by Dennis Dalman
Tuesday, Oct. 1 was the big day for the most major health-care reform program in nearly a half century – the federal Affordable Care Act, also dubbed “ObamaCare.”
On that day, the marketplace exchanges started in Minnesota and elsewhere across the nation. Those without health insurance now have a chance to do online comparison shopping for a health-care insurance policy best suited to their needs. In central Minnesota, five private insurance companies offer, in total, about 140 policy plans that range from basic to more comprehensive.
Once people choose and sign up for insurance policies, they will go into effect Jan. 1, 2014.
People will have from Oct. 1 to March 31 to sign up for some form of health insurance without being penalized for not having any.
The ACA requires all Americans to have an insurance plan by next year. Those who don’t (except for some hardship or religious exemptions) will be fined, and the fines will increase from $5 the first year to several hundred dollars in subsequent years. Fines would be levied through the Internal Revenue Service, which could deduct fine amounts from tax refunds.
Those who already have insurance can keep exactly what they have.
The rationale underlying the ACA is that more people with health insurance will widen the insurance pool, translating into lower premium costs for all and a downward push on medical costs, largely through the benefits of preventive care and healthier lifestyles.
Starting Oct. 1, small employers (those with 50 or fewer employees) will also be able to shop on the online market exchange, which in Minnesota is known as MNsure. Larger employers, those with more than 50 employees, can start choosing group insurance polices through ACA starting in 2017.
About one in five Minnesotans do not have health insurance or have plans that are very inadequate. Up to an estimated 1.2 million Americans are eligible for the ACA.
The first step toward seeking coverage under the ACA is to determine one’s eligiblity for tax credits, which are federal subsidies to help people who need help paying premiums.
The whole idea behind the Affordable Care Act is the word “affordable,” making it possible, through subsidies, for everyone to have care that costs a set portion of annual income. For most people of very low incomes in Minnesota, there are two programs they are already enrolled in or are eligible for: MinnesotaCare or Medicaid. Those people will stay on those programs as long as their annual incomes remain within the low limits.
Affordability, under terms of the ACA, is paying no more than 9.5 percent of annual income for an insurance policy.
For the rest of the uninsured, calculating annual incomes is very important. On the market-exchange website (www.MNsure.com), there will be a “calculator” function available on which people can enter their income information and which will instantly calculate eligibility for a federal subsidy and how much. People can also determine subsidy eligibility through an insurance broker.
Murray Herstein, who lives in the Twin Cities, is one of many brokers throughout the state connected to a hotline help number to assist seekers of insurance through the ACA. Specially certified and trained as a MNsure agent, Herstein and a newly hired assistant expect hundreds if not thousands of calls in the coming three months.
In an interview with the Newsleader, Herstein emphasized how important it is for people to find out if they are eligible and for how much. That information, he said, is vital so when shopping on the MNsure marketplace website, people will be able to balance what they have to spend with the type of insurance policy they decide to choose.
The MNsure site will also inform seekers about “navigators” and “assistors,” a network of specially trained helpers throughout the state, many of them employees of clinics, hospitals and organizations. They, too, will be able to help someone determine subsidy eligibility.
Herstein noted eligibility for subsidized premiums can be up to 400 percent of the federal poverty guidelines. An individual who makes $46,000 annually or less in gross adjusted income is eligible for a federal subsidy. The less that person makes under that amount, the more the subsidy. A family of four that brings in $94,000 or less in annual income is also eligible. Under the ACA, each member of a family can, if they choose, pick a different plan, Herstein noted.
To get an idea if you are subsidy eligible, the gross adjusted income is located on tax forms (Line 4 on 1040EZ form, Line 21 on 1040A form and Line 37 on 1040 form).
Another important step before you begin shopping on the MNsure exchange is to examine your health, habits and lifestyle. Such factors will help you know which level of health insurance best fits your needs.
Prospective health-care shoppers should make a list of health factors, asking themselves the following questions:
• Do I live a sedentary lifestyle or an active lifestyle or somewhere in between? If someone is too sedentary, there could be lurking health problems such as obesity, high blood pressure, cholesterol and more. If a person is very active, such as an athlete or an adventurer-daredevil, the person might be prone to serious injuries.
• Do I drink to excess? Do I smoke cigarettes or abuse drugs? All are risk factors.
• What is my family background? Which relatives suffered or died because of certain medical conditions? Are those factors perhaps hereditary?
• When was my last medical check-up? What were the results? It’s a good idea to get a new medical check-up before shopping for a policy. That way, you will have an idea of your overall general health and if medical issues need some attention.
