ACA health marketplace opens for 3rd year

Oct. 31--Whatever your economic status, if you don't have health insurance, you should learn your options under the Affordable Care Act, urged Jamila Allen, a patient navigator in Hampton for Enroll Virginia!, a nonprofit engaged in health care education, outreach and enrollment assistance.

Her office, which provides free advice on the ACA, also advises people on Medicaid and Medicare, and points everyone to appropriate resources.

"Use us. Still come even if you don't think the marketplace can benefit you. If we don't have the answers, we can get them for you," she said. "It's very cumbersome, it's new and it's stressful. Let us help you deal with it."

The third annual ACA open enrollment through Virginia's federally facilitated marketplace, healthcare.gov, opens Sunday, Nov. 1, and runs through Jan. 31. The deadline for 2016 coverage effective Jan. 1 is Dec. 15. Last year, 335,000 Virginians opted for insurance coverage through the marketplace; of those, 80 percent received federal tax credits to reduce their monthly premiums by an average of $270.

This year, despite premium increases that range into the double digits in some states, the U.S. Department of Health and Human Services has said 80 percent of subscribers will be able to purchase health insurance for less than $100 a month after tax credits.

In Virginia, the average increase for a benchmark plan (the second lowest cost "silver" plan) is 4 percent, among the lowest in the nation.

(Health insurance plans on the marketplace are classified by metal level, which range from bronze with the lowest premiums but the highest deductibles and co-pays, to platinum with the highest premiums and lowest deductibles and co-pays. In Virginia, no platinum plans, which are reserved for the healthiest populations, are offered.)

The state has a competitive market with an additional insurance carrier serving the Richmond area this year, and in Hampton Roads three companies -- Optima, Anthem Blue Cross/Blue Shield, and Aetna -- have returned with more plans than last year, said Allen.

The federal government has set a goal of enrolling 10 million nationwide, an increase of 1 million people. But Jill Hanken of the Virginia Poverty Law Center, which oversees Virginia's outreach, declined to set a specific goal for the state's 2016 enrollment. "Our overall approach is to help everyone who's enrolled in the past to re-enroll. Then we're trying to reach the eligible, but unenrolled. Many are younger, Hispanic or other immigrants," she said, citing an abbreviated enrollment period of 13 weeks as a challenge.

Individual health insurance coverage is mandated by the ACA and those who opt out in 2016, who are deemed to be able to afford health insurance -- 8 percent or less of household income -- will face a minimum fine of $695 (or 2.5 percent of taxable income, whichever is greater) when they file their 2016 taxes. That's up from $95 this year, and $325 or 2 percent for 2015 taxes. "Those are the people we're seeing who are angry -- new people who got hit by the penalty," said Allen.

She emphasized the newness of the law: "It's like jumping in the pool. It's a shock to your system no matter what the temperature is." People need to develop new habits, such as updating their profile during the year if they have any income changes. "Most people aren't accustomed to that, but it comes out better in the long run," she said.

For the first time, re-enrollees are expected to be in the majority. Experts encourage them to return to healthcare.gov to shop around for the best deal. A new HHS report showed that Virginia consumers who re-enrolled last year and who switched plans from 2014 -- 28 percent of those returning --saved $141 for the year for the same level of coverage. "Shop around. Taking 15 to 20 minutes can save a lot of money. It's a life decision," said Allen.

She also encourages those who fall into "the Medicaid gap" -- those who don't qualify for existing Medicaid but can't afford to purchase coverage through the ACA -- to apply through the marketplace. "If they get their application in and if Medicaid expansion happens, which I feel it must, then they'll be in the system," she said.

"They're the most confused. They need it the most. They're mostly the working poor," she added, referencing the estimated 400,000 Virginians denied coverage by Republican legislators' opposition to Medicaid expansion for those living between 100 and 138 percent of the federal poverty level. Likewise, if their status changes and their income rises, they can apply for ACA coverage outside the enrollment period, Allen said. In the interim, she provides them with a list of local resources, including medical and dental clinics that provide care either free or on a sliding scale.

In addition to educating clients about special enrollment periods, Allen also helps people identify the "5 million exemptions" to mandated coverage. These include exemptions for unpaid medical bills dating back two years, a recent utility shut-off, or a death.

"Come and talk. Understand your options," she said.

Here are some tips from Allen:

--Be patient. Allow 30 minutes to two hours with a trained navigator or counselor to learn what you need to know before enrolling.

--Be patient if you call the federal marketplace (1-800-318-2596) and reach an uninformed assistant. Politely hang up and call back until you find someone who can give you appropriate advice.

--When you make an appointment with a navigator, counselor or assistant there is no commitment to enroll; you can also apply online with no commitment to enroll.

--Look at more than the premium cost; the deductibles can be in the thousands. If you have diabetes, asthma or another chronic disease, you may want to spend more for a premium to get a lower deductible. Consider all the expenses together, including premium, deductible, maximum out-of-pocket costs and medication costs.

--Send documents twice, by mail and upload online; if you don't receive an acknowledgment that they've been processed, send them again.

--Learn the terminology -- co-pays, in-network, etc. -- either at healthcare.gov or get in-person help.

--Parents may keep children on their plan until age 26, but they are not required to do so.

--If you haven't done so, file your 2015 taxes by Dec. 31, or you won't be eligible for 2016 tax credits.

--Be aware of special enrollment periods for those whose status has changed, and also the possibility of qualifying for an exemption.

--Individual insurance costs are based on "a tax household," not individual income.

--Get tested for HIV/AIDS at your local Health Department. If you're HIV positive, the ADAP program pays the premiums for silver plan coverage.

--If you fall into "the Medicaid gap" and can't afford coverage through the ACA, apply anyway so if your circumstances change, you'll already be in the system.

--Women in the Medicaid gap still qualify for family planning services, including a pap smear, through Plan First.

--Call Enroll Virginia for free help. 1-800-318-2596 (TTY: 1-855-889-4325).

Salasky can be reached by phone at 757-247-4784.

Enrollment info

--HealthCare.gov offers detailed information about each health insurance plan sold in the area, including out-of-pocket costs, customer service, and more. For help, call 1-800-318-2596 (TTY: 1-855-889-4325) at any time, or find free, confidential in-person assistance in your local area by visiting localhelp.healthcare.gov. Assistance is available in 25 languages. All services are free.

--Consumers may contact Enroll Virginia's staff by calling, toll-free 1-888-392-5132. Other trained assisters can be reached by calling, toll free, 1-866-659-7474. Online, go to enrollva.org or coverva.org.

For local in-person help, contact Jamila Allen, health care navigator, Enroll Virginia,30 West Queens Way, Hampton; call 757-275-0125, ext 513; or fax 757-275-0087;email at [email protected]. The service is free and impartial regarding plans offered.

Enrollment events

Celebrate Healthcare will offer several free events to help those seeking to enroll in health insurance coverage through the Affordable Care Act's marketplace, healthcare.gov. Enrollment for 2016 coverage runs from Nov. 1 through Jan. 31; for coverage effective Jan. 1, the deadline to enroll is Dec. 15.

The events will include health screenings flu shots, exercise classes, an employment fair, and enrollment information.

10 a.m. to 1 p.m. Saturday, Nov. 7, Boo Williams Sportsplex, 5 Armistead Pointe Pkwy, Hampton;

10 a.m. to 1 p.m. Saturday, Nov. 14, St. Paul Baptist Church, 806 Lincoln Ave., Suffolk;

6-8 p.m., Monday, Nov. 16, Green Run High School, Virginia Beach.

For more information, call 757-287-0277, or visit celebratehealthcare.net.

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