Explaining The Affordable Care Act and Its Impact on Older LGBTs
The presentation was held in order educate the the LGBT community about the open enrollment period that began on October 1 and to let those in the community ask how the ACA, colloquially known as Obamacare, affects their personal healthcare needs.
“This is a pertinent issue to the LGBTQ community, and we needed to have it since it is open enrollment right now” said Shannon Marling, co-chair of the SAGE Steering Committee, “We’ve got a lot of folks in our population who are going to qualify for going into the marketplace, so it’s going to be beneficial for them to have the information.”
Sara Cariano, M.S.W, M.P.H, a certified navigator from ENROLL Virginia was invited to speak at Sunday’s presentation. ENROLL Virginia is a nonpartisan, non-profit founded by the Virginia Poverty Law Center (VPLC), Young Invincibles, and other legal aid programs. Certified Navigators for the group are required to complete 20 hours of training on the new health insurance marketplace, available insurance plans, financial assistance, and Virginia’s Medicaid and FAMIS programs.
The online marketplace is built as a price comparison website, where citizens can compare and contrast different plans based on personal information, such as household income, policy numbers of current coverage, dependents and more.
Health insurance obtained through the marketplace will cost less than 8 percent of household income, while insurance through an employer will cost less than 9.5 percent.
Those looking for insurance are not required to look for insurance through the marketplace and can go through a broker or an employer instead. Citizens who are covered under Medicaid, Medicare, FAMIS, or Veteran’s health coverage can also stay with their current plans.
Healthcare in Virginia is now required to meet 10 essential health benefits; Ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventative and wellness services and chronic disease management, and pediatric services, including dental and vision care.
Four qualified health plans are offered by the Marketplace, Bronze, Silver, Gold, and Platinum, which respectively pay 60, 70, 80, and 90 percent of costs. The Bronze plan has lower premiums, but leaves higher out-of-pocket costs. The Platinum is the opposite, with a high premium but a low co-pay.
Premiums for insurance are based on age, geography, and smoking habits. They can not be based on gender or current health status, meaning those with pre-existing health conditions will be able to get and afford health insurance.
Aetna Life Insurance Company, Coventry Health Care of Virginia, Anthem-Healthkeepers and Optima Health Plan are the four companies providing statewide plans through the marketplace. CareFirst BlueChoice, Group Hospitalization and Medical Services, Innovation Health Insurance Company, and Kaiser Foundation Health Plan are also offering plans, but only in Fairfax. Piedmont Community Healthcare is also providing a plan for customers in Lynchburg.
Financial assistance through the marketplace is possible as well for those with a household income between 100 and 400 percent. An independent filer with an income between $11,490 and $45,960 is eligible. A household of four with an income between $23,550 and $94,200 qualify for the assistance.
Financial assistance will be provided two different ways; tax credit sent directly to your insurance company or cost-sharing protection which lowers out-of-pocket costs.
The tax credit is determined by the difference between the cost of a Silver plan and the percentage of household income. The percentage is based on a federal poverty line evaluation. Those between 100 and 200 percent of the federal poverty level will have 2.0 to 6.3 percent subtracted from the estimated cost of a Silver plan to make their tax credit. Those between 200 and 400 percent will have 6.3 to 9.5 percent considered.
The tax credit is not limited to the Silver plan, but open to any plan that’s available on the marketplace. Cost-sharing however, is limited to the Silver plan.
Cost-sharing protection can be obtained if household income is less than 250 percent of the federal poverty line. Cost-sharing protection raises the percentage of costs paid for by the Silver plan. Those between 150 and 200 percent of the federal poverty level will have 87 percent of costs covered by the Silver plan, while those in the 100 to 150 percent range will have 94 percent paid off.
Those who chose to go uninsured will face a tax penalty. Initially, the penalty in 2014 will be $95 dollars for an adult, plus $47.50 for each child, with the maximum penalty being up to $285. The penalties will increase every year until 2016, where adults will face a penalty of $695 and $347.50 per child. The penalty will cap off at $2,085.
Few people will be exempt from having to purchase healthcare. Anyone who’s lowest-price plan cost more than 8 percent of their household income will not have to buy healthcare. Those who fall below the income tax filing threshold of $10,000 for a single adult, $20,000 for a couple, are also exempt.
In the weeks since open-enrollment has begun, the system has faced glitches. Users have been unable to properly submit their applications, with insurers receiving duplicated numbers and incorrect information. The Obama administration has yet to reveal what has been the source of the problem plaguing the online marketplace.
Navigators like Cariano believe that their work is aiding the public in understanding the function of the online marketplace, “I think today’s been really reflective of how it’s been, there’s been a lot of questions,” said Cariano about Sunday’s presentation, “There’s a lot of information and it’s hard to process it all – people want to make sure how it works and how it applies to them.”
Members of SAGE believe that comprehension of what the ACA is may sway public opinion, “You can ask people if they like Obamacare or the Affordable Care Act, they don’t often realize it’s the same thing,” said Marling, “Especially in our Transgender community, I hope this is an opportunity for a lot of folks who need coordinated healthcare to actually be able to access it.”
Marling imagines that members of the Transgender community will come to embrace the ACA in the months to come during open enrollment, “Right now, when they go to the hospital it’s costing them a fortune,” said Marling, “If people have the information and know how to access it and go through the process to enroll, they’ll have better health outcomes.”
Most Americans will be expected to have health insurance by January 1, 2014. Open Enrollment ends March 31, 2014.
Those in these Central Virginia area with questions can contact Healthcare Navigators at these numbers:
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