By AMANDA KIMBLE
ERATH COUNTY (October 31, 2016) – Community members without health insurance, listen up. The Affordable Care Act’s (ACA) Health Insurance Marketplace is open for enrollment.
But, before you log on and sign up, call on the assistance of certified navigators. The trained professionals are available to answer questions, help determine if applicants qualify for financial assistance and assist in selecting the best plan for every individual or family
While the number of uninsured Americans is at an all-time low, there are still many who remain without health insurance, according to Laverne West, a certified navigator working with Pecan Valley Centers (PVC). The organization’s three navigators provide assistance with ACA related questions and Marketplace enrollment in Erath, Hood, Johnson, Palo Pinto, Parker and Somervell counties.
The current open enrollment period begins November 1, 2016, and continues through January 31, 2017. West said to guarantee coverage by January 1, marketplace subscribers need to complete the enrollment process no later than December 15.
Individuals and families who have a current Marketplace must renew or change their existing plans during the open enrollment period, and subscribers must update income and household facts on their 2017 applications to determine eligibility for financial aid.
While West said applying for coverage through the healthcare.gov can be complicated, she suggested individuals all consumers could benefit from the free assistance provided by certified navigators.
PVC navigators will be available at various locations across their six-county coverage area. An open enrollment event will be held from 3 until 8 p.m. Thursday, November 10, at First United Methodist Church Fellowship Hall in Stephenville.
An event is also planned to take place in Glen Rose this Saturday, November 5, at the community center located at 107 Sheppard Street.
“We will have extra computers onsite for those who don’t have access to their own computers and for individuals who need help with the enrollment process,” West said. “We will help community members apply for a tax credit to help lower premiums and help them get enrolled in qualified and affordable health insurance plans.”
Many Marketplace subscribers have recently turned to social media to voice frustration over the drastic hike in 2017 premium rates, but West said she has also seen an increase in tax credits. She said many subscribers are not completing the necessary steps to receive the tax credits available to offset the cost of coverage.
“A household of four with an annual income of at least $24,300 and up to $60,750 may qualify for a premium tax credit,” West said, adding the same family with an income of up to $33,500 could receive an additional cost-sharing allowance. “That would make their copays and deductibles much lower, and that is something a lot of people do not understand.”
Searching on the Marketplace website, The Flash determined a single-parent household with two minor children and a $25,000 annual income could qualify for credits of more than $400 per month.
According to the federal government, more than 8 in 10 applicants are eligible for savings and most can find plans priced between $50 and $100 per month after accounting for their tax credit. Selection of certain plans also increases potential savings.
While “Obamacare” has caused outrage for many Americans, West said her experience with the program has also put her into contact with many people who say they could not afford health insurance prior to ACA implementation.
She also said the program is not perfect, and changes with insurance companies and other provisions mean even those who are currently insured through the Marketplace need to closely review their plans during open enrollment.
“They need to make sure everything will still work for their families in 2017,” West said, referring to approved healthcare providers and services. “I advise everyone to look at their plans, no matter what kind of insurance they have – even Medicare – because not everything remains the same from year to year.”
The state of Texas is one where there will be a greater number of uninsured adults, but that fact is not attributed to the size of the state alone. West said many adults with an income of less than $24,300 will remain uninsured since state legislators failed to expand the Medicaid program to protect the impoverished. But, she said children in the same homes can qualify for health insurance benefits through the Children’s Medicaid and Children’s Health Insurance Plan (CHIP).
“There is a gap,” West said, adding many individuals and families will be exempt from paying mandated fines when filing their income tax returns. “We can help those families by making sure they have the paperwork they need to claim their exemption and avoid paying the fee.”
West said upcoming open enrollment events are open to walk-ins, but appointments can cut down on wait times. Call 817-579-4488 to schedule an appointment. Spanish speakers can call 817-579-4472.
She also said navigators are available after hours and by appointment by calling the numbers above.
Navigators undergo extensive training including an introductory course that spans 40 hours, followed by additional hours and testing through the Texas Department of Insurance. They also receive ongoing training and certification to remain qualified and up to date with the latest changes, rules and regulations.
Navigator services provided by PVC are available at no cost, and all proprietary records and personal information, except the name and telephone number of those served by the organization, are returned to the client.
“We do not keep personal records,” West said.
Finally, she suggested all Marketplace subscribers keep their login and password, as well as eligibility and exemption letters filed with their income tax related paperwork so they can be easily located when it’s time renew coverage or provide required information to the Internal Revenue Service.
While some families will qualify for exemptions and will not be required to pay a penalty for remaining uninsured, the fee for others who are not exempt is considerable. The fee is calculated two different ways, according to healthcare.gov, which state violators will pay the higher amount. The 2016 fee is 2.5 percent of the household income or $695 per adult and $347.50 per child under the age of 18. The fee will be adjusted annually for inflation.
To be eligible to enroll, all applicants must live within the United States and be a citizen or national. West said when attending an open enrollment event, documented proof of citizenship such as a social security card must be presented. Enrollees must also present verification of household income.