Insurance Marketplace Opens Oct. 1

Terri Clark, with Arkansas Insurance Department, during an informational course Tuesday, Sept. 17, 2013 about open enrollment for the health insurance exchange at the JTL Shop on Emma Avenue in Springdale. Enrollment starts Oct. 1. The Arkansas Insurance Department is providing training seminars for people who will be working on enrolling people into the exchange.
Terri Clark, with Arkansas Insurance Department, during an informational course Tuesday, Sept. 17, 2013 about open enrollment for the health insurance exchange at the JTL Shop on Emma Avenue in Springdale. Enrollment starts Oct. 1. The Arkansas Insurance Department is providing training seminars for people who will be working on enrolling people into the exchange.

The 572,000 Arkansans without health insurance can begin shopping for a plan in nine days and make side-by-side comparisons of prices, quality and benefits.

Everyone must have health insurance starting Jan. 1 or face a penalty unless they fall into one of the few exceptions. The individual mandate is a key part of the Affordable Care Act, signed into law by President Barack Obama on March 23, 2010.

If you have questions about all these changes, you are not alone.

“There are still a lot of misconceptions out there about the law,” said Mary Eakin of the

AT A GLANCE

Changes Already in Place

The Affordable Care Act also has provisions on patient protection. Some of the changes already in place are:

• Nearly all adult children are eligible to stay on their parents’ health insurance policies until their 26th birthday regardless of marital status, financial dependency, enrollment in school or residency.

• Preventive services are available without cost if using an in-network or participating provider.

• Children under age 19 cannot be turned down for coverage because of pre-existing conditions. This clause will be expanded to include everyone after Jan. 1, 2014.

• Small businesses that provide health care for employees can apply for a tax credit.

• Some seniors on Medicare prescription drug coverage received a rebate to help cover costs.

• Lifetime limits on coverage are prohibited, and by Jan. 1, 2014, annual limits on essential health benefits will no longer exist.

Source: Staff Report

Web Watch

www.arhealthconnector.org

Web Watch

Health Quiz

nwaonline.com/healthcarequiz

Arkansas Department of Health. She gave a presentation Wednesday to 25 people at NorthWest Arkansas Community College about insurance options.

If you have insurance, you don’t need to change a thing.

If you are on a federal program, such as Medicare or Medicaid, you are set.

If you work somewhere that doesn’t offer insurance, that could change in 15 months. Employers with more than 50 workers have to offer insurance or pay a penalty starting Jan. 1, 2015. But for 2014, you need to find your own coverage.

The federal law is aimed at insuring the 41.3 million people across the country the U.S. Department of Health and Human Services estimates don’t have coverage. The agency says 23.2 million of those may qualify for Medicaid, state programs for children or a tax credit.

The state’s insurance marketplace is called the Arkansas Health Connector and can be found at arhealthconnector.org. The state’s marketing plan for the program is in high gear. You’ve probably seen or heard commercials with the slogan “Get In.”

You can’t see plans and prices or sign up until Oct. 1, but the site does have answers to many questions you might have, and it can help you find a trained helper to walk you through the process.

You can also call 855-283-3483 to ask questions or 800-318-2596 to enroll after Oct. 1.

To sign up you need your Social Security number, employer and income information from pay stubs, W-2 forms and tax statements.

You don’t have to sign up for coverage on the marketplace. But if you want to try to qualify for a tax credit, you need to buy through the Health Connector. Tax credits for insurance are based on income and household size and are assessed on a sliding scale.

Kathy Grisham, executive director, is preparing for an increased demand for services at the five Community Clinic sites in the area: Rogers, Springdale, Siloam Springs and school-based clinics in Fayetteville and Springdale. Clinics offer health care on a sliding scaled based on income and household size. Most patients end up paying a $20 copay.

The clinics saw demand grow from 14,527 patients in 2008 to 29,295 in 2012.

“People just don’t know what the law is all about and are surprised to learn it will impact them,” Grisham said.

She estimates about 60,000 people in Benton and Washington counties will be affected.

