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Affordable Care Act - What You Need to Know

The Affordable Health Care Act, the ACA, healthcare reform, or Obama Care…whatever you choose to call it, it means big changes are in store for the way individuals select and purchase health insurance. The Puyallup Public Library is providing the following information as a general overview so that our library patrons can find the resources they need to make informed decisions about their health insurance.

Overview of Affordable Care Act

In a nutshell, the ACA is meant to provide access to affordable health care. It provides for subsidies and tax credits to make premiums more affordable. It will allow families to keep their children on existing policies until the child is 26 years old. It will also require most people over the age of 18 to have coverage by January 2014 or be assessed a penalty. Insurance plans must cover ten basic services that include maternity care, mental health services, and prescription drug coverage. Insurance companies may no longer deny coverage based on an individual’s pre-existing conditions. They may not cancel a policy if you get sick, and they may not put limits on your benefits over your lifetime.

The ACA also established health insurance marketplaces. Washington is one of 17 states that implemented a state-run insurance marketplace. Additionally, Washington chose to expand Medicaid. The Healthplanfinder website (www.wahealthplanfinder.org) will be the place to apply for individual and family coverage or Medicaid. On Healthplanfinder, a person should expect to enter information about their family and income. In about 45 minutes, that person should know:

  • whether they are eligible for a tax subsidy to help pay for insurance premiums,
  • whether they qualify for Washington’s expended Medicaid,
  • what their individual choices are for health insurance.

At this same site a person can compare all the plans sold in their county and select the one that best suits their family’s needs. Washington’s exchange will notify an individual if they may qualify for additional state benefits and help they apply for them through Washington Connection (www.washingtonconnection.org).

The Washington Exchange has created a network across the state to provide customer support and training. The state has been split into 10 areas, each with a “lead” organization to oversee outreach and enrollment support. The lead organization in Pierce County is:

Tacoma-Pierce County Health Department

3629 South D Street | Tacoma WA 98418

Designated geographic service area: Pierce County

Understanding the basics of ACA

  • Open enrollment is October 1, 2013 to March 31, 2014. The next open enrollment is October 15, 2014 through December 7, 2014. There are special circumstances where an individual may enroll outside of open enrollment. Those include things like losing a job or COBRA.

  • You must be a legal resident of Washington to purchase insurance on the Exchange.

  • Healthplanfinder will notify applicants if they might qualify for additional state services with a link to WA Connects where they can apply for those benefits directly.

  • In Washington, to qualify for a federal tax credit, you must use Healthplanfinder.

  • Payment must be made at time of enrollment for the first month’s premium. This must be electronic form of payment - such as a debit card, e-check, or credit card. After the initial payment, subsequent payments can be sent electronically through the Healthplanfinder, or the Exchange can accept other forms of payment such as a paper check.

  • It is believed that a preloaded cash cards for the exact amount of the premium will be acceptable. Theoretically an applicant with no credit or bank account could apply for insurance and save their work when they get to the point of payment. They could get a preloaded cash card for the exact amount, and return and complete their enrollment and payment. Subsequent payment may be made by check in the mail.

  • Paperwork likely needed may include:
    • tax return
    • current health insurance plan information
    • possibly a form from employer.  Because of the delays for large business employers to cover their employees, this form may not be necessary. Further clarification is needed.

  • Current Medicaid recipients will have to use Healthplanfinder to reapply or re-certify.  This will be under expanded Medicaid program.

  • The penalty for not having insurance in 2014 is 1% of yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher. In 2014 the fee for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285.

  • There are penalty exemptions. Uninsured people won't have to pay a fee if they:
    • Are uninsured for less than 3 months of the year
    • Are determined to have very low income and coverage is unaffordable
    • Are not required to file a tax return because their income is too low
    • Would qualify under the new income limits for Medicaid, but their state has chosen not to expand Medicaid eligibility
    • Are a member of a federally recognized Indian tribe
    • Participate in a health care sharing ministry
    • Are a member of a recognized religious sect with religious objections to health insurance

 

For Non-English speakers:

Washington Healthplanfinder will be available in both English and Spanish. Individuals needing assistance in other languages may receive customer support through a network of in-person assistance available through local organizations, or through toll-free interpreter services offered by the Washington. Help by phone will be available in up to 175 different languages. Call 1.855.WAFINDER (1.855.923.4633) or TTY/TDD 1.855.627.9604.

  • Healthplanfinder Customer Support Center started September 1, 2013. Translated applications and customer communications will be available in Cambodian, Simplified Chinese, Korean, Laotian, Russian, Somali, Spanish and Vietnamese.

ACA (Affordable Care Act) Resource List

Washington Healthplan Finder

http://www.wahealthplanfinder.org/

Phone: 1.855.923.4633


Tacoma/Pierce County Health Department (lead organization in Pierce County)

http://www.tpchd.org/health-wellness-1/health-care-reform/


Local In-Person Assister Agencies

Tacoma-Pierce County Health Department is one of 10 lead organizations that the Exchange selected to train and coordinate local in-person assisters. Through various community agencies, Pierce County residents can get one-on-one support that will allow those who are not likely to use a website or call center to learn about their options and enroll in health coverage. Locally, those agencies include:

  • Community Health Care

    • 1019 Pacific Ave. | Tacoma, WA 98402
    • 253.722.2154 for information and to make appointments

  • Point Defiance AIDS Project/NASEN

    • This is the Tacoma Needle Exchange located in downtown Tacoma. They will be doing special enrollment events. Call: 253.272.4857 Or 253.381.5229 for information.

  • Sea Mar Community Health Centers

    • Puyallup Clinic: 10217 125th Ct. E. | Puyallup, WA 98374
    • 1.855.289.4503 for Puyallup information and other locations in Pierce County

  • South Sound Outreach
    • 1106 Martin Luther King Jr. Way | Tacoma, WA 98405
    • 253.593.3499 for other Pierce County locations and to make an appointment

LINKS AND RESOURCES:

Washington Health Benefit Exchange

Washington Healthplanfinder

Other state Exchanges:

Get Covered Idaho

Cover Oregon

State Information other than Idaho and Oregon

Information on Medicaid Expansion in WA

Information for small business and health care

If you suspect fraud or health care scams call or email the Washington State Insurance Commissioner’s Office

CUSTOMER SUPPORT

Customer Support Center: Toll-Free Customer Support Center is now open to answer questions about health coverage options, access financial help, and to provide other information about the enrollment process. Call center business hours will be 7:30 am – 8:00 pm Monday through Friday. Help will be available in up to 175 different languages. Call 1.855.WAFINDER (1.855.923.4633) or TTY/TDD 1.855.627.9604.

Find a Broker: Washington Healthplanfinder will offer assistance through registered Insurance Brokers. Brokers are educated and licensed professionals that can help select health insurance plans. Healthplanfinder’s brokers are the only individuals who are able to recommend an appropriate health care coverage plan for you. Please email Healthplanfinder at: producer@wahbexchange.org if you need help locating a Broker.

Find a Navigator: A Navigator/In-Person Assister is a trained, certified representative who can help you enroll in health care coverage through Washington Healthplanfinder.

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