Health exchanges kick in this week

What you need to know as six-month enrollment period starts Tuesday

NOTE: This story was modified at 11 a.m. Monday, Sept. 30, to correct eligibility information based on 100 to 400 percent of the federal poverty level.

State health exchanges will open for enrollment Oct. 1, allowing the uninsured and the underinsured to shop for health insurance plans that best meet their needs.

The exchanges are a provision in President Barack Obama’s health care law, known as the Affordable Care Act (ACA), that was signed into law in 2010. The law, also known as Obamacare, will ultimately require everyone to have health insurance, or otherwise pay a penalty.

States had the choice of running their own health insurance exchanges or opting into a state exchange run by the federal government. Missouri’s lawmakers decided not to set up an exchange and to allow the federal government to initiate one.

Enrollment for all state exchanges begins Oct. 1 and runs through March 31, 2014. Health coverage for those who enroll before Dec. 15 will begin Jan. 1, 2014.

Missourians may begin viewing available coverage plans and enrolling online in the marketplace Oct. 1 at healthcare.gov.

Who is eligible?

Michelle Miller, public policy liaison for the Missouri Foundation for Health (MFH), said more than 17 percent of Missourians are without health insurance and MFH would like that to be less than 5 percent.

Anyone can shop Missouri’s health exchange, also known as a marketplace. But, not everyone qualifies for financial help or tax credits to cover portions of the costs of plans offered through the marketplace.

Covermissouri.org, a health exchange resource site that is operated by MFH, says individuals qualify for tax credits if:

• You don’t have access to affordable health insurance through work.

• You don’t receive Medicare.

• You use the Missouri Health Insurance Marketplace to buy insurance.

• You have a household income between 100 to 400 percent of the federal poverty level, which is between $23,550 and $94,200 for a family of four.

Exchange resources

Missourians are not expected to navigate the state’s health insurance marketplace alone.

Several Missouri organizations are offering assistance.

MFH has formed a coalition, the Cover Missouri Coalition, which includes more than 300 individuals from across the state.

“It’s a group of providers, nonprofits and individuals that agree to the commitment of helping Missourians find affordable coverage,” Miller said.

The coalition and MFH have produced a variety of plan-based materials to help consumers.

“We have more than 1 million fact sheets and graphics in the hands of our coalition partners,” Miller said. “Covermissouri.org is a touch point for Missourians on these issues.”

The Missouri Hospital Association has a similar resource website, enrollmissouri.org.

The U.S. Department of Heath and Human Services (HHS) also awarded grants to Missouri organizations to aid the agencies in offering health exchange assistance to Missourians.

The Missouri Alliance of Area Agencies on Aging was awarded a $750,000 grant. The organization is a leading voice for older adult services, information and advocacy in the state.

Primaris Healthcare Business Solutions was awarded a $1,045,624 grant. Primaris, a federal health services contractor, has offered free Medicare insurance counseling for Missourians, and counselors have helped clients navigate the marketplace of Medicare prescription drug plans, as well as Medicare Advantage plans.

According to HHS, Primaris will use its existing infrastructure to facilitate the enrollment of consumers in the marketplace’s private health plans.

Missouri also licenses entities and individuals as navigators for the exchange. Not every state requires navigators to be licensed. Missouri’s navigator license law was signed in July.

The navigators help Missourians understand their marketplace options and also help Missourians enroll in coverage.

As of Friday, the Missouri Department of Insurance had licensed more than 40 individuals as navigators, as well as more than 40 medical entities.

Jefferson City resources

The Community Health Center of Central Missouri was one of 22 health centers in the state to receive a grant from HHS to help enroll the uninsured in new health coverage options through the ACA.

The Jefferson City health center’s grant totaled $76,534, and the funds were used to hire two new outreach enrollment staff to help the community understand their coverage options in the marketplace.

Heather Feeler, communications coordinator for St. Mary’s Health Center (SMHC), said the hospital is preparing to help people understand and benefit from the new health insurance exchange.

The hospital has applied to the Centers for Medicare & Medicaid Services (CMS) to become a “certified application counselor organization.”

“With this designation, we will oversee the certification of our staff, so we can assist people in finding insurance coverage through the exchange,” Feeler said. “While we await approval, we have begun to educate our financial counselors so that St. Mary’s will be prepared to assist the general public on Oct. 1 when enrollment begins on the exchange.”

Feeler said SMHC is well-prepared to meet the opportunity because the staff already has experience enrolling people in Medicaid and the Children’s Health Insurance Program.

Debby Froebel, director of Patient Financial Services at Capital Region Medical Center (CRMC), said the hospital’s Medicaid company will be providing enrollment assistance for the exchange in-house.

“We will have fliers and things to hand out with the bills, and will have posters with the website and navigator phone numbers to refer patients to,” she said.

Emily Mantle, communications coordinator for Jefferson City Medical Group (JCMG), said JCMG is not offering enrollment assistance to patients, but is partnering with insurance agencies for the service.

What to do on Oct. 1

• Visit healthcare.gov to browse insurance options for Missouri and to compare health plan options.

• Apply for financial help on the site.

• Enroll in the plan of your choice.

• You may also call 800-318-2596 for assistance.

Who is eligible for tax credits?

Anyone can shop the marketplace, but you may qualify for tax credits if:

• You don’t have access to affordable health insurance through work.

• You don’t receive Medicare.

• You use the Missouri Health Insurance Marketplace to buy insurance.

• You have a household income between 100 to 400 percent of the federal poverty level, which is between $23,550 and $94,200 for a family of four.

• Visit www.covermissouri.org for a calculator to determine if you’re eligible for a tax credit.

Resource websites

Covermissouri.org

Enrollmissouri.org

Healthcare.gov

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