Open enrollment underway again for ObamaCare
Silvia Rangel of Port Arthur tried to obtain health insurance before for herself and her family, but she was unsuccessful. “It was too expensive,” she said.
She though coverage was out of reach until she enrolled last year in a plan under the Affordable Care Act. “I would had have to pay $300 a week (before the ACA). I now pay $125 a week. It’s much better,” Rangel said. ACA Navigators, or Certified Application Counselors (CACs) helped Rangel through the paperwork to enroll. She got a PPO for herself, her husband, and their child. “Everything’s covered. I have the Gold Plan. It’s based on how much you pay,” she said.
For instance, Rangel spent a week in the hospital. Her plan paid for 80 percent of the cost and she paid the remaining 20 percent difference. Emergency rooms will also accept her plan. Rangel said the ACA has made a difference in her life and she likes her insurance. “It’s been an improvement. I recommend it to everybody. It’s cheap and at a good price,” Rangel said.
Lesly Johnson, likewise, is assisting residents to enroll in the ACA or renew their coverage if they haven’t done so already. Johnson is the Community Relations Manager for Legacy Community Health Services in Beaumont and she also the chair for events on the Enroll Southeast Texas subcommittee. She wants to remind everyone the enrollment period for the ACA is from Nov. 15, 2014 through Feb. 15, 2015 and that there is also help out there to apply.
We’re hosting an educational event that’s free to the public. We can get the enrollee’s information and contact them and do a follow-up with a Certified Application Counselor. The free event is called Enroll Southeast Texas for residents to learn how they can benefit from the new health insurance law.
It runs from 9 a.m. to 12 p.m. on Saturday, Nov. 15 at Central Park Community Center, 640 Fourth St. in Beaumont. Call 1-866-683-3627 for more information.
The other event is from 8 a.m. to 4 p.m. on Saturday, Nov. 15 at Gulf Coast Health Center, 2548 Memorial in Port Arthur. Call 409-985-2656 for more information.
There will be Certified Application Counselors available to help with:
Understanding options and comparing plans
Determining the level of financial assistance eligibility
Applying for health coverage
Making follow-up appointments to enrolling
Refreshments and children’s activities will be available.
Attendees are asked to bring their W-2 form or income estimate, driver’s license, list of medications, list of current health care providers and Social Security number.
The event is sponsored by Enroll Southeast Texas, Christus Health- Southeast Texas, Iheart Media, Spindletop MHMR, the Beaumont Enterprise, Gulf Coast Health Center, Inc., Cumulus Beaumont, Magic 102.5, Q94, Nash FM 101.7 and Sports Radio 1450 AM and 1510 AM.
CACs can walk enrollees through the online enrollment process either at the events on Saturday or during other times. Participants may also enroll via telephone, filling out a paper application, or face to face with a CAC in addition to online.
Healthcare plans range from a bronze plan to a platinum plan. “People can window shop and browse different plans and see what their monthly premiums would be. Each will also have a deductible,” Johnson said. As with Rangel, an enrollee’s insurance plan will start paying a percentage of medical costs such as insurance paying 80 percent and the enrollee paying 20 percent out of pocket.
“There’s a broad spectrum of plans. It puts insurance back in your hands; you get to pick,” Johnson said. “You can pick something this year and something else for next year.” She gave an example of going with dental insurance or opting out, or a young couple purchasing ahead of time for a pregnancy.
Legacy, along with Spindletop MHMR, and Gulf Coast Health Center, are part of the ACA coalition because they have CACs. Other stakeholders are Christus St. Elizabeth, Baptist Hospitals of Southeast Texas, and the Salvation Army.
Johnson cautioned that the law dictates residents who have a certain income above a certain level are required to carry health insurance or pay a tax penalty. The penalty was $95 or one percent of income for year one of the ACA, $325 or two percent for year two, and $695 or two-and-a-half percent for year three. She added year three is the plateau amount but it still may rise due to inflation. “It’s no jail time, it’s just a tax penalty. You have to weigh the costs and benefits. It’s important to look at each plan,” she said.
Also, Medicaid expansion wasn’t accepted in Texas to cover those workers making less than or up to $11 an hour and without insurance. On the other hand, those who couldn’t get insurance previously can now get coverage. Medicaid is still available, but only for those with a very low income. Furthermore, they won’t be expelled from their coverage for preexisting conditions.
“If they have to go to the ER, they don’t have to wonder how they will cover this emergency (under the ACA) out of pocket or how it will affect my credit because it will be reported to the credit bureaus,” Johnson said.
A person may also see a physician immediately after consulting with an CAC and after enrolling in the ACA. The ACA, additionally, covers mental health under different plans.
Johnson said all three coalition partners- Legacy, Spindletop and Gulf Coast- help people who don’t meet the enrollment criteria due to low income. All three also have grant funding and sliding scale payments.
While one needs to be a U.S. citizen to enroll in the ACA, one doesn’t have to be a citizen to use Legacy.
Though officials at the Department of Health and Human Services (HHS) on Monday projected that up to 9.9 million people would be enrolled in ObamaCare in 2015, millions fewer than Congressional Budget Office (CBO) estimates, Johnson said more people will be enrolling locally in the ACA this year. “There will be more people this year. More will re-enroll and the word is getting out it’s a good thing,” she said.
Getting at least a bronze plan is a good idea because it can cover unexpected health issues such as cancer or heart attack.