Daily Progress, Jacksonville, TX

February 15, 2014

Officials prep for questions on Affordable Care Act rules

Jo Anne Embleton
Jacksonville Daily Progress

CHEROKEE COUNTY — As a March 31 deadline for Insurance Marketplace Open Enrollment period looms nearer, Debbie Hamilton expects she'll hear questions about the 2010 Affordable Care Act on an even more frequent basis.

Things like, “ 'How do I enroll?' and 'If I have insurance through my job, do I need to do anything?' ” the healthcare navigator said, recalling questions from a community presentation held earlier this month.

The healthcare act is designed to provide individuals with insurance information using a common set of benefits, such as premium costs and other features, supplied by private health care companies. Three plan levels have been set up, with varying premiums and patient payment responsibilities.

Because it is legally mandated, a penalty can be assessed on those not in possession of health care insurance.

“Anyone who is uninsured in 2014 will be subject to an individual responsibility fee of $95 per adult or one percent of income, whichever is higher, (plus) half for each uninsured child. This rate is scheduled to increase in 2015 to two percent, and by 2016, will be at 2.5 percent, or $695 per uninsured adult,” she explained.

Individuals can enroll in the marketplace using several different methods: Applying online, through the healthcare.gov website; by contacting the health insurance marketplace at 800-318-2596; by scheduling an appointment with a local navigator; or filing a paper application, which Hamilton pointed out as the slowest of the four processes.

To better assist clients, healthcare navigators like Hamilton undergo 30 hours of training and are registered with the Texas Department of Insurance, as per by new navigator requirements added in Texas.

This, she said, ensures that a consumer gets one-to-one, in-person assistance with questions about enrolling into the Marketplace.

“After open enrollment ends, we will continue to answer questions regarding the Affordable Care Act and will continue to provide education regarding compliance within the community, both to families and to small business owners,” she said.

Individuals must bring their Social Security cards (or documents numbers for legal immigrants), employer and income information for each member of the household needing coverage, and birth dates for each.

“If an individual has a job-based insurance plan available to someone in their household, that information will need to be provided as well,” Hamilton said.

ACCESS is open during regular business hours. However, because Hamilton works out of both the Jacksonville and Palestine offices, appointments are necessary to allow her enough time to assist clients with their particular needs.

Hamilton also gives out information at community meetings and events like a Feb. 18 Alto Health For All Clinic, held from 1-3 p.m.

A date has yet to be fixed for an upcoming event in Anderson County, she said.

Additional things to know, per Hamilton:

• Advanced premium tax credits and cost sharing reductions are only available in Marketplace plans. A person can qualify for tax credits if their income falls in the 100-400 percent of the federal poverty level (FPL), $15,960 is the current federal poverty level for individual.

• Household size and income level will determine individuals' qualification for available subsidies.

• A household income level between 100-250 percent of the FPL could also qualify for a reduced deductible and/or co-pay when choosing a Silver Plan in the marketplace.

• A consumer is able to complete an application in the marketplace and compare plans and pricing prior to enrolling in a plan. Once an application is complete, he is able to see whether he is eligible for any lower out-of-pocket costs.

• If an application indicates that a member of the household qualifies for Medicaid or CHIPS (Children’s Health Insurance Program), information will be forwarded to the appropriate state agency

• Individuals on Medicare, covered through a job-based insurance or COBRA, or who have retiree coverage, VA benefits or an individual private insurance are considered covered in the marketplace.

To learn more about the Insurance Marketplace Open Enrollment, contact Healthcare Navigator Debbie Hamilton at 903-541-2597.