Deadline looms to get health insurance by Jan. 1

jholleman@thestate.comDecember 20, 2013 

Another major Affordable Care Act deadline is coming up. Monday is the last day people can sign up on the Health Insurance Marketplace and have coverage assured by Jan 1.

Here are the answers to some of the basic questions surrounding this deadline:

Can I sign up for insurance on the federal marketplace after Monday?

Sure. The Monday deadline is only to have insurance in place by Jan. 1. You can keep buying insurance policies on the Health Insurance Marketplace through March 31. But your coverage won’t start until a few weeks after you sign up.

There’s a penalty for not having health insurance next year. Will I face a penalty if I don’t have coverage Jan. 1?

No. The penalty provision allows for a lapse of up to three months of coverage during a year. So you won’t face the penalty unless you still don’t have insurance after March 31.

What is the penalty for not having insurance?

For 2014, it’s the greater of $95 or 1 percent of your annual income. Because the penalty is handled through the Internal Revenue Service, it won’t be paid until you file your tax return in 2015.

Is the healthcare.gov website working smoothly now?

Insurance agents and the navigators paid to help people sign up say the website is working much better than a few weeks ago. Wanda Pearson, who is directing the navigator program for The Cooperative Ministry in Columbia, said the process can be completed in less than an hour if people come in prepared with all of the right information (latest tax returns, any current health insurance policy information, Social Security number).

Could the healthcare.gov website be overwhelmed again as this latest deadline approaches?

Sure. Even though the website is performing better, it’s going to be tested by a new wave of applicants in the next few days.. Because of the website’s balky first two months, very few people signed up before December. In South Carolina, for instance, applications were completed for 33,596 people eligible for the marketplace by Nov. 30. That’s just 4.6 percent of the estimated 726,000 uninsured state residents estimated to be eligible for coverage through the marketplace.

Will I qualify for government help paying for the policy?

It depends on your income. An individual earning less than $46,000 annually, and a family of four earning less than $94,000 will qualify for a tax credit. The credits are greater for those with lower incomes. The tax credit is used immediately to reduce the monthly premiums, so you don’t have to wait for the next tax return to benefit from the subsidies.

When will I have to make my first payment?

Because of the backlogs and delays on the website, the major insurance groups have agreed to allow the first monthly premium to be received as late as Jan. 10.

I have insurance though my employer. Do I need to do anything?

No.

I have Medicare. Do I need to do anything?

No.

My old policy was canceled because of the ACA. Is my new policy going to be more expensive?

First of all, check with your current insurer. The Obama administration changed course and allowed companies to offer policies that don’t meet ACA requirements in 2014. If your company opted to take advantage of that change, you should have received a letter from your company about this. If you do need to get a new policy, it likely will be more expensive – unless you qualify for tax subsidies. The new policy also likely will cover some things your old policy didn’t, and it likely will have higher deductibles and out-of-pocket expenses and a smaller provider network.

Can I sign up without help from insurance agents or navigators?

Yes. People with internet access can do it on their own. The process isn’t terribly difficult, but insurance terms can be confusing and comparing aspects of the various policies can be mind-boggling. If you have time to work with someone like a navigator who knows the system well, it might help you get through the process more quickly. While the navigators can explain terms in the policies, they’re not supposed to make choices for you. Certified insurance agents have the training to provide those recommendations, and you don’t have to pay a commission.

How can I find local navigators?

Call one of the navigator groups in the area – The Cooperative Ministry (803) 799-3853, Greater Columbia Community Relations Council (803) 733-1129, S.C. Progressive Network (803) 445-1921 and the Benefit Bank of S.C. (800) 726-8774.

How can I find certified agents?

The most balanced help comes from independent agents with no direct connections to the insurance companies. Go to http://www.nahu.org/consumer/findagent2.cfm and check “South Carolina” and “PPACA” to find some local certified agents. Only licensed agents certified to sell the policies should want to work with you because they’re the only ones qualified to earn the sales premium from the federal government.

Can I buy directly from the insurance companies?

Yes. Search online for BlueCross BlueShield of S.C., Blue Choice Health Plan, Consumer’s Choice Health Plan or CoventryOne. But remember, those agents will steer you to their company’s plans.

What do I need to look for in the various plans?

It’s important to check monthly premium (how much you will pay each month), deductible (the amount you have to pay for medical service before the insurance company begins paying), out-of-pocket maximums (the most you pay in a year other than premiums), co-payments (which lists what doctor visits and procedures the policy will pay for before the deductible kicks in) and provider network (showing which doctors accept which specific insurance plans). In general, the best policies have low deductibles, low out-out-of pocket expenses and broad provider networks. Those also generally will be the most expensive policies.

Can I check to see if my doctor is in the provider networks?

Yes, but it will take a little work. Click on the “Details” box next to the plan you’re considering. Then click on provider network and search for your doctor. It’s also a good idea to search for hospitals. For instance, Lexington Medical Center is in network only for CoventryOne, and only for its Tier 2 plans. If you sign up for one of the other companies’ plans, you will have to pay full price for most procedures at Lexington Medical Center.

What’s with these bronze, silver and gold levels?

Those are categories set up to indicate which policies are better. But this isn’t an exact science. Depending on your situation, a silver policy might be just as good as a gold, and cheaper. That’s why you need to pay attention to the individual plan details.

Is anybody offering special help in the next few days?

Yes. The Cooperative Ministry office at 3821 W. Beltline Blvd., Columbia, will be open 10 a.m.-3 p.m. Saturday and Sunday, and the Greater Columbia Community Relations Council plans a blitz on Monday, with several navigators on site at 930 Richland St., Columbia, 9 a.m.-7 p.m.

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