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Health care exchanges open to applicants

10/10/2013 - West Side Leader
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By Kathleen Folkerth

GREATER AKRON — The Health Insurance Marketplace opened for business Oct. 1, but local health officials said individuals interested in signing up for health coverage don’t have to hurry.

“People have some time,” said Donna Skoda, Summit County Public Health (SCPH) deputy commissioner. “There is a six-month open enrollment period. People have time now to think about what they need.”

That’s probably a good thing, as heavy traffic kept many from being able to navigate the online site www.HealthCare.gov since it went live at the beginning of the month.

Skoda said the Affordable Care Act (ACA) will allow those who do not currently have insurance, either through a government program (Medicaid and Medicare) or through their employer, the opportunity to purchase insurance.

In Summit County, Skoda said the health department estimates that between 63,000 and 65,000 people don’t have health insurance. That’s about 10 percent of the county’s population.

As of Oct. 1, those individuals were able to shop and apply for insurance through the marketplace, also called health care exchanges.

Skoda said the website www.HealthCare.gov provides fact sheets and explanations of the options available to those who are looking for coverage.

From the site, before applying, individuals can first click on the “Learn” tab to explore topics and find answers to frequently asked questions about the health care marketplace.

To check into plans, the website will first ask for the individual’s state. Once that is clicked through a drop-down menu, the site will direct the applicant to a different site or stay on the HealthCare.gov site. In Ohio, the exchange is operated by the federal government, as it is in 27 other states, according to the Kaiser Family Foundation, so those who are applying will remain on the HealthCare.gov site.

Skoda said the Internet is just one way to find answers to questions and to apply for insurance. Individuals without a computer or Internet access can apply and find answers to questions in other ways, she said.

Calling 800-318-2596 will help residents get answers to questions and apply for coverage. In addition, forms to apply for coverage are available at the SCPH office at 1100 Graham Road Circle in Stow. Skoda said they also could be mailed to residents who request that. Certified application coordinators are able to help by calling SCPH’s Care Coordination Department at 330-926-5660.

Forms also are accessible at the SCPH website at www.schd.org. The website also has fact sheets from the Department of Health and Human Services that explain various aspects of the ACA.

Skoda said that residents should be aware that the government will not be sending them forms to fill out to apply for coverage. Mailed forms that claim to be an “official government document” may be a scam, she added.

Insurance coverage for those who apply through the marketplace can begin no sooner than Jan. 1, Skoda said. She added that government officials said those who apply by Dec. 15 would be under a policy by Jan. 1.

Skoda said after the first of the year, anyone in need of insurance could apply and be covered within a month, which is similar to the time frame when one acquires coverage after accepting a new job.

If someone is without insurance and they purchase coverage through the marketplace but then they find a job that provides them coverage, they just have to cancel the policy or stop paying their premium, Skoda said.

Starting in 2014, the ACA mandates that all citizens have minimum health insurance coverage or they will pay a fee on their federal tax return. The fee is called the “individual shared responsibility payment.” In some cases, citizens will be able to be exempted from the fee.

There are several situations that will allow an individual to be exempt. They include:

  • being uninsured for less than three months of the year;
  • the lowest-priced coverage available would cost more than 8 percent of your household income;
  • you don’t file a tax return because your income is too low; and
  • being part of a religious sect that has religious objections to insurance.
  • There are also several hardship exemption reasons, such as:
  • you were homeless;
  • you were evicted in the past six months or were facing eviction or foreclosure;
  • you were the victim of domestic violence; or
  • you recently experienced the death of a family member.

Exemptions can be claimed on the HealthCare.gov website by filling out an application, or when filing income taxes after the start of the new year.

Those who can’t get an exemption but still wish to opt out of the program will be subject to a fee starting in 2014 that is 1 percent of their income for the year or $95 per person in your household, whichever is greater. For children, the fee is $47.50 each. Regardless of the number of people in a household, the maximum a family could pay that first year is $285. The fee would be due at the same time income tax is due — April 15.

In subsequent years, the fee will increase. In 2015, it will be 2 percent of income or $325 per person, whichever is higher. The fee for a child at that time will be $162.50 per child.

The fee will increase to 2.5 percent of income or $695 per person in 2016.

Skoda said there are several reasons why someone may not want to apply for coverage.

“For some, $95 isn’t enough to deter them for now,” she said. “The other issue is there’s not a cultural belief that health insurance is important.”

Skoda said that from a public health viewpoint, the ACA is a positive thing.

“The biggest positive change is it offers individuals a chance to get preventive care,” she said. “It allows them to get early identification of diseases or prevention, which is huge if you’re trying to prevent mortality. It’s equal access based on income and any number of factors. You are only charged more if you are a smoker, but it won’t penalize you if you are a sicker human.”

Some aspects of the ACA have already been implemented, such as the provision that dependent children can be kept on their parents’ health insurance policies until they turn 26.

The new program does have challenges, Skoda said.

“Our concern is that there will still be a group that will be uninsured because we don’t have Medicaid expansion in Ohio,” she said.

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