Lois Stewart found herself among the uninsured two years ago after losing her job at Tyson Foods. The Tontitown woman said finding a full-time job with benefits at age 58 is challenging, and she won’t be eligible for Medicare until she turns 65. She works part time as a substitute teacher with no benefits.

Stewart wound up in the hospital twice last year and was diagnosed with congestive heart failure, adding to her difficulties finding insurance. She looked into private insurance, but said the $500 a month price tag was more than she could afford on her $1,000 a month income. Doctors prescribed a few medications, and Stewart said luckily most are not expensive.

“I have worked for 40 years and always had insurance. Now when I need it, I don’t have it,” she said. Her husband is insured as a Cherokee Indian and a veteran, but Stewart said she can’t get on his plans. The couple made about $10,000 last year and Stewart said she expects to qualify for free care.

“Finally some good news,” she said.

A report released by the the Department of Health and Human Services on Tuesday estimates 6.4 million Americans who are eligible to buy insurance through the marketplace will pay $100 or less a month in premiums because of tax credits.

Arkansas is one of 25 states expanding Medicaid programs next year. The government program will cover people with incomes up to 133 percent of the federal poverty level, or about $15,800 a year for an individual or $32,500 for a family of four.

Patricia Rodriguez of Fayetteville attends NorthWest Arkansas Community College and works part time. She said her child is covered by ARKids, and she is exploring her coverage options. She is changing jobs and will lose the health coverage she gets as a Sam’s Club employee. She said her old coverage had a $3,000 deductible, and she is hoping to find an affordable plan with a lower deductible.

“I want to get signed up in January. I guess I will cross my fingers nothing happens until I’m covered,” she said.

Anyone wanting coverage Jan. 1, 2014, must be signed up by Dec. 15.

Who’s Affected?

The Affordable Care Act requires most Americans not covered by employer-sponsored plans, Medicare, Medicaid or an approved health plan to get insurance through the state’s marketplace. Groups exempted from the coverage requirement are people who would have to pay more than 8 percent of their income for health insurance, people with incomes too low to file taxes, those who qualify for religious exemptions, undocumented immigrants, people who are incarcerated and members of American Indian tribes.

To be eligible for the Arkansas plans, you must be a U.S. citizen or lawfully in the country and be a state resident.

If you have insurance through your job, you can choose a plan on the exchange but will not be eligible for a tax credit unless your plan is considered unaffordable. If you switch to an exchange plan from a work plan, you will also lose the employer contribution.

Unaffordable plans are those that cost more than 9.5 percent of your taxable income, said Corry Hull, employee benefits consultant with Legacy Capital Group in Springdale. You can also seek a plan from the marketplace if your plan does not offer essential coverages (listed below) laid out in the law.

If your work-sponsored insurance also covers other people, the 9.5 percent threshold does not apply. The law sets no limits on how much a family plan costs through employer plans because employers are not required to provide insurance for anyone other than their workers.

The Plans

The premium you pay on a plan purchased through the Arkansas Health Connector will be based on your household income and family size. You can’t be denied coverage because of a pre-existing condition, and the only factors that can increase your premiums are age, geography and tobacco use.

The state will not release the plans or their costs until Oct. 1, but the federal government has released baseline costs that should be close to state costs, said Heather Haywood, public information manager for the Arkansas Insurance Department.

There will be four plan levels available: platinum, gold, silver and bronze. Each will have varying levels of premiums and benefits. A bronze plan must cover 60 percent of costs, leaving you responsible for the remaining 40 percent. This is the lowest level of coverage and has the lowest premiums.

Platinum plans must cover 90 percent of the costs and are the highest level of coverage with the highest premiums.

Federal tax credits are based on silver plans and all estimated costs are from that level.

Let’s say you are in a family of four with a household income of $45,000. Your premium without any tax credits could be $822, but because of your income and family size, you are eligible for a credit of $607. Your monthly premium would be $216.

Other estimated premium costs figuring in tax credits are: $94 to $142 a month for an individual making between $21,000 and $25,000 annually; $0 to $102 for a single-parent of two children making between $26,000 to $30,000; or $355 to $395 for a married couple with a household income of $46,000 to $50,000.

