West Virginia State Health Insurance-Assistance Program (SHIP) presented a seminar on the Affordable Health Care Act (AHCA) to community rehabilitative providers (CRP) and the Division of Rehabilitative Services (DRS) at Tamarack in Beckley on Nov. 13.
“The marketplace is a new way to find and buy health insurance that fits your budget, and allows you to shop for affordable private coverage from Qualified Health Plans (QHP),” explained Teresa N. Hicks, a SHIP coordinator, in an overview on the new Health Insurance Marketplace, which is the Obamacare website. She explained, “The QHP are run by private companies, and must cover a core set of benefits called Essential Health Benefits. You will have guaranteed coverage and renewability, regardless of pre-existing conditions.
Essential Health Benefits include preventative and wellness services, chronic disease management, rehabilitative services and devices and emergency services. Plans must also cover prescription drugs, hospitalization and laboratory services. Maternity, newborn and pediatric services including oral and vision-care must be covered. Mental and behavioral health issues must be covered in these plans.
Hicks informed the room of CRP and DRS employees, “Depending on where you live in the country, you may have more choices of providers to choose from; but here in West Virginia only one of three providers have followed through with becoming eligible to be in the marketplace. Highmark Blue Cross Blue Shield, the lone provider has agreed to provide Essential Health Benefits, and pledges to offer the same premiums whether offered within or outside the Marketplace. The company is offering a variety of plans.
Hicks stated, “We were not given a reason from the other two providers as to why they did not wish to provide Essential Health Benefits at this time.”
The open enrollment period started Oct. 1, and ends Mar. 31, 2014. The deadline may be extended due to the website problems during the first month. Hicks reports the website is up and running at this time; and that people can also shop or sign up over the phone or by mail.
Application results may be different for individuals and their spouses or children.
An individual may apply and get insurance via the Marketplace; but their children or spouse may get Medicaid coverage, or rely on insurance through an employer. Sometimes it will be cost effective to have your whole family on an employer’s plan; and sometimes it will be cheaper for the spouse and children to use the marketplace.
West Virginia is one of the states accepting federal assistance to expand Medicaid to provide insurance to more people below the poverty level. On the www.Healthcare.gov website, you may choose to shop without having to buy. At the end of the shopping process you will find out how much your premiums would be, or if you are eligible for Medicaid. Tax credits are also available to offset insurance premiums if you do not qualify for Medicaid. An example of qualifying for expanded Medicaid in West Virginia would be a family of four with an annual income of $32,499. There are no insurance premiums for Medicaid.
The individual mandate requiring all persons to have insurance was designed to spread the cost of healthcare across the whole populace. The AHCA is relying on the large population of young adults paying lower premiums and being healthy to offset the rest. This is the same protocol of all insurance companies already practice; only now everyone is going into the insurance pool.
There are varying tax penalties for individuals who do not have insurance; but there are also exemptions available. Exemptions include extreme poverty, being a member of the United States Congress, following religious doctrine prohibiting healthcare or having Medicaid.
The www.Healthcare.gov website is up and running with an option for real-time online-chat assistance in filling out applications or shopping for a policy. You will find all of the information you need on the website.
Greenbrier Valley Medical Center will host a meeting on Thursday, Dec. 5 at 5:30 p.m. in the New River Community College auditorium. The meeting will cover the AHCA, the Marketplace website, Medicaid expansion and where to find assistance in signing up.
Visit www.localhelp.healthcare.gov to find help in your area, by searching your city, state and zip code. A most recent search lists 121 area agencies, phone numbers and locations offering assistance in signing up for Obamacare, including the Department of Health and Human Services office in Fairlea. You may find help as an individual or as a business owner through this informative website.