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ACA helpers combat insurance sign-up confusion


The Herald-Dispatch

HUNTINGTON, W.Va. — Although often discussed if not full-on argued, the many questions surrounding health insurance are rarely answered with much clarity or certainty in the public forum – often generating confusion among those who most stand to benefit from it.

With enrollment now open for the Affordable Care Act’s Health Insurance Marketplace as well as Medicare Advantage plans, experts are working to cut through the confusion and help potential buyers navigate the market with as much knowledge as possible.

“We don’t know what the future holds as far as health care options in this country, but we just tell people to take it year by year,” said Jeremy Smith, project director for WV NaviCare, a nonprofit campaign designed to guide West Virginians through the Health Care Marketplace’s various plans and options offered through the ACA, informally known as Obamacare.

For those planning to browse the marketplace, Smith said the most important piece of information to first have on hand is an estimation of their 2018 income. This is because plans are priced based on a household’s income and family size, and also because it helps calculate a monthly tax credit that can be used toward payment. While the size of the credit varies based on income as well, Smith said 85 percent of buyers qualify for a tax credit to some degree.

For example, if an insurance plan were to cost $800 a month for a household that makes $20,000 annually, Smith explained, that family may receive a monthly subsidy of about $700. The credit decreases as household income increases, he continued: an $800-a-month plan for a household earning $40,000 annually may only receive a $600 subsidy.

The marketplace’s offerings are mostly unchanged for 2018, Smith said, and those who qualified for a subsidy last year should expect similar prices this coming year. The remaining 15 percent of marketplace buyers who earned too much to qualify for a tax credit, however, can expect a slight increase in their premiums scaled to their income.

Questions regarding financial assistance arose after the Trump administration recently halted the federal government’s offering to pay insurers as an incentive to offer cost-sharing measures to the buyers, Smith said. Consumers still have the option for plans with subsidized co-pays and deductibles for 2018.

“We want people to know that the financial assistance is still in place for folks as it was last year if they get their insurance through the marketplace,” Smith said.

Subsidies are only available through, and Smith cautioned buyers against searching for plans elsewhere on the internet – most others offering simple short-term, catastrophic plans that may open potential applicants to a flurry of unsolicited telemarketing calls.

“These are just different health care plans, but a lot don’t meet the requirement to not pay taxes on them under the (ACA),” Smith said.

Smith also emphasized the annual enrollment window has been sliced in half, six weeks shorter than last year. Open enrollment began Nov. 1 and ends Dec. 15 in West Virginia, whereas buyers had until after the holidays to sign up last year.

Although the buying process can take just an hour or so to complete, Smith admitted navigating the marketplace can be confusing – highlighting the importance of WV NaviCare’s free and public program in helping buyers make the decision best suiting their needs. WV NaviCare can be contacted at 304-356-5834 or toll-free at 844-982-2737 for a phone consultation or to schedule in-person appointments, which are hosted weekly at the Cabell-Huntington Health Department in Huntington.

Medicare Advantage

November is also the height of Medicare’s annual election period, the equivalent to an open enrollment, having started Oct. 15 and open until Dec. 7. Most applicants are retirement age – 65 and older – meaning employer-based insurance is usually not an option. Beneficiaries also include those who have been disabled for more than two years and those with an end-stage renal condition requiring kidney dialysis.

Many people eligible for Medicare enroll in Medicare Advantage plans offered by private insurers. Enrollment can especially become a confusing time for seniors, explained Cathy McAlister, Highmark spokesman for West Virginia, who herself struggled to explain the process to her 93-year-old father-in-law. Although of an active mind, McAlister said the news and headlines regarding health care, the Affordable Care Act, Medicare and “repeal and replace” can all blend together into a confusing situation to try to grasp at any age. Even with a proper understanding of the facts, navigating the purchasing process can prove a challenge for seniors – particularly complicated when computers come into play.

“For a 93-year-old person, that’s something that’s very difficult,” McAlister said. “They might not even know what a mouse is, for goodness’ sake.”

Highmark offers its own navigators for Medicare Advantage plans similar to what WV NaviCare provides for the Health Insurance Marketplace. The 93-year-old man was eventually guided through the process by Stephanie Stanley, one of Highmark’s Medicare sales advisers.

“A lot of the confusion comes from what they see in the paper or online, and it does become very confusing,” Stanley said. “A lot of them are just point blank honest that they need help.

“But once they talk to me, their fear is over.”

Stanley and other Highmark agents also make in-person house call appointments, or a public meeting at a restaurant or library, which she added many seniors find more comfortable than over-the-phone help.

“To have someone like Stephanie come do it with you, you can’t put a price on that,” McAlister said, speaking over her father-in-law’s own experience.

Highmark can be contacted via phone at 866-682-7969.

Follow reporter Bishop Nash on Twitter @BishopNash.

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