Tax Credit

You may qualify for a tax credit that is based on a sliding scale for people who make up to 400 percent of the federal poverty level. According the U.S. Department of Health and Human Services, 400 percent of the 2013 poverty level is $45,960 for an individual and $94,200 for a family of four.

Mary Goff, attorney at the Low Income Taxpayer Clinic for Legal Aid of Arkansas, said there are two ways someone can get the credit: advanced or refunded.

“A person who wants it to go to their premium costs can have the credit sent from the IRS to the insurance company or they can choose to have it all refunded when they file they taxes the next year,” she said. “Most people will need the tax credit to pay the premium cost each month.”

The Penalty

If you decide to go without insurance, you face a penalty that is the greater of $95 or 1 percent of your taxable income when you file your taxes in 2015. The penalty will increase to $695 per adult or 2.5 percent of taxable income in 2016. Starting in 2017, the tax penalty increases annually based on a cost-of-living adjustment.

Goff said the only way the IRS will collect the penalty is by withholding the funds from a tax refund. The IRS will not enforce through levy or liens.

Essential Benefits

All insurance plans sold after Jan. 1, 2014, must cover the following: outpatient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventative and wellness services and chronic disease management; and pediatric services, including oral and vision care.

How to Apply

People can apply for insurance through the marketplace starting Oct. 1 online, over the phone, in person or by mail.

Go online to arhealthconnector.org or call 800-318-2596.

You can also walk into one of several locations with trained and licensed helpers.

Haywood said the state’s goal is to have 537 licensed helpers through 25 approved organizations ready Oct. 1.

Five organizations are offering this help in Benton and Washington counties: each county’s Health Department, Economic Opportunity Agency of Washington County, Community Clinic, Hispanic Women’s Organization of Arkansas, Mental Health Council of Arkansas and Friendship Community Care.

Haywood said a list of all sites will be on the Health Connector website Oct. 1 under the “Get Help” tab.

Health Care Quiz

Test your knowledge with the quiz below.
Source: Arkansas Insurance Department

Starting in 2014, everyone must either have health insurance or pay a penalty.
True
False

There are exceptions: members of Native American tribes and people not required to file taxes, people with approved religious reasons for not believing in insurance; people who go without coverage for less than three months; those who are incarcerated because of a conviction; and people who cannot afford premiums because they cost more than 8 percent of the family's income. There is also a general hardship exemption that covers unusual circumstances.

The government will administer all plans offered on the Health Insurance Marketplace.
True
False

The government has set requirements on health insurance carriers in regards to the plans that can be offered on the marketplace. However, the government will not be administering these plans. Health insurance carriers will administer their plans, just as they do today.

All health care is now free.
True
False

Consumers will still have payment responsibilities with the new Health Insurance Marketplace. For example, consumers may still have to pay monthly premiums, co-payments, coinsurance, deductible and out-of-network costs.

People cannot be denied coverage because of pre-existing conditions.
True
False

This policy starts in January.

The coverage offered will be very limited.
True
False

The government has set 10 essential health benefits that all plans on the Health Insurance Marketplace must offer.

You must enroll through the Health Insurance Marketplace in order to not pay a fine.
True
False

False. No one is required to purchase coverage through the Marketplace. Consumers can stay on their current plans, purchase through private insurance companies, through their job or the military.

You must enroll through the Health Insurance Marketplace to receive financial assistance.
True
False

Anyone wanting to check their eligibility and receive financial assistance for private health coverage must enroll through the Health Insurance Marketplace.

People in the United States without proper documentation will receive federal aid to buy health insurance.
True
False

People in the country illegally cannot purchase from the Marketplace and are not eligible for federal aid, tax credits and Medicare or nonemergency Medicaid.

People may have higher premiums because they use tobacco products.
True
False

Health insurance carriers may set higher premiums for those who smoke, however there is a limit as to how much higher. Insurance companies in Arkansas can charge tobacco users up to 20 percent more.

All businesses will be required to provide health insurance to all of their employees.
True
False

Only businesses with more than 50 employees will be required to provide health insurance to their workers starting Jan. 1, 2015. Businesses with fewer than 50 employees won't be required to provide health insurance to their employees.

Upcoming Events