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Thinking about Health: Getting insurance under the Affordable Care Act
January 02, 2014 Trudy Lieberman   

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On October 1, millions of uninsured Americans---232,000 in Nebraska, (105,000 in South Dakota, 716,000 in Colorado) ---suddenly got a new way to buy health insurance. They can now shop in the state insurance exchanges. Many of them had been shut out of the insurance market because they have pre-existing health conditions. In January it will be illegal for insurers to turn away sick people.

Itís expected that about 24 million people will find insurance coverage in the exchanges, and about 60 percent of them will be eligible for a subsidy to help them pay the premiums. For families with incomes hovering around the federal poverty level ($23,550 for a family of four; $11,490 for individuals) and somewhat above, subsidies will be large and might cover a good chunk of the premium. Families with higher incomes will get smaller subsidies and will have to pay most of the premium themselves. That could be a big chunk of the family budget if they choose a policy with good coverage.

Customers in the exchanges will mostly be those who have no coverage and those who now buy it in whatís called the individual market. If you have employer coverage, Medicare, Medicaid, or coverage from the military or the Indian Health Service, forget the exchanges. The law assumes you already have health coverage.

The poorest of the poor in the 26 states that have chosen not to expand their Medicaid programs including Nebraska (and South Dakota.) cannot shop in them either. They have incomes below the poverty level, and because their states have chosen not to expand, they have few options. Because of the way the law was written it was assumed that people with incomes below the poverty line would get Medicaid as well as those with incomes between 100 and 138 percent of poverty.

Because of the court decision, that meant those whose incomes were 99 percent of the poverty level are out of luck if their state has chosen not to expand. Their incomes are too low for them to buy insurance on their own and unless their state offers benefits to childless adults (most donít), they canít get Medicaid either.

People who have coverage theyíve already bought in the individual market can also check out the exchange to see if they can get a better deal. That includes freelancers, retirees not yet old enough to get Medicare, people between jobs, and families of workers whose employers provide insurance for employees but not for their spouses or kids.

A Hastings woman who is disabled because of a medical error is one of those who will be looking for an insurance deal on the exchange. She and her husband already have insurance they bought in the individual market. She had heard about the new law and went online to do a bit of research. She left her name on the site of ehealthinsurance.com, and received calls from 15 agents eager to sign her up when the exchanges opened for business. One from Florida told her if she didnít sign up quickly her application would not be accepted. The woman told me the agentís message was ďif you donít work with me on this, youíve blown it, honey.Ē

That brings up the matter of where to go for help. One place to start is the website healthcare.gov, the entry point for people in states like Nebraska (South Dakota). The federal government also runs The Marketplace Call Center 1-800-318-2596.

You can also look for a navigator, a real live person trained to help people enroll in a policy. They are supposed to be unbiased and canít steer consumers to any particular policy. To find one in Hastings, I clicked on LocalHelp.HealthCare.gov. It gave me three choices: a hospital in Lexington, Community Action of Nebraska, and Planned Parenthood of the Heartland, both in Lincoln. Not exactly help around the corner.

Once you find your way to a list of insurance offerings either on a website or with a navigatorís help, the task becomes tricky. Choosing health insurance is never easy, whether youíre buying inside or outside an exchange.

You donít have to rush into anything right now. Take your time and study the options. Open enrollment doesnít end until March 31. If you buy a cheap policy that doesnít cover your needs when youíre sick, you may be stuck with it for months until the next open enrollment. ďItís like walking into a chasm of uncertainty,Ē the Hastings woman said. ďItís a little like shopping for a used car. You donít know if youíre getting a lemon.Ē

Editorís note: Funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association, the Rural Health News Service provides Nebraskans with unbiased health-related information, designed to help better understand the health issues facing our communities, state and nation.
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