Navigating the Health Insurance Marketplace

Affordable Care Act open enrollment period ends Feb. 15

By Molly Priddy

Sitting at an open table at ImagineIF Library in Kalispell last week, Daniel Verardo knew he was facing the calm before the storm.

As one of the certified application counselors specialized in helping people navigate the Health Insurance Marketplace, Verardo has appeared at the library every other week since open enrollment began on Nov. 15.

With the open enrollment period scheduled to close on Feb. 15, Verardo will only get busier until the deadline passes.

“Now, we’re seeing more and more people,” he said.

When the Affordable Care Act was signed into law in 2010, it was one of the most significant overhauls of the U.S. health care system the country had seen since Medicare and Medicaid.

The law included a broad range of provisions, including the much-debated individual mandate, which requires all individuals not covered by employer-sponsored health insurance plans, Medicaid or Medicare, or public insurance programs to purchase an approved health insurance plan or pay a penalty.

This individual mandate was upheld by the U.S. Supreme Court in a June 2012 decision, though various organizations and groups in Congress still challenge it.

Regardless, the mandate is in effect, and Americans looking for health coverage have the option of purchasing insurance on the new health insurance marketplaces.

According to the U.S. Department of Health and Human Services, as of Jan. 16, nearly 7.2 million Americans selected or were automatically re-enrolled in health insurance plans in the marketplace during this open enrollment period, including 47,206 Montanans.

In the first month of open enrollment, 85 percent of the consumers in Montana who purchased insurance plans were eligible for financial assistance to lower their monthly premiums.

There are also four insurance issuers in the Montana marketplace, up from three in 2014, and there are 40 health plans to choose from, an increase from the 26 in 2014.

As of December, 65 percent of the Montana marketplace enrollees could find coverage for $100 or less after applicable tax credits in 2015.

The prospect of picking out personal health insurance can be daunting, Verardo said, which is why he and other counselors are available to help. Their salaries are paid through grants, and they are not beholden to any insurance company, nor do they receive commission from signing people up.

His role is to serve as a guide and translator, to help people navigate the marketplace and find a plan that works for them.

“There’s a lot of information about the Affordable Care Act that people aren’t aware of,” Verardo said.

Part of that information is about preventative care, and what the ACA mandates insurers cover. He said he’s helped people with chronic illnesses finally find health coverage, when they were convinced such insurance wasn’t in the cards for them.

“There’s that gratification of seeing people get things that they need,” he said.

When the marketplace first launched, it was a failure, with the websites crashing and technical glitches blocking people from signing up. Montana Commissioner of Securities and Insurance Monica Lindeen said in an interview last week that the marketplace has completely come around since then.

“I think it’s an understatement to say that it’s working better,” Lindeen said. “It’s 100 times better. We get literally very few calls even asking about how to work the system any longer.”

There are still tens of thousands of uninsured Montanans, Lindeen said, and about 50,000 to 70,000 of those people fall into the Medicaid coverage gap, meaning they make too much money to qualify for Medicaid but do not qualify for marketplace subsidies.

Verardo said even those people who fall into the coverage gap should come for a counseling session, because they are likely exempt from the individual mandate penalty, and he can help them file for that exemption.

Both Lindeen and Verardo said there are questions about how long the ACA will be in place, though Lindeen said it would take a change of administration in the White House and a willing Congress to adjust the law.

“Until you know exactly what changes are made it’s difficult to even respond,” she said. “Certainly something could happen … (if it does) there’s going to be time for the market to adjust.”

Open enrollment lasts until Feb. 15, and anyone with questions is encouraged to speak with licensed insurance agents or a navigator like Verardo, Lindeen said. Finding such individuals is possible on www.montanahealthanswers.com, which is run through Lindeen’s office.