November 1 marked the start of open enrollment for health insurance coverage.
Enrollment guidance and financial assistance remains available for those needing to consider the latest options available in Missouri to purchase health insurance under the Patient Protection and Affordable Care Act (ACA).
“If people hear nothing else, they need to know the ACA – what people call ‘Obamacare’ – is still the law,” Nancy Kelley, program director for Expanding Coverage at the Missouri Foundation for Health. “No matter what you might have heard on TV or different statements, ACA is still the law of the land. There are plans every county in Missouri has to choose from.”
Three insurers are offering plans in Missouri; however, not all three are offered in all locations. Cigna and Ambetter (Centene Corp.) are Marketplace offerings in the St. Louis area. Anthem BlueCross BlueShield, which is not offered in St. Louis, is an option in outstate, rural counties.
Kelley said the two types of financial assistance, cost-sharing reductions and premium tax credits, are still available this year.
“Over 80 percent of people in Missouri qualified for some level of tax credits this year, and we expect that to be the name next year,” Kelley said. “It brings down the cost in most cases, to what the government calls ‘affordable.’ A lot of people get plans for $100 or less per month.”
Kelley said cost–sharing reductions, or CSRs, reduce the out-of-pocket costs of health care.
“Someone might get coverage, but we all know that when you have to pay a co-pay, or you’ve got your out-of-pocket costs, sometimes that makes it hard to use your insurance,” Kelly said. “Cost-sharing reductions, based on income, reduces the cost for people so they can actually use their insurance.”
Cost-sharing reductions are paid to the insurance companies, and the insurance companies offer those as discounts to the consumer. Those cost-sharing subsidies are what President Donald Trump announced in mid-October that he was ending – as part of his ongoing effort to dismantle Obamacare.
“President Trump issued an executive order that stopped the CSR payments, so the insurance companies are no longer getting those payments,” Kelly said. “However, the law says the consumers get them so the consumers are still getting them, it’s just the insurers who are now having to eat that cost. The good news is that people who are receiving them will still get those discounts this year.”
In the end, consumers may still pay. “The impact could be insurers over time are going to raise up their prices because they have to make up that difference of that expense somehow,” she said.
The Cover Missouri Coalition is holding “Rock Enrollment” events this weekend to help support health insurance open enrollment.
- Saturday, Nov. 4 from 9 a.m. – 1 p.m. at the Community Action Agency of St. Louis County, 2709 Woodson Rd. (63114)
- Saturday, Nov. 4 from 11 a.m. – 2 p.m. at the National Blues Museum, 615 Washington Ave. (63101).
- Saturday Nov. 4 and Sunday, Nov. 5, from 11 a.m. to 5 p.m. at the Missouri History Museum, in conjunction with the Dia de Los Muertos Festival in Forest Park, 5700 Lindell Blvd.
Signing up for coverage
The six-week window to sign up for health coverage can pass by sooner than you anticipate, Kelley said. There are certain documents you need to get started.
“When they sit down to enroll, be it by telephone or at their computer or with an assister, they would need to have access to an email address, because they have to create their own account on the Marketplace,” said Lorna Vaughn, of Bilingual International Assistant Services in St. Louis.
“They would need their Social Security card, their permanent resident card; proof of income, be it a W-2 or a pay stub, so we can calculate their income for the year; and a list of current doctors and medications – because that way we can kind of look to see which plan would work better for you. You can be an informed consumer when you shop for your insurance.”
Additionally, Vaughn said shoppers also need the Social Security number and date of birth for all the people who are carried on your tax return.
“The big factor is the number in the household,” she said.
Vaughn, a community access worker and mental health counselor, focuses on churches in the African-American community to talk about health insurance coverage, because churches are places where people seek help.
“That’s also the place where you find the grandmothers, the aunts and the uncles who can also take the message back to the young group that we’re trying to reach,” she said.
Vaughn said her main message is simple.
“You have to health insurance, and you should have health insurance,” Vaughn said. “I give them the analogy that you insure your phones, you insure your cars, your fur coat, your house, your boat – whatever else you have – why not your health? Because, without your health, you can’t use any of those other things.”
When young adults come in and look at rates, Vaughn said they are surprised at the affordability. For people 18 to 25 who don’t smoke, she said, health insurance may cost “less than a pack of cigarettes.”
Open Enrollment is also the time for individuals and family who already have existing coverage through the Marketplace to a look at plans offered in Missouri for 2018 as some may have changed or are no longer available. If you do nothing you will be automatically placed into a similar plan. However, if you and your family re-enroll automatically without looking at what is available for 2018 and the plan does not have the doctors or other service options you preferred, you are stuck with that for a year.
Penalty for no health insurance
For persons who do not have health insurance coverage through their employer, a government program or the Marketplace, the penalty for not having insurance remains part of the Affordable Care Act. It is $695 per uninsured adult and $347.50 per uninsured child in each household (up to $2,085 for a family) or 2.5 percent of income, whichever amount is greater.
“Per adult means that if you are a head of household, every person that you carry on your tax return has to be insured, otherwise, you’ll get penalized for whatever period of time that person or those people and children are not insured,” Vaughn said.
If you are due an income tax refund, that penalty for not having health insurance comes out at tax time.
Kelley makes the case by saying when you consider paying less than $100 a month for coverage in Missouri versus paying a $695 per adult penalty for not having insurance – you could have health coverage for that same amount of money.
Visit HealthCare.gov, CuidadodeSalud.gov or call 1-800-218-2596 to complete an application and enroll in a 2018 health insurance plan.
Apply for coverage at HealthCare.gov; by telephone at 800-466-3213; with paper applications; or with free, in-person guidance of federally trained and certified assistors or navigators.
The health insurance shopper will be the one making all of the decisions in the health insurance plan purchase. However, an assister can guide shoppers through the enrollment process, along with calculators and other information, at no charge by calling 800-466-3213.
Free marketplace counseling for non-English speakers is available locally from bilingual navigators by calling Bilingual International Assistance Services at 314-645-7800.
The CoverMissouri.org website can also help you find a certified health insurance navigator or assister in your area.
Visit HealthCare.gov, CuidadodeSalud.gov or call 1-800-218-2596 to complete an application and enroll in the Exchange for a 2018 health insurance plan.
