January 15, 2014
Despite the initial problems with the federal government’s Affordable Care Act (ACA) implementation, the website www.HealthCare.govcontinues to improve and more and more individuals across the entire country are now able to sign up for new health insurance options through March 31. More than 2.2 million persons have successfully enrolled and are now awaiting coverage for healthcare.
Still, confusion regarding the enrollment process exists.
According to the recently released study entitled “The Uninsured Midway through ACA Open Enrollment: Results of a National Survey of Uninsured Adults 18 to 64” the website’s technical problems have not been a significant barrier to enrollment. However, seven in ten uninsured adults have not yet visited the website’s on-line health insurance marketplace. The reason, say the study authors, is that most uninsured persons believe they cannot afford health insurance.
The irony in this belief is that significant tax subsidies exist to help those of low income receive health insurance coverage. Sixty-nine percent of respondents were unaware of the tax subsidies and financial help available. Study authors believe that the concern about costs and the lack of awareness around subsidies may be the biggest challenge to increased enrollment numbers.
However, a majority of uninsured adults (62%) say they definitely (31%) or probably (31%) plan to get health insurance in the near future. Only 16% suggest they will not get insurance.
Also, eight in ten uninsured adults (81%) do not know when they need to sign up for insurance in order to avoid getting a fine. The “individual mandate” component of the health care reform law requires most uninsured individuals who can afford health insurance to purchase insurance. The penalty for not getting insurance, which applies to most people, in 2014, is one percent (1%) of yearly income or $95 per person for the year, whichever is higher.
Some say the deadline was in December 2013 (12%); some say January (19%); and a plurality says they are not sure (45%). Only 19% gave the correct response – March 31, 2014.
The Patient Protection and Affordable Care Act has four primary goals. They are:
• Provide access to health coverage for millions of Americans, including those with pre-existing conditions who have in the past been denied health insurance;
• Increase competition among insurers and therefore, make health insurance more affordable, with greater common benefits such as preventive care and adding younger, healthy people into the mix to spread the risk and costs associated with those risks among a larger pool of subscribers;
• Provide consumers with greater control over which insurance plan they select, rather than being dependent upon whichever plan their employer selects for them;
• Encouraging regular visits with primary care doctors and nurse practitioners and putting great emphasis on preventive services to make nationwide changes that result in healthier lifestyles for all.
The Health Insurance Marketplace will make the first three goals a reality, while 100 percent coverage for preventive care by insurance companies is gradually becoming the rule as the healthcare reform law becomes effective. Dozens of preventive services are now covered fully by insurance plans, requiring no office visit co-pay. Even more fully covered preventive services will be required with the new plans available in the Health Insurance Marketplace.
The new Health Insurance Marketplace offers different types of health plans to meet a variety of budgets and coverage needs for persons seeking health insurance without the benefit of an employer sponsored plan. This is especially important to persons and families affected by changes in the 2014 State of Wisconsin BadgerCare Plus eligibility allowances.
Accounts can be established on the website www.HealthCare.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325).
Consumers seeking to enroll in the Health Insurance Marketplace program should be able to do so without assistance. A variety of local resources exist to assist new applicants and others to better understand the health insurance options available through the Health Insurance Marketplace where Certified Application Counselors (CACs) have been trained to offer enrollment assistance. These individuals can assist consumers in the application and enrollment process available at www.HealthCare.gov. They cannot make recommendations regarding which coverage should be selected. For more information, please contact these agencies and healthcare providers:
Fort HealthCare Business Services
UW Health Partners- Watertown Regional Medical Center
Patient Financial Services
Southern Consortium, Medicaid and BadgerCare Plus
1 888-794-5780 (toll free)
1 800-362-3002 Option #7 (Español)