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Department of Health provides useful Affordable Care Act information

Published 12:00pm Thursday, October 31, 2013

The Mississippi Department of Health hosted a free education session on the Affordable Care Act  Tuesday night at St. Matthew’s Missionary Baptist Church.

Ashley White, a consultant with i-Think Group, a public health consulting firm working with Mississippi Department of Health, said the ACA was signed into law in March 2010 and is “the most significant health-related legislation since the passage of Medicare and Medicaid.”

The  session was mainly to discuss the  Health Insurance Marketplace and White suggested those who already have Medicare and Medicaid speak with their Medicare and Medicaid representatives on how the new health care law will affect their coverage.

White said the intent of the law was to address the issue of access to health care, the rising cost of health care and the rising cost of health insurance.

With the ACA, premium rates are based solely on a person’s, or a family’s, income and not on any other factors. Also, people with pre-existing conditions no longer can be denied coverage because of their condition or have their premium raised based on those conditions.

The ACA allows parents to keep children on their health insurance policy until the child turns 26 years old. White said this applies even if the child is married. However, a parent can’t provide health insurance to the child’s spouse.

White said, 80 percent of a premium cost must be spent by a health insurance company on a person’s health care needs, only 20 percent can be used to cover administrative costs. If the company doesn’t spend 80 percent of the insured’s premium on health care needs, a refund check will be issued to the individual for the amount not spent.

Under ACA, policy amounts  on most benefits are no longer limited throughout a plan’s lifetime or within a year, she said. Before ACA, an insurance company could place a limit on how much could be spent during the lifetime of a policy or within a year.

 Additionally, ACA focuses on quality of care over quantity of care and preventative health. Co-pays have been eliminated for preventative health services under ACA. A complete list of preventative health services no longer requiring co-pays can be found www.healthcare.gov.

Starting in 2014, ACA will require most U.S. citizens and legal residents to have health insurance. Health insurance will be verified when an individual files income taxes. Those without health insurance will not be penalized if there was no affordable health care option that met their needs.

The penalty for those without insurance who had an affordable option available to them will be $95 per adult and $7.50 per child. By 2016, White said that penalty will increase to $695 per adult.

She said tax credits will be available to help individuals and families pay their premiums and are based on income.

Also beginning in 2016, health insurance companies will be able to start selling across state lines, creating more competitive prices. Currently, only two companies are authorized to sell in Mississippi, Humana and Magnolia, White said.

She said Humana is the only health insurance option in the private Health Insurance Marketplace for residents of Pearl River County. Originally, Humana was the only health insurance company providing coverage to individuals in Mississippi, which would have left 36 counties without a health insurance option in the marketplace. Magnolia recently joined the marketplace to fill that void in coverage for the 36 counties, White said.

She said the private Health Insurance Marketplace is only for individuals and families with incomes over 100 percent of the federal poverty level, including those without health insurance coverage or for those looking for a cheaper health insurance option. People with Medicaid, Medicare or those insured through an employer, Veteran’s benefits, or the military don’t need to shop on the marketplace unless they are looking for a different option.

White stressed throughout the meeting that if an individual or family doesn’t have insurance, they should apply for coverage through the private Health Insurance Marketplace.

White said even if an individual thinks he or she doesn’t make enough to find an affordable choice that fits their needs, that person still should look on the marketplace because the marketplace will be able to say if a person qualifies for Medicaid or Medicare.

While the Mississippi legislature chose not to expand Medicaid coverage under ACA, the legislature can vote to offer the expansion during the next legislative session, White said.

She explained the Medicaid Expansion is an option that allows individuals and families under the age of 65 to qualify for Medicaid if they make up to 138 percent of the federal poverty level. The federal poverty level for an individual is $15,856 and for a family of four, $32,499.

Coverage begins on Jan. 1, 2014 for those who enrolled between Oct. 1 and Dec. 15, 2013 and made their first payment. Open enrollment in the private Health Insurance Marketplace ends on March 31, 2014. White said someone can get insurance through the marketplace after March 31 if only there is a qualifying life changing event, such as job loss, birth or divorce.

Individuals can receive help enrolling in the Health Insurance Marketplace by visiting a qualified navigator or certified application counselor. A list of locations where help is available can be found at www.localhelp.healthcare.gov.

An individual can apply online at www.healthcare.gov, by phone at 1-800-318-2596, through a paper application or by contacting an insurance broker.

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