Marketplace still open for those seeking health coverage
Many people still have questions about their health insurance, or where they need to go or what they need to do to sign up for insurance under the terms of the Affordable Care Act.
That’s where the Health Insurance Marketplace comes in, according to Cindy Hermes, health care consumer ombudsman and director of public outreach with the Kansas Insurance Department.
The Marketplace, as it is described by the Cover Kansas Navigator Project, is an internet portal where private companies sell insurance plans to those who need them. It’s designed to help individuals find health coverage as mandated under the Affordable Care Act, which was created to expand access to affordable health care coverage to all Americans.
“All the plans that are for sale cover the 10 essential health services,” said Hermes, noting those services include outpatient treatment, emergency treatment, hospitalization, maternity and newborn care, mental health services and addiction treatment, prescription drugs, rehabilitative services, laboratory services, preventive services and pediatric services.
Hermes said Kansans have a handful of options available to them in signing up for health care coverage during the open enrollment period for 2015, which ends Sunday, Feb. 15. However, those who do not already have insurance and get signed up by this Thursday will have coverage that goes into effect on Sunday, Feb. 1.
For those who use the internet to sign up for health care coverage, they can go to www.healthcare.gov, and in Kansas, people who need to sign up may do so at www.insureks.org — a Web site run by the KID. In the latter case, “navigators” are available for those who need at-the-moment assistance in signing up.
“On the left hand side, we’ll have that assistance for people who click on the county of their residence, and they can choose whether they want to see an agent, whether they want to see a navigator or a consumer counselor,” Hermes said.
The option of signing up through a local insurance agent is also available, but Hermes said people whose income falls within a certain range may be able to use an “advanced premium tax credit” to lower their monthly costs. Those with incomes below those levels, she said, may also qualify for a cost-sharing reduction that lowers out-of-pocket costs associated with the insurance plan.
“If you’re a single person making between $11,670 and $46,680, you’re eligible for a tax credit,” she said. “But if you’re making $50,000, go to the agent. You don’t need to go through healthcare.gov and you’re not going to get a tax credit.”
For a family of two, the income range for an advanced premium tax credit is $15,730 to $62,920. For three, it’s $19,790 to $79,160; for four, $23,850 to $95,400; for five, $27,910 to $111,640; and for six, $31,970 to $127,880.
According to ACA regulations, people are considered covered if they have a job-based insurance policy or any policy they purchased on their own in effect. Other insurance plans that count as coverage under the regulations include Medicaid, Medicare and the Children’s Health Insurance Program (CHIP).
Those who do not have minimum essential coverage may also qualify for an exemption from the penalty if any of the following apply:
* Being uninsured for less than three months of the year.
* The lowest-priced available coverage would cost more than eight percent of full household info.
* Not having to file an income tax return due to income being considered too low.
* Membership in a federally-recognized tribe or eligibility for services through an Indian Health Services provider.
* Membership in a recognized health care sharing ministry.
* Membership in a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
* Not being lawfully present in the U.S.
* Qualification for a hardship exemption, such as homelessness, bankruptcy filing or natural disasters.