After an honest assessment of risk factors, those who have a more healthy lifestyle might want to choose a less costly insurance plan. Those with high-risk factors or a history of medical issues probably need a more comprehensive plan.
There are four levels of health policies to choose from, rated from least expensive to most expensive: bronze, silver, gold and platinum. A bronze policy will cover 60 percent of medical costs, a silver 70 percent, a gold 80 percent and a platinum 90 percent. The ACT, however, mandates all plans and all levels must offer certain “essential benefits” that include preventive care, maternity care, prescription drugs, lab tests and more. In addition, the ACT requires the insurance plans to accept people with pre-existing medical conditions and prevents companies from placing lifetime cost limits on medical care. Companies, under the ACT law, must put caps on out-of-pocket costs, must let children stay on their adults’ policies until they are 26 and requires 80-85 percent of every dollar paid in premiums be spent solely on delivering medical care or improving health care – otherwise refunds will be mandated.
The ACT also requires the products on marketplace exchanges to be written in layman’s language so shoppers can compare the plans side by side – apples to apples, so to speak. It must be plain to each shopper exactly what each plan does (and does not) offer.
Because of ACT mandates, even the least expensive insurance plans on the online marketplace were designed to offer good value for the premiums paid, according to MNsure advocates.
On the marketplace, there are nine regions in the state for which plans are offered. Central Minnesota is in Region 8 of the state’s nine geographical regions. Shoppers should be sure they are perusing plans within their region because costs vary region to region.
The private insurance companies for Region 8 are Blue Cross Blue Shield, HealthPartners, Medica, PreferredOne and UCare. Each offers dozens of varying plans, a total of about 140.
Premiums (not counting subsidies) range from as low as $91/month for an individual bronze policy to as high as $634/month or more for a family of four on a platinum policy.
Before shopping, people should learn certain health-care terms, especially the following two:
Deductible: This is the amount you are required to pay for medical services before the insurance company kicks in with its payments. Generally, the lower the deductible, the higher the premium you will pay and vice versa.
Co-payment: A usually fixed amount you pay for a covered health-care service. That amount varies plan-to-plan, but a typical one is $15.
For other insurance-policy terms, refer to the “Glossary’ on the marketplace website.
Co-insurance: Once you’ve met your deductible amount, the co-insurance is the amount you would pay after the insurance company pays its share. For a silver plan, for example, the company would pay about 70 percent, and you would pay about 30 percent of the cost of medical procedures.
As you peruse and compare health plan to health plan, take notes on the ones that most appeal to you. Later, revisit them while considering the factors you have determined: eligibility or not for subsidies; your general health, habits and lifestyle; and what you can afford (with or without subsidies). People who have a favorite doctor or clinic should call that doctor or clinic to find out if they will accept insurance from the plan you favor choosing.
It is highly recommended people spend time reading the background information on the MNsure site before beginning to shop for a plan.
On the MNsure site, there will be instructions as to how and where to sign up for a plan. On the marketplace website, there will also be, under “Help,” numbers to call and places to contact for assistance. Some valuable websites for background information are – besides MNsure – www.healthcare.gov, the Minnesota Department of Health, Minnesota Health Care Programs and the Minnesota Department of Commerce.
One of the best ways to receive help in choosing insurance is to call the MNsure Contact Center, located in St. Paul. Its toll-free number is 1-855-3MNSURE (1-855-366-7873).
There will also be local help in the greater St. Cloud area from specially trained people known as “assistors” and “navigators” shortly before Oct. 1. More information about that will be published later, as it becomes available.
There are currently 27 staff members at the contact center, according to its media-relations coordinator, Jenni Bowring-McDonough. More staff will be added, as needed. Some, she said, have been working around the clock taking calls and answering questions.
The contact center can help people determine their eligibility for subsidies and can assist people who don’t have access to computers. Its staff can also refer callers to person-to-person assistance near their homes.
The contact center will be open from 7:30 a.m.-8 p.m. Mondays-Fridays; and 9 a.m.-4:30 p.m. Saturdays. Those hours may be extended should the need arise.
Dalman was born and raised in South St. Cloud, graduated from St. Cloud Tech High School, then graduated from St. Cloud State University with a degree in English (emphasis on American and British literature) and mass communications (emphasis on print journalism). He studied in London, England for a year (1980-81) where he concentrated on British literature, political science, the history of Great Britain and wrote a book-length study of the British writer V.S. Naipaul. Dalman has been a reporter and weekly columnist for more than 30 years and worked for 16 of those years for the Alexandria Echo Press.