Local help offered to navigate through health care maze

The largest health care overhaul in recent history may have opened for business more than a month ago, but confusion remains a word closely linked to the Affordable Care Act and the health care marketplace. 

“There is so much information and so many pieces,” Certified Application Counselor Sarah Morgan said. “We’re still learning and will be for quite some time.”

Morgan, along with four other members of the Montgomery County Memorial Hospital personal accounts department, became certified through the Iowa Hospital Association to assist customers with the ins and outs of the ACA. 

Since the marketplace opened Oct. 1, Morgan said they’ve only had two custom 

ers apply locally for insurance through the federal website and several others call with questions, but she expects to see more in the next month as the Dec. 15 deadline to apply for coverage approaches. 

The enrollment period has been extended through March without penalty, but Morgan said the December deadline is required for those needing coverage effective Jan. 1. 

During the first month, 27,000 people nationwide have applied for insurance through the federal website with only about 130 in Iowa. 

The Facts

The ACA, also known as Obamacare, passed in 2010 and aims to increase the affordability and accessibility of health care nationwide.  

Morgan said one of the biggest misconceptions about the ACA is everyone needs to change their insurance. 

In fact, the majority of people, including those who receive insurance through their employer or are on Medicare or Medicaid are virtually unaffected. However, they will see more benefits through their existing plan. 

Only the uninsured or those opting out of a plan offered by their employer are impacted by the new legislation.  

The ACA outlines 10 benefits all insurance companies (private companies and those in the marketplace) must provide. They include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitation services and devices, laboratory services, preventive and wellness service and chronic disease management and pediatric services, including oral and vision care. 

“It’s giving flexibility and opportunities that some people have never had before, and I think once it gets going we may see a decrease in costs,” Morgan said. “We’re not going to have these exorbitant prices for all the bad debt that hospitals are having to write off. It’s going to be a shift for the doctors because they might start to see an increase of patients coming in but that’s good because they are going to catch a problem right when it starts to happen instead of after it’s progressed and it becomes costly.”

Controversy has surrounded the ACA since its inception; most recently, though, private insurance companies have been dropping individual plans for failure to cover the 10 essential benefits. 

To retain coverage for those who lost coverage, President Barack Obama called for a one-year extension to current insurance policies through the independent marketplace.  The specific details and the effectiveness of this plan are not yet known.

“Just like anything, it’s going to take some time,” Morgan said. “There will be ups and downs, but once we get into it, I really think it’s going to be a great benefit for the American people.”

The Costs

Those who do not apply for health insurance will pay a penalty through their income tax, according to Morgan. But despite the rumors, the penalty isn’t necessarily cheaper than the cost of coverage, and it increases every year.

For 2014, each uninsured person will pay $95, or one percent of his or her annual income, whichever is greater. That number increases to two percent or $325 in 2015 and 2.5 percent or $695 in 2016. 

There are penalties for uninsured children as well. Parents will be charged $47.50 per child with a $285 maximum. 

For those who cannot afford insurance through the marketplace, there are tax credits and cost sharing options available, according to Morgan. 

There are two types of tax credits available, both of which are offered based on income and are only available to those who have not been offered a qualified plan through an employer. First, the customer can pay for services up front and receive a credit toward his or her income tax, or the customer can pay a portion of his or her bill each month and the credit will apply to the balance given to the insurance company. 

The marketplace offers four cost sharing plans each with different percentages paid by the customer and the insurer. Morgan said exactly how these plans will work has yet to be seen, but supposedly, the lowest plan will have lower premiums but will cost more out of pocket and vice versa for the highest plan. 

For those who cannot afford any of the plans through the marketplace, Morgan said there are options. 

As customers input their income information on the marketplace website, it will be validated through social security and the IRS. So should a customer fail to meet income requirements, the enrollment process in Medicaid, Medicare or state-funded assistance programs will be automatically started.    

Should someone not qualify for those programs, they will receive a certificate exempting them from the penalty.

There are also exemptions available for certain religious affiliations, undocumented immigrants, members of Indian tribes and those who are incarcerated.   

The Application

Morgan said the enrollment process through the marketplace does still have its kinks, but is easier than anticipated. 

“It really is not a difficult process,” she said. “Once consumers actually get online, it’s a pretty self-guided process. It’s not as difficult as a lot of people are making it out to be.”

The federal website, which had some initial hiccups, is accessible at healthcare.gov. Morgan said she hasn’t had any success finishing the enrollment process through the site, but was able to help the two customers finish the process over the phone, which only took 10-15 minutes. 

When on the marketplace, customers need a social security number, employer and income information (pay stubs, W-2 forms, wages and tax statements), policy numbers for any current health insurance plans and a completed Employer Coverage Tool form, which is available at healthcare.gov. 

Once an application is completed, customers will receive a packet in the mail outlining the different plans available to meet their financial needs. There are two companies in Iowa that offer coverage through the marketplace, Co-Opportunity and Coventry. 

For those wanting assistance in enrolling, Morgan said the counselors at MCMH are ready to assist. Contact the hospital at 623-7000 and ask for a Certified Application Counselor; evening and weekend times are available by request.