The Enid News and Eagle, Enid, OK

Local news

October 6, 2013

Working the bugs out of health insurance coverage

ENID, Okla. — By Robert Barron

Staff Writer

The national Affordable Care Act opened marketplaces last week, allowing people to begin shopping for health care coverage.

But navigating the marketplaces can be difficult, so grants are being awarded to train professionals to assist the public in finding insurance coverage.

Angelica Berry, of Community Development Support Association, said Thursday people interested in health insurance should wait a while before calling.

“The best advice I can give people right now with the government shutdown and an overwhelmed new system, is to give it a couple of weeks to get the bugs worked out before looking into marketplace options,” Berry said.

Cheri Ezzell, CDSA executive director, said as of Thursday people cannot be sure what coverage will be available because they can’t contact the federal government.

CDSA obtained a grant to help people navigate through the program and find information that will enable them to decide where to find the coverage they need. Berry is one of those navigators.

“We will assist people in enrollment and present information so they can decide which coverage they should choose. The computer will help to show if they qualify for special tax credits or premium assistance,” Berry said.

Anyone not on government-funded health care is eligible to search the marketplace for insurance options. The marketplaces are for people who don’t have insurance or those who want to see if they can find cheaper coverage than their employer-sponsored insurance. People will not receive premium assistance if they leave their employer-sponsored insurance plan.

If a person loses his or her job, if his or her income changes or if they have a change in family status, they could be eligible to enroll, Berry said. If a person chooses not to participate in some type of insurance program, he or she must pay a fee if they do not qualify for an exemption. The fee currently is $95 for adults and $47.50 for children, and fees increase each year to 2.5 percent of income by 2016.

There is a long list of exemptions, Berry said. As one example, she said, people who do not meet the income level to file a tax return are exempt.

The health care act is as complicated as it sounds if people do not have general knowledge of how the health industry works, Berry said. That is the reason people must be certified to assist others in finding the information they need to decide, she said.

While Oklahoma does not have its own health care exchange, enrollment is not more complicated, Berry said, but it does require a different process. The only difference for states that do not offer an exchange, she said, is that the ACA uses local definitions for inclusion in some programs, she said.

Payment must be made before coverage begins, and coverage begins Jan. 1. Berry said she does not know if there are direct payment options in the program.

A website run by the Kaiser Family Foundation — www.kff.org — includes a calculator that will help assist people in choosing which plan would be better for them. The site includes health factors such as tobacco use and personal habits to determine whether the cost of a new plan and the quality of coverage is worth leaving a person’s present insurance plan, Berry said.

All health plans offered through the marketplace, she said, must cover a comprehensive set of benefits, including physician visits, preventive care, hospital stays and prescriptions. The plans must treat everyone fairly; discrimination against pre-existing conditions is prohibited.

Those seeking insurance may call CDSA at 242-6131 and ask for a navigator. They will be directed to Berry and her staff and can make an appointment for consultation. Berry said appointments will last about an hour. CDSA is open 8 a.m. to 5 p.m. Monday through Friday.

The insurance marketplaces are for health insurance only, and do not cover dental or vision coverage, Berry said.

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