Sept. 29--Love it or hate it, the Affordable Care Act is inching ever closer to reality.
In fact, beginning Oct. 1, Kentuckians will be able to sign up for health insurance through a state-created program at the website Kynect.ky.gov. Here are some frequently asked questions that will help you navigate your way.
What is this?
Under the Affordable Care Act, also known as Obamacare, every American -- with very limited exceptions -- must have health insurance or face a penalty. State officials estimate 640,000 people are without health insurance in Kentucky, about 15 percent of the population. Of those, 308,000 will be eligible for Medicaid, the rest will be able to buy insurance through the state program.
What happens if I am on Medicare?
State officials have said people now on Medicare will not be affected by this program.
Will someone contact me about signing up?
It doesn't work that way. It is up to everyone to determine the best option for themselves and their families and to take action. There will be help available.
The center of activity for health care reform in Kentucky will be Kynect.Ky.Gov, which carries the tagline "Kentucky's Healthcare Connection." You can't sign up for insurance until Oct. 1, but the website has a list of frequently asked questions, a short explanatory video, and fact sheets including general information about the scope and cost of coverage. You also may request a paper insurance form to fill out.
What can I do today?
About 60 people have been answering questions since a Lexington-based call center opened Aug. 15. The number of operators will rise to 100 as needed. The number is 1-855-459-6328, and operators are available 8 a.m. to 7 p.m. Eastern time Monday through Friday. Saturday hours will begin Oct. 5.
What are the plan options?
Kentucky's health care plans are divided into four categories -- bronze, silver, gold and platinum. Individual health insurance companies will design plans to match the individual requirements for policies.
A platinum plan has a higher premium but lower out-of-pocket costs. A bronze plan has a lower premium and higher out-of-pocket cost. Specific coverage details will be available when open enrollment begins Oct. 1.
What companies are offering plans through the state program?
There are five providers sanctioned in Kentucky: Anthem, UnitedHealthcare, Humana, Bluegrass Family Health and the Kentucky Heath Cooperative. Not every company is offering a policy in every area of the state. Specific rates will be available starting Oct. 1.
What determines how much I will pay for insurance?
The rating system takes into account four things -- your age, where you live, whether you smoke or otherwise use tobacco, and how many people are on your policy.
Wait -- if you smoke or use tobacco?
Yes, Kentucky has placed as much as a 40 percent surcharge on the insurance used by smokers. When you disclose that you smoke or otherwise use tobacco, you face the penalty. It is applied after any discounts you might receive. The rule and surcharge does not apply to those who receive Medicaid.
What if I have a pre-existing condition, such as diabetes?
You cannot be denied coverage because of a pre-existing condition.
What do I need to do to get insurance?
You can sign up for health insurance beginning Oct. 1. Enrollment runs through March 31. The earliest that coverage can take effect is Jan. 1.
Is enrolling early better?
Those who apply by Dec. 15 will be eligible to begin coverage Jan. 1. Otherwise, applications will be processed and become effective on a rolling basis. The best thing to do is ask when you enroll when you policy will become active. People who are eligible for health insurance will be able to qualify as long as they enroll in a plan before the March 31 deadline. Access to all of the plans will be available through the entire enrollment period.
What if I can't afford it?
Kynect.ky.gov will be connected to federal databases -- including IRS databases -- to determine, based primarily on income, whether you qualify for assistance in paying a premium. People qualifying for Medicaid won't have to pay a premium. Others might be eligible for some payment assistance or tax credits. You must sign up for insurance through Kynect.ky.gov to receive assistance. The subsidies are not available if you buy insurance through a private broker.
The program does place a cap on what percentage of your income must be spent on health insurance.
Is there any other type of assistance?
There is also some assistance available to defer the cost of out-of-pocket expenses. But to be eligible for that particular assistance, the state requires that you enroll in a silver-level plan. The insurance company doesn't matter, but it must be a silver-level plan.
What if I don't qualify for assistance?
You can still buy health insurance at Kynect.ky.gov, or you can go directly to an insurance company. You will pay the full premium. The state has said only about 50,000 currently uninsured Kentuckians will have to pay the full premium.
Is there help using Kynect?
Yes. Here are some options.
-- Public libraries: The state is training library staffs to help people without home Internet access to use library computers to access the website.
-- Department for Community Based Services: People may go to the local offices, which now administer social services such as Medicaid and food stamps.
-- Call-center workers can answer questions for people who are on KyNect.
-- Public health departments are also being asked to assist with outreach and education.
What are the "navigators"?
Navigators are specially trained folks who can help you determine which plan is best for you. Navigators also will help fill out paperwork.
Community Action Kentucky and the Kentuckiana Regional Planning Development Agency will cover five of the state's eight geographic Medicaid regions. The other agencies have not been announced.
A form and instructions on how to participate as a certified application counselor are available at Kentucky Health Benefit Exchange, HealthBenefitExchange.Ky.Gov. This opportunity is open to representatives of health care organizations and certain nonprofits, and mental health outreach workers or other designated groups. These people will be doing outreach work, going out into the community to tell people about what is going on and helping them to sign up.
There are several levels of training but overall the state is calling the group as a whole "Kynectors" (pronounced "connectors").
So these people can me tell which plan to pick?
No. People working for the state in the call center or out in the community are specifically instructed not to recommend individual plans. The only people who may recommend individual plans are health insurance agents or brokers. About 3,400 insurance professionals have been trained in the system.
What if I don't sign up for insurance?
If you don't sign up for health insurance of some kind, you will have to pay a fee. In 2014 it will be 1 percent of your annual income, or $95, whichever is higher. The fee increases every year.
In 2016, it will be 2.5 percent of your income or $695 a person, whichever is higher. The fee will be collected by the Internal Revenue Service. There also is a penalty for not providing coverage for children.
Sources: Kentucky Cabinet for Health and Human Services; Kynect.ky.gov; Healthcare.gov; IRS.gov; Foundation for a Healthy Kentucky; KaiserHealthNews.org; and Carrie Banahan, executive director of the Health Benefit Exchange
(c)2013 the Lexington Herald-Leader (Lexington, Ky.)
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