Page 32 - Flathead Beacon // 1.28.15

32 | JANUARY 28, 2015 BUSINESS MONTHLY FLATHEADBEACON.COM Navigating the Health Insurance Marketplace
Affordable Care Act open enrollment period ends Feb. 15
By MOLLY PRIDDY of the Beacon
Sitting at an open table at ImagineIF Library in Ka- lispell last week, Daniel Verardo knew he was facing the calm before the storm.
As one of the certified application counselors spe- cialized in helping people navigate the Health In- surance Marketplace, Verardo has appeared at the library every other week since open enrollment be- gan 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, in- cluding the much-debated individual mandate, which requires all individuals not covered by employer-spon- sored 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. Su- preme Court in a June 2012 decision, though various organizations and groups in Congress still challenge it.
Regardless, the mandate is in effect, and Ameri- cans looking for health coverage have the option of purchasing insurance on the new health insur- ance marketplaces.
According to the U.S. Department of Health and Human Services, as of Jan. 16, nearly 7.2 million Amer- icans 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 Mon- tana 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 market- place enrollees could find coverage for $100 or less after applicable tax credits in 2015.
The prospect of picking out personal health insur-
ance can be daunting, Verardo said, which is why he and other counselors are available to help. Their sala- ries are paid through grants, and they are not beholden to any insurance company, nor do they receive com- mission 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 insur- ance 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 fail- ure, with the websites crashing and technical glitches blocking people from signing up. Montana Commis- sioner 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 work- ing 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 Mon- tanans, Lindeen said, and about 50,000 to 70,000 of those people fall into the Medicaid coverage gap, mean- ing 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 cov- erage 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 ques- tions about how long the ACA will be in place, though Lindeen said it would take a change of administra- tion 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 some- thing 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.
[email protected]
7.2 million
Consumers who selected a plan or were re-enrolled in the Federally Facilitated Mar- ketplace during open enrollment as of Jan. 16
47,206
Montanans who have selected a plan or were re-enrolled since Nov. 15
85%
Percentage of consumers who were determined eligible for financial assistance to lower their monthly premiums
4
Insurance providers in Montana's marketplace in 2015
40
Average number of health plans from which Montanans can choose
65%
Percentage of Montana enrollees who could obtain coverage for $100 or less after applicable tax credits
Source: U.S. Department of Health and Human Services