Affordable Care Act made easy
Navigating the government’s Health Insurance Marketplace
website to see if individuals qualify for federal assistance on health insurance has already become
a nightmare for many.
As terms like “tax penalties” and “coverage gap” became more commonplace than “consumer rights” and increased transparency among providers, local community health organizations have stepped into the picture to provide better insight and understanding.
Organizations like High County Community Health are taking the guess work out of the entire process, with free individual assistance sessions during the month of March.
According to Eric Schneider, a certified application specialist for High Country Community Heath, the ACA has ushered in a series of sweeping changes for the betterment of those seeking health care, many of whom will be covered for the first time in their lives.
But HealthCare.gov’s Health Insurance Marketplace has become a point of contention with individuals who seek out the site to see if they qualify for government assistance.
“This has been some controversial stuff,” Schneider said. “This has been the most controversial thing to come into law in a long time. This legislation is not perfect, but it can be beneficial. We don’t want people pre-assessing themselves because they have reservations about where the law is coming from or because of their political views.”
Schneider suggests that individuals place politics aside to take advantage of the benefits offered and avoid any potential penalities.
The ACA has impacted every state differently, he said.
In 2012, when the Supreme Court convened on the constitutionality of the law, high judges ruled that the individual mandate of the law should be upheld, but there was some division over the required Medicaid expansion.
This requirement was rejected by the courts and left up to the individual states.
States could expand Medicaid or divert those funds into the marketplace. “North Carolina was one of those who did not expand (Medicaid),” Schneider said.
Now, if a Tar Heel resident did not have access to Medicaid (and were below the poverty level) and insurance premiums are to remain at full price, these citizens would fall into what is known as a “coverage gap,” because they would not be covered.
These individuals will be exempt from the penalty, but will still need to file in the system, Schneider said, adding, “It’s better to be safe than sorry.”
The penalty for not having insurance in 2014 is calculated one of two ways. Those who don’t have insurance will pay whichever penalty amount is higher. The first penalty option calls for the delinquent buyer to pay 1 percent of their yearly household income. The second penalty option charges $95 per person for the year. The maximum penalty per family using this method is $285, according to HealthCare.gov.
The road to universal health care in America follows years of rising health costs nationwide.
“What a lot of people don’t realize why health care is so expensive is because people who don’t have access let things start out as minor (injuries) and fester until it becomes a life threatening problem,” Schneider said. “Instead of getting good ongoing care and preventive care, things that were preventable become life-threatening, and they end up in the emergency room, which is most expensive of all.”
As a result, Schneider said these expenses oftentimes go unpaid and become “leveraged on the health care system, as whole.”
It’s a lot to swallow, he admitted, which is why High Country Community Health is offering free, one-on-one help from trained enrollment experts Friday, March 21, from 12:30 to 8 p.m. at High Country Community Health, located at 126 Poplar Grove Connector in Boone.
Appointments are available, and walk-ins are welcome. To schedule an appointment, call (855) 733-3711 (toll-free) from 9 a.m. to 5 p.m. Monday through Friday and from 6 to 9 p.m. Monday and Thursday.
The events are sponsored by the Morganton office of Legal Aid of North Carolina, a nonprofit law firm for low-income people, and High Country Community Health, which provides affordable medical and dental care in Watauga and Avery counties.
To enroll in a health insurance plan, consumers need to provide Social Security numbers and dates of birth for everyone covered under the plan, employer contact information (if applicable), policy numbers for current health insurance coverage (if applicable) and proof of household income.