The Affordable Care Act went into effect earlier this year. It is the same thing as Obamacare. The latter is just a nickname sometimes used to describe the act, which lays out the new healthcare system in the United States.
Monique Martin is a government relations specialist with the Alaska Native Tribal Health Consortium, or ANTHC, which is a healthcare navigator organization.
Martin was in town Tuesday, December 10th, to answer questions about the Affordable Care Act and how it impacts rural Alaskans.
Here are some of those questions and answers. They are divided into three categories–Nuts & bolts, the people it covers, and the plans and website:
NUTS & BOLTS
Who is eligible to sign up for a health insurance plan under the Affordable Care Act?
“So pretty much what I encourage folks to do is think about themselves and each member of their family. Do they have insurance now? So, do you have access to insurance through your employer or maybe your spouse’s employer? For you and your children, do you have access to Medicare, Medicaid, Denali KidCare, or Veterans’ benefits? If you have those types of insurance, you’re good—you don’t have to worry about the Affordable Care Act. Really, it’s for folks who are maybe paying a lot through a Cobra or maybe just don’t have access to insurance, or who may be paying a lot through their employer for coverage. You can go to healthcare.gov and enter some information and see if you qualify, or if you even qualify for a subsidy.”
Does everyone have to sign up for a healthcare plan?
“Well, as part of the law, each of us—as citizens of the US—needs to show that we have healthcare coverage. So, each one of us should be able to look at our circumstances—our spouse, our children, maybe our grandparents or other relatives and think, do they have healthcare coverage? Because every one of us should be able to show that we have healthcare coverage or we could face a tax penalty without that coverage.”
What is the tax penalty and how much would I have to pay if I don’t sign up for an insurance plan?
“So, if you think your insurance is just too expensive or you have personal beliefs and you don’t want to purchase insurance, there’s a tax penalty for those who aren’t able to prove they have insurance. A lot of folks have told me: ‘Oh it’s just $95. I’ll just pay that $95.’ The tax penalty is a little bit more lengthy than that. You could actually pay up to 1% of your household income. So, if you’re a family earning $50,000 a year, your tax penalty would actually be $500 for the year. So I like people to understand it’s not so cut and dry as just $95. So that’s a big one.”
I already have health insurance. Can I stay on my current plan or do I have to sign up for something new?
“That’s a big question we get a lot. Most people can stay. Their employer’s insurance might be changing a little bit. Many plans have to come up to the new requirements of the Affordable Care Act. So, a lot of folks we’ve talked to haven’t seen many changes if they have employer-sponsored insurance. It really depends on the situation. They might be seeing some small tweaks and changes based on the new law. But, a lot of folks we’ve talked to are able to keep their insurance from their employer or if they’ve purchased insurance directly from Primera, for example, they might see some changes that way. But employer-sponsored insurance is pretty much staying the same.”
If I stay on my current insurance plan, how will my coverage change under the Affordable Care Act?
“What we’ve found is that some people are seeing improvements to their insurance that they have through an employer. That’s because things like preventative care should be provided at no cost, with no co-pay and no deductible. So there’s some changes to insurance people are starting to see that way.”
If I want to sign up for a new plan, is there a deadline, or can I do it anytime?
“There’s been a couple of changes to deadlines. Now, if someone wants insurance to begin January 1st, they have until December 23rd to buy it. So that deadline was pushed way back. There was a change also [to the final deadline]. As long as someone has purchased insurance by March 31st, they will not face a tax penalty.”
THE PEOPLE IT COVERS
I am a self-employed fisherman. What do I need to think about before signing up for coverage?
“I think the big thing to look out for is: are you reporting your income properly? Because you could qualify for some pretty significant help from the federal government depending on how much you’re earning, or even potentially how many people are in your family. Another thing, too, is depending on people’s circumstances, the rules for Medicaid are all changing for our state as well. So, potentially fishermen who maybe couldn’t qualify because they owned a boat or had a fishing license of some sort—those were looked at as assets. Now, that asset test is going away. So, they could potentially now qualify for Medicaid, depending on their circumstance and how much they’re earning.”
I am a small business owner. Do I have to provide my employees with insurance?
“If you have less than 50 full-time employees, you have no requirement to offer insurance to your employees. I think that’s probably a bigger one for smaller communities like Wrangell and other communities in Southeast where they’re worried about—as an employer, what am I needing to do to be in compliance with the law?”
I am Alaska Native. Do I have to get insurance under the Affordable Care Act?
“Alaska Natives and American Indians are exempt from the requirement to purchase insurance and to show healthcare coverage. But, they must apply for an exemption. That is one of the big pieces we are trying to spread the word on. There will actually be a paper application available in the first part of the new year that every Alaska Native who doesn’t choose to purchase insurance must fill out for them and their family members to avoid the tax penalty. They can contact us at the Alaska Native Tribal Health Consortium to get a copy of that form, or maybe go to AICS and get a copy.”
