Agencies Ramp Up For Health Insurance Opener

Nov. 13--During the calm before the storm, the website for insurance coverage under the Affordable Care Act appears to be running smoothly -- it's more user-friendly that during last year's disastrous start-up.

Open enrollment in the federal marketplace starts Saturday, although potential patrons can go to Healthcare.gov now to check out plans and get estimates of premiums and possible tax credits. The site and estimator have been working efficiently, unlike the inaugural period last year, when the site crashed repeatedly and froze up in the middle of enrollments.

"We've had more interest this year," said Sandy Brekke, director of the St. Clare Health Mission in La Crosse, a free clinic for the uninsured and underinsured that has application counselors to help people enroll.

"We're anticipating that there won't be a huge rush because so many signed up last year, but there still are people out there without insurance," she said.

Counselors will help patients navigate the marketplace during the mission's open hours Tuesday and Thursday evenings, and it has a full schedule of appointments during daytime hours next week for patients and nonpatients alike, Brekke said.

Education remains one of the main needs for people who never have been insured before and may not understand premiums, deductibles and co-pays, she said.

Many don't know that the insurance is available despite widespread efforts to inform people about Obamacare, she said.

A Kaiser Health Tracking Poll last month bore that out, finding that 89 percent of uninsured people did not know that open enrollment begins again this week, 66 percent said they knew just a little or nothing about the Affordable Care Act and 53 percent didn't know they could get tax credits to offset premium costs.

Also gearing up for the Nov. 15 to Feb. 15 enrollment period are the La Crosse County Health and Human Services Department and the Western Region Enrollment Network, which includes La Crosse, Buffalo, Clark, Jackson, Monroe, Pepin, Trempealeau and Vernon counties.

People who have insurance coverage through their workplaces and those on Medicare don't have to enroll in the federal marketplace, which is intended for the uninsured, underinsured or those who want to change their plans.

Those who are happy with their present plans can stand pat and be re-enrolled automatically, but representatives of Mayo's Health Tradition and the Gundersen Health Plan -- two of the major vendors in La Crosse and neighboring counties -- advise checking coverage details to make sure that information is up to date.

Inaccurate information could affect premium subsidies and tax credits, they said.

"We're advising all consumers to go out and look because they need to check their subsidy amount," said Mike Eckstein, marketing director at Health Tradition.

Most enrollees at the federal marketplace, also available through many private insurance agents, qualify for tax credits in the hundreds of dollars to offset premiums.

"About 80 percent of the business we have are getting subsidies," said Greg Skemp, sales and marketing director for the Gundersen Health Plan.

Health Tradition's premiums increased an average of 2.5 percent over last year's, Eckstein said, and Gundersen Health Plan's are up 3 to 4 percent, Skemp said.

Health Tradition and Gundersen were the only two companies with state approval to sell in La Crosse County through the marketplace last year, but two others have been added this year -- Anthem Blue Cross Blue Shield and United Healthcare. Residents in neighboring counties also can tap policies through other companies, with such options available at Healthcare.gov.

There is no average premium, because the plans pivot so much on household income, the number of people covered and the plan chosen.

"The gist of it is very complex, depending on the number of people and income, so people really need to check the plans to see what meets their needs," Eckstein said.

The plans have the metallic labels of bronze, silver, gold and platinum. Bronze is the least expensive -- costing nothing in some cases after subsidies -- but deductibles and out-of-pocket ceilings are much higher. Premiums increase and deductibles decrease as policies move up the chain.

Those who don't obtain insurance also should be aware that the penalty for not doing so will rise from 1 percent of household income this year to 2 percent next year, or $325 (half that for a child under 18), with the maximum penalty per household being $975.

The opening of the Small Business Health Options Program (SHOP) Marketplace offers an opportunity for small businesses that choose to offer their employees insurance to get tax credits up to 35 percent of the premium costs, Eckstein said.

Such businesses are not required to offer coverage under the Affordable Care Act, but those who do can choose one of the color levels in SHOP and allow employees to pick their own plans in that level, he said.

"It's good that our community can offer choice," he said.

That choice is available in only 14 states, including Wisconsin and Iowa.

___

(c)2014 the La Crosse Tribune (La Crosse, Wis.)

Visit the La Crosse Tribune (La Crosse, Wis.) at www.lacrossetribune.com

Distributed by MCT Information Services