As deadline looms, local help available to buy health insurance through exchanges

March 09--Betty Sims, executive director of Big Country AIDS Resources, said she has seen confusion dwindle when it comes to clients enrolling for insurance through the Affordable Care Act's website, healthcare.gov.

"It is simple to get through the system as long as the person has all the required info with them," she said. "We used to encourage people to call in rather than attempt to navigate the website. Now, we are using the website with people. "

But though initial hiccups with the site have smoothed, time is running out for many who might choose to buy health care through the federal exchange.

The deadline for purchasing insurance coverage for 2014 is March 31, Sims and others noted.

After that, enrollment will only be open for those experiencing certain major life events -- a marriage, divorce, childbirth, loss of a job, etc.

Once the deadline passes, you won't be able to enroll for coverage through the exchange until November, that coverage becoming effective Jan. 1, 2015.

Several entities in the Abilene area -- Blue Cross/Blue Shield of Texas, Abilene Regional Medical Center, the Betty Hardwick Center, BCAR and the West Central Texas Council of Governments, among them, are offering help to those who still need to enroll.

"We feel like this is our job to raise awareness," said Dr. Dan McCoy, vice president and chief medical officer with Blue Cross and Blue Shield of Texas. "Part of our goal is to work with consumers to help them make the best health care decision they can for them and their family."

An educated consumer "is a good thing," McCoy said, the reason behind the company's "Countdown to Coverage" campaign, an "educational push by Blue Cross to make sure that people are aware of their opportunities."

Many of the entities offering help offer in-person counseling or help over the phone.

And in general, many of the entities helping connect people with coverage have gone beyond just offering aid to their own clients.

"We've been at Boo at the Zoo, we've been at Feast of Sharing, any and everywhere we can get into," said Connie Cholewinski, a health care navigator with the Betty Hardwick Center in Abilene. "We've been at the Abilene Public Library three times. We did a meeting at the Sears Recreation Center last week and we partnered with the Hispanic Leadership Council."

The Center has also worked closely with the population of the International Rescue Committee, Cholewinski said, and has left brochures "anywhere we're allowed to."

The West Central Texas Council of Governments has teamed up with Betty Hardwick for some of the aforementioned events and has conducted its own outreach throughout the 19 counties it serves, said Christal Martin, the organization's community programs service specialist.

"We're ready to sign people up then and there," she said, traveling to rural counties with computers and Wi-Fi hot spots in tow to sign interested parties up quickly.

The Council also offers help through its offices in Abilene, Martin said.

"The majority of the people we see are people who don't know anything about insurance and aren't comfortable on a computer," she said. " ... I haven't seen many people who are young -- by which I mean people under age 35."

Confusion over basic terms -- such as the definitions of premiums and co-pays, or the difference between an HMO or PPO plan -- makes many of the clients seeking help nervous about signing up for coverage, Martin said.

"And that makes complete sense to me," she said. "You want to make sure what you're getting is what you need."

UNDERSTANDING OPTIONS

The penalty for not buying health coverage in 2014 is $95 per consumer and $47.50 per child -- or 1 percent of the consumer's yearly household income, whichever is higher, Cholewinski said.

"But it does max out for (this) year, and the most a family would pay for everybody in the family who is uninsured is $285," she said, adding that "after that, it goes up a lot for 2015 and 2016."

Plans through the government exchange are divided up into bronze, silver, gold and platinum levels.

In general, the "Silver" plans have proved most popular among those still shopping around, those interviewed agreed.

In exchange for higher premiums, each successive plan in general reduces the health costs for which the consumer is responsible.

A bronze plan has a 60-40 percent split, 60 percent of costs the insurance company's responsibility, 40 percent the consumer's. A silver plan is akin to a 70-30 split, McCoy said, while a gold is 80-20.

But those numbers are a little bit misleading, McCoy said, because many people are going to qualify for subsidies that can help absorb costs.

Generally, those who fit within a certain income range based on the Federal Poverty Level qualify for subsidies, he said.

In 2014, the federal poverty level is $11,670 for a single person, $23,850 for a family of four -- which means that those making under 400 percent of the poverty level income can get advanced premium tax credits that lower premium costs.

Further, those who make less than 250 percent of FPL can get subsidies to lower their out-of-pocket costs.

Unfortunately, McCoy and others noted, there is a group of lower-income Texans who will not be eligible for subsidies, since they were initially supposed to have been scooped up in expanded Medicaid coverage -- something that ultimately didn't happen in Texas.

The change means that those who make less than 100 percent of the FLP do not qualify for subsidies on the health insurance marketplace -- ironically, a group that would have benefitted greatly from such help.

People who don't make enough to quality for tax credits can file an exemption, meaning they won't be penalized for not having insurance, Martin said.

And Cholewinski said that those stuck in the gap still get as much help as those offering advice can give.

"We try to assist them in letting them know where the indigent funds are in Abilene and the community centers they can utilize," she said.

UPS AND DOWNS

Sims said her organization has helped its own clients and "a few others" to get coverage, turning out some real success stories.

"Earlier this week one of the staff helped someone all the way through the website," Sims said. "The client reviewed his options, picked a plan and enrolled. ... The person was very glad we walked him through the process and felt confident enough to say that he was going to see his father that afternoon and would help him enroll as well."

But not all stories have had a happy ending, largely because of the aforementioned Medicaid gap.

"I've had several folks hoping to get insurance only to find they make too much to qualify for Texas Medicaid, but not enough for the full federal assistance," Sims wrote in an email. "(I) really felt sorry for them."

WCTCOG's Martin agreed.

"I hate being the person who says, 'I'm sorry, you don't qualify for tax credits,'" she said.

But Sims, echoing many others, said that ultimately, people shouldn't be "afraid of the ACA."

"The website is an easy way to find out what if any financial assistance you will receive to help pay for insurance premiums and once you pick a plan, tell you how much the premium will be."

The rest of the enrollment process, she said, is buying a good insurance plan from an insurance company that already does business here.

"You are not buying or getting a government run insurance plan; here in West Central Texas you are buying coverage from either Blue Cross Blue Shield or First Care," she said -- though "slight variations" in available plans make things not as easy as that might be.

The biggest client barriers to enrollment, Sims said, "seem to be the lack of an email address and the lack of an electronic payment method -- (having) no credit or debit card."

Ultimately, the right plan depends on who you are, Cholewinski said.

"We cannot choose a plan for you, but we may ask questions, such as how often you go to the doctor," she said. " ... If you're going to the doctor once a week, we don't want you to sign up for a bronze plan because that's all out of your pocket."

The primary goal of all those offering help, Cholewinski said, is connecting the right plans with the right people before the deadline passes, though electing to take coverage is still up to the individual.

"I'm going to give you all the options, and then you can walk away if that's what you want to do," she said.

___

(c)2014 the Abilene Reporter-News (Abilene, Texas)

Visit the Abilene Reporter-News (Abilene, Texas) at www.reporternews.com

Distributed by MCT Information Services