy. 5, Versailles is hosting an outreach session from 9 a.m.-6 p.m. Saturday, March 29.
Walk-ins will be helped as time allows at the upcoming event, but Magana recommends making an appointment for the event or for another day. Call or text her about an appointment at 660-287-7702.
Another local enrollment event will be held from 12-3 p.m. Sunday, March 30 at Community Church, 1064 N. Business Route 5, Camdenton.
A Health Insurance Coverage Fair will also be held from 9 a.m.-3 p.m. Thursday, March 27 at Mercy, 1235 E. Cherokee St., Springfield. An enrollment event will be held from 11 a.m.-4:30 p.m. March 27 at the Career Center of Lebanon, 757 Brice St., Lebanon as well.
Central Ozarks Medical Center in Osage Beach at 573-302-7490 and Central Missouri Area Agency on Aging at 573-422-3322 are also available to offer assistance, according to Cover Missouri.
A few ACA basics
Individuals and households generally fall under three basic categories in the ACA.
The first are people who aren't on Medicaid already and for which there is no "affordable" insurance available. To be legally defined as unaffordable under the ACA, insurance would have to cost more than 8 percent of your income, or you would have qualified for Medicaid if Missouri had chosen to increase eligibility.
If the application process fails to come up with an affordable plan after tax credits, Magana says they can help individuals and families at this income level file for a hardship waiver to avoid the ACA penalty for non-insurance. There may also be other exemptions available under the hardship waiver.
The second group falls within an income range of 100-400 percent of the federal poverty level dependent on the total number in the household. Again, this is the true "Obamacare" part of the ACA. While they may not be able to afford insurance on their own, they are required to be insured because there's hope that they can get it with varying levels of premium tax credits - basically government subsidies.
The third group is required to have insurance, but would not qualify for a subsidy.
For those who already have insurance, there may have been some changes to your plan as the ACA requires all plans to offer certain "essential" benefits, such as emergency services, care for pregnant women, new moms and babies, prescription drugs and certain preventive services like health screenings. What doctors or other health care providers are covered under your plan may have changed as well.
The law also requires insurance companies to cover you even if you have a pre-existing health condition, and they can't cancel the policy if you get sick. Young adults can also be covered under their parents' health insurance until they turn 26 years old.
Most Americans were required under the ACA to have health insurance starting Jan. 1, 2014, but there's been no penalty so far. It will soon kick in.
While open enrollment ends March 31, the actual deadline to have active insurance by April 1 was March 15. The effective date for those signing up for insurance now will be May 1, but the penalty will be prorated for those who go ahead and buy insurance at some point this year, according to Magana.
In 2014, the fine for non-insurance is $95 per adult and $47.50 per child or 1 percent of income - whichever is higher - up to $285 for a family. Next year, it will go up to $325 per adult and $162.50 per child - or 2 percent of income up to $975 for a family. In 2016 and beyond, the fine will be $695 per adult and $347.50 per child - or 2.5 percent of income up to $2,085 for a family.
The Internal Revenue Service (IRS) is responsible for collecting these penalties, but they are not allowed to use liens or levies to collect the fines. Instead, you will be asked to show proof of health insurance when you file your federal income taxes. If you are found to owe a penalty, the amount will be taken out of any tax refund you are owed.