Local ACA “Navigators” Available to Help

by Lin McNulty

Washington Health Benefit Exchange website. This may be where you start your journey, but there is navigation help available, locally, from Orcas Affordable Care Collaborative, before you reach the slopes of that mountain.

The U.S. Government shut down sixteen minutes ago (as I begin to write this). All sources indicate that the Affordable Care Act, also known as Obamacare, will not be affected by this battle in the House and Senate to defund or delay implementation of this health care law.

Orcas Affordable Care Collaborative is a group formed locally by Orcas Family Connections (Erin O’Dell and Kalie McGinnis), Orcas Medical Center (Pegi Groundwater and Michael Moss), and Orcas Family Health Center (Aaimee Johnson and Dixie Morrison), along with valued cooperation from Orcas Island Community Foundation, Orcas Island Library, Orcas schools, and County Health & Community Services. Individuals from the Collaborative have been undergoing training for the past few weeks to learn how to help locals navigate the new bureaucracy. As part of the ongoing process, they held an informational meeting on Monday evening to share some basics with those of us seeking answers.

Aaimee Johnson of Orcas Family Health Center opened the meeting by stating “we are not experts. We have been learning as we go along, and learning from each other. The system is changing as we move into it.” Yet the Collaborative has been diligent and more than willing to create a local system to help islanders get signed up for this new government mandate of health insurance for all, as they work to set up access points, such as the Library, where computers will be made available to sign up online through the Washington Health Benefit Exchange.

The enrollment period begins Tuesday, October 1 and will continue for six months—through March 2014. Coverage, however, is mandated to begin on January 1, 2014. After October 15, appointments with members of the Orcas Affordable Care Collaborative will be available to assist anyone not willing to set off solo on this journey.

So, here we are. Now what? That’s what the Collaborative set out to answer in this meeting. (Please note that another opportunity for a public meeting with this group is expected in mid-October. Date to be announced.)

The first step is to visit the Washington Health Benefit Exchange website, which will be open for business on October 1. There you will find charts, calculators, videos, and a plethora of information meant to fully explain (and perhaps simplify) the process.

A call center (1-855-923-4633) has been established in Spokane with a helpful, well-trained staff set to answer your specific questions Monday-Friday from 7:30 a.m. — 8 p.m. Members of the local Collaborative say the staff there is seriously dedicated to providing answers, and if they don’t have them, they will find out and get back to you.

“Don’t stop your current insurance,” reminds Pegi Groundwater of Orcas Medical Center, as the new plan does not go into effect until January.

Here are some Frequently Asked Questions from Whatcom Alliance for Health Advancement that may get you started:

How will it affect me?

Thousands of people up to age 65 who could not afford health insurance may now be able to get it. If you are very low income, you may get free insurance called Washington Apple Health (formerly Medicaid). If you have been denied Medicaid before, you may be able to get it now. (Note: if you are over 65, you are not affected; your Medicare will continue, with a few more benefits thrown in for free. By 2020, the medication “donut hole” will completely be eliminated.)

People with higher incomes may be able to get help paying premiums for individual health plans so it would be more affordable.

To get an estimate of what your costs might be, use this website tool. If the search tells you that you are Medicaid eligible, you will pay nothing for your insurance premiums. If your income level is higher, it will tell you the estimated amount you would pay per month for your premiums. You may then enter the actual Exchange portion of the site to choose which provider you would like. (Note: At this time, only three insurance providers have been approved to offer services in San Juan County: Group Health Cooperative, Lifewise, and Regence. Should this situation change or be updated, it will be posted to the Health Exchange website.)

What if I am sick (have a pre-existing condition)?

In 2014, no one can be denied heath insurance if they are sick. If you could not get health insurance before, this is your time to do so. Make sure you take action before March 20, 2014.

What happens if I don’t have insurance in 2014?

Most people will have to have health insurance in 2014 or will have to pay a penalty. If you don’t have health insurance by January 1, 2014, most people will have to pay an annual penalty of $95 per adult and $47.50 per child, up to $285 for a family, or 1 percent of their household income, whichever is greater. That penalty will increase each year.

The following people are not required to carry insurance:

• Low income (would pay over 8 percent of income on insurance or make too little money to have to file taxes). While this group will not have a penalty, they qualify for free insurance so should consider signing up.
• A member of a recognized Indian tribe.
• Those who qualify for a religious exemption.
• Incarcerated.
• People under age 30 may have catastrophic insurance coverage and not have a penalty.

What if I am not a citizen?

Legal immigrants must abide by current federal government immigrant eligibility restrictions in Medicaid, including the five-year or more waiting period. However, lawfully present immigrants may purchase a private plan and will be eligible for subsidies if their incomes are low.

Undocumented immigrants will not be eligible for Medicaid, Medicare, or be allowed to purchase private insurance through this program. They will be exempt from paying a penalty.

When can I sign up?

You may sign up beginning October 1, 2013. Coverage will start January 1, 2014. People who have Medicaid-level incomes may sign up anytime after that.

People who want to buy private plans have only between October 1, 2013 and March 23, 2014 to sign up. After that time, they have to wait until October 1, 2014 for the next open enrollment opportunity.

Coverage goes into effect the first of the month following your signup, as long you do so by the 23rd of any given month.

What is available to me?

You will be offered several choices of plan prices and coverage. If you need help, you have the following choices:

• Call Washington HealthPlanFinder at 1-855-923-4633.
• Contact a broker listed on the website.
• Call a local officer where certified assistance can help you. Most places will require an appointment, so it’s generally best to call first.

“We know this is confusing,” adds Kalie McGinnis from Orcas Family Connections, “but we still have plenty of time to figure it out.”