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News Feature

Blue Hill
Originally published in Community News, December 5, 2013
Understanding the Affordable Care Act
How individuals can enter the health insurance marketplace

Federal poverty level chart

This chart, provided by Healthcare Navigator Lynn Cheney, shows the federal poverty guidelines. If a household’s gross adjusted income falls below 400 percent of the federal poverty line (FPL), then that family will likely qualify for a subsidy to help defray the cost of the monthly health insurance premiums purchased through the Health Insurance Marketplace, created by the Affordable Care Act. These subsidies are tax breaks paid directly to the insurance companies to reduce premiums.

by Jessica Brophy

The Affordable Care Act, also known as “Obamacare,” was passed in 2010 and is still rolling out its provisions. The major component of the law, the health care exchanges where the uninsured are able to shop for coverage and find out what subsidies they might be eligible for, is now enrolling consumers.

This piece will explore the steps required to sign up for health insurance through the Health Insurance Marketplace.

There are five steps to sign up for a health insurance plan as an individual, family or owner-operator of a business.

First, create an account on healthcare.gov, the government’s healthcare insurance marketplace website. For those that would prefer to fill out a paper application or fill in by phone, that is an option.

Second, enter required information, including Social Security numbers and income information. That information is necessary to see what subsidies, if any, the individual qualifies for. Since the plans will be covering the 2014 year, individuals must project what they think they will make in 2014.

One of the challenges of this step, said Healthcare Navigator April Gilmore of the Maine Lobstermen’s Association, is that for those who are self-employed or who work in a business like lobstering—where income is unsure—it can be difficult to predict what the profit for the coming year will be.

If someone predicts their income too low, the subsidy they receive on their premiums would need to be returned to the government at tax time if the person in question earns more. If someone predicts their income too high, they will pay more out in premiums (though they will receive any difference at tax time).

“It can be very confusing,” said Gilmore. She recommends that lobstermen—and anyone else whose income isn’t easy to predict—continually update their predicted income as the year goes on. This can adjust premium subsidies according to the projected income and help keep the price of the plan where it should be and avoid tax-time headaches.

“I would suggest updating the account quarterly, so you can get as close as you can,” said Gilmore.

The same goes for anyone who has a major shift in income over the course of the year.

The subsidies—taken directly out of the cost of the monthly premiums of the healthcare plans, are based on adjusted gross income. There are subsidies available for individuals and families whose gross income is less than 400 percent of the federal poverty limit (see accompanying chart).

Michele Levesque and Michael Rossney of Sedgwick attempted to sign up for insurance, but were stymied by the process. “We’re trapped,” said Rossney. The pair had gone through the process several times, but there was a problem verifying Rossney’s identity. Rossney mailed a photocopy of his driver’s license to an address in Kentucky, and he hopes that will take care of the hiccup.

“I would like to finish,” said Rossney. “I am looking forward to completing the process, I think it’s going to be a huge improvement in our healthcare.”

Sedgwick resident Chris Leith had more success, and signed up for individual insurance in October, not long after the government’s website became available. Leith did experience a few hiccups with the website, she said, but was able to call a toll-free number for help and she was able to see her subsidy number. Once she knew what the plans would cost her, she could move on to the fourth step—comparing plans available to her.

One of the reasons it’s easier to compare health plans is that all healthcare plans that are ACA compliant must offer a new package of services. These range from coverage for emergency services, maternity and newborn care, mental health and substance use disorder services, lab services, preventive care and pediatric services—including oral and vision care for children (though not for adults).

This means all the ACA-approved plans have certain commonalities, and the question then becomes what level of copay, out-of-pocket expense and other levels are offered by each plan. The plans are presented as bronze, silver, gold or platinum plans, with a separate category for those under 30 who want to purchase catastrophic coverage.

The fifth step is to choose one of the plans available, and enroll. Health insurance coverage can begin as early as January 1, 2014.

The enrollment period to enroll for 2014 is open until March 31. Next year, to enroll for 2015, the open enrollment period will be from November 15, 2014 to January 15, 2015.

This is the second in a series of articles about the Affordable Care Act and the new insurance marketplace.