If I am Alaska Native and I want to purchase an insurance plan, is my coverage different in any way?
“There are some special benefits in the Affordable Care Act for Alaska Natives like monthly enrollment. Even after the open enrollment period closes, Alaska Natives and American Indians can go on healthcare.gov at any time, make changes, start a new plan, cancel a plan or whatever they’d like to do. There’s also some cost-sharing reductions available specifically for Alaska Natives and American Indians. Cost-sharing just means those copays and deductibles you might have to pay with a plan when you go to see the doctor. And, there’s some specific cost-sharing reductions for Alaska Natives and American Indians.”
I have a pre-existing condition. Am I still eligible for health insurance?
“That’s maybe one of the hugest parts of the Affordable Care Act that we’re really seeing is that people are coming out from everywhere that have not been able to get access to insurance because maybe they have diabetes or maybe they’ve had cancer before. No insurance companies would provide coverage to them. So, that restriction of pre-existing conditions is going away. You can no longer be denied health insurance due to a pre-existing condition. That’s folks that we hear from quite a bit. They’ve not been able to have insurance for years and years and years and are not taking medications they really need to be the most healthy they can. So, that’s a big population we’re helping get enrolled right now.”
Does the Affordable Care Act affect healthcare for children?
“The only difference would actually be for children under the age of 19. One of their essential health benefits is including dental and vision coverage. So, that’s something that must be offered for all children.”
Under the new law, how long can children stay on their parents’ health insurance before they have to get their own?
“Children can stay on their parents’ insurance up to the age of 26 now. There used to be a requirement that they had to be going to college or some sort of trade school, and that’s no longer the case. They can just stay on insurance up until the age of 26. But they can also look at—would they be able to get a better deal going to healthcare.gov? Kids can stay on their parents’ insurance until they’re 26 but they can also shop for their own. So, it’s kind of the best of both worlds there.”
THE PLANS & WEBSITE
I’ve heard about bronze, silver, gold, and platinum plans. What’s the difference?
“We don’t have platinum plans [in Alaska]. In Alaska, we have bronze, silver, and gold plans. There’s also a catastrophic plan but that gets a little confusing. It’s sort of a ranking for insurance plans. Typically what you might think is that if a person has a bronze plan, they might be paying less per month for their premium but when they go to the doctor, maybe they have a higher deductible to meet, or copays that they have to pay when they go see the doctor. That’s compared to someone with a gold plan. They would be paying more per month in their monthly premium. But, when they go to the doctor, they’re going to have a lesser deductible to satisfy or maybe lower copays or co-insurance when they go and see the doctor.”
So, basically, I have to decide whether I want to pay more on a regular basis or just when I get sick?
“You know, I like to compare it to car insurance. Do you have a plan where you say—I want a really low deductible. If I get into a car accident, I want to only have to pay $500 to fix my car. Or, maybe I’m confident that I’m a good driver and I’m not driving on the snowy and icy roads of Alaska. So, I’m going to choose a plan with a $1000 deductible so I’m going to pay less per month for my insurance and I’m going to take a chance that I’m not going to get into a car accident and have to pay that $1000.”
Does every plan have the same types of medical coverage? Or can I choose the benefits that I think I’ll need?
“So, some of the plans might be a little different. All of the plans have to offer dental and vision for children. But, I’ve seen some plans will offer coverage for hearing aids. Some won’t. Some will offer adult vision coverage or adult dental coverage. So, really take a look at the plans. There are 10 categories of healthcare coverage that all plans must offer at a minimum. And then some of the other plans might add in other types of coverage that you typically don’t see in insurance.”
I’ve heard about all the problems people have had trying to sign up on the healthcare.gov website. Are those problems fixed?
“Yeah. The website was a real challenge in the beginning for us. In fact, really until the 1st of December, it was an issue. Now, we’re really trying to hit the ground running and get people enrolled. One of the things that I actually realized just today in helping some people is that there are some links on the website that don’t work, related to finding who are the preferred providers for networks for Alaska. And that can be a bit of a challenge. Some of the brochures that it links to to provide you more information [don’t work]. So, I’m trying to go about another way to get that information for folks who came to see us today that have more questions about that plans and what does it mean for folks living in Wrangell.”
What are some tips or suggestions for using the healthcare.gov website to sign up for a plan?
“I haven’t found anything that’s too daunting yet. I think the biggest thing I can recommend for folks is: don’t go on and think that you’re going to do this in 15 minutes. Take your time. You can save your application and go back to it. I think that’s really the big thing is to take a little bit of time to really study what your options are. If you’re enrolling a family, make sure you have social security numbers, dates of birth, income information, what you think you’re going to make in 2014. There’s a lot of information you can kind of get together and make the process a lot smoother and less painful for yourself.”
Where can I get more information about the Affordable Care Act and what it means to me?