Understanding the Affordable Health Care Act
The enrollment period to apply for the Affordable Health Care Act is under way and there is much to consider.
Jennifer Busch, an insurance navigator for Genesis Health Systems, said it is difficult to determine even average costs involved because each person is different. She said so much depends on their income and number of people living in their household.
But in general, the best thing to do is to call and find out the particulars of your case.
“If people lose their job, they may be eligible for a special enrollment period,” she said. “The prices are all based on family size and gross income. But people with lesser income generally would qualify for greater benefits.”
For instance, she said of the four plans available, there are different levels of coverage. The Silver Plan has levels that would pay 73 percent, 87 percent and up to 94 percent of all costs, and in some cases, no deductible and reduced co-pays. However, in some cases, if a person loses their job, it may be more prudent to accept the COBRA package by their company offered for right now.
“But if a person loses their job and if their monthly income now is less than $1,250, they could qualify for Medicaid,” she said.
There are actually two ways to file for Medicaid. One, is the traditional period that takes 30-45 days before approval. The other option is to get temporary coverage until Medicaid coverage becomes official. That would cover the person if a medical issue develops, officials with UnityPoint Health Hospitals said.
But regarding regular coverage, Busch said it really is not good to try to gauge what your costs may be based on amounts that are quoted because it may not be correct in your situation.
“It may not be as expensive as you think and the deductible may not be as high, either,” she said. Linaka Kain, the manager, marketplace exchange for UnityPoint Health Hospitals, also suggested that the best way to proceed is to make an appointment to find out where you stand.
“There are no standard numbers. Everything is case-by-case,” she said. “Not all customers get the tax credits.”
She said it really boils down to size of your household and income. That also makes the amount of deductibles vary.
She said open enrollment began Nov. 1 for health insurance plans that are now made available as part of the Affordable Care Act. Like Genesis, UnityPoint Health has certified and trained staff to help individuals and families better understand and enroll in the Health Insurance Marketplace.
For those not already enrolled in a public or private health care plan or who do not have health insurance through an employer-provided plan, the open enrollment period will be the time to purchase coverage or risk paying a tax penalty.
New dates for the open enrollment period will be from Nov. 1, 2015, to Jan. 31, 2016, and the tax penalty increases to $162.50 per child and $325 per adult – or 2 percent of yearly household income, whichever is greater – in 2015 for not enrolling in a qualified plan.
Kain said the good news is that each year, the process seems to get easier for consumers to understand and more people are making appointments.
And with Genesis and UnityPoint providing free assistance, it makes things even less daunting for people. An appointment allows people to determine exactly their costs, co-pays, whether their doctors in the network, among other issues.
But many already are taking advantage of the service.
“This year is far better than last year and we have lots of appointments,” Kain said. “We are completely booked.”