The six-week window to sign up for health insurance coverage is now open. From November 1 until December 15, the federal healthcare Marketplace is open to sign up for health insurance coverage at healthcare.gov.
“I think it’s super important to keep and then maintain health insurance,” said Tim Williams, manager of the St. Louis hub of Cover Missouri, “because it is a way to get access to our health care system and, even more specifically, to get really good access to great preventative care.”
Cover Missouri is a coalition of certified application counselors that work across the St. Louis area to answer questions and provide free, one-on-one assistance to whoever needs or wants assistance in making an application on healthcare.gov.
Preventative care for adults and children includes disease screenings, vaccines, behavioral and other health assessments by providers in your selected health plan’s network.
Although the mandate for health coverage and penalty have been removed as a way to systematically dismantle the Patient Protection and Affordable Care Act, those who qualify on the Marketplace get health insurance options with tax credits and cost-sharing to help pay their monthly premiums.
“The vast majority of people who do enroll in health insurance through the online Marketplace qualify for a lot of tax subsidies in the form of tax credits that are applied to their premiums as well as cost-sharing reductions that help lower their out-of-pocket costs … sometimes to zero,” Williams said.
He added that those short-term health plans offered on the commercial market don’t cover as much and do not provide cost savings for consumers.
The Marketplace is the only place that you can get this financial assistance, he said, as well as consumer protections for those with preexisting conditions and “that full comprehensive coverage in the form of those ten essential health benefits that are required under the Affordable Care Act.”
Healthcare.gov describes 10 categories of services or benefits that health insurance plans must cover under the Affordable Care Act to include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Plans are required to offer dental coverage for children; however, dental benefits for adults are optional. The plans offer different levels and types of covered health services.
Most who sign up for Marketplace health insurance coverage in Missouri qualify for lowered monthly premiums, according to Cover Missouri.
“The vast majority of people that do come on to the Marketplace qualify,” Williams said. He said the majority of people whose income falls outside of being eligible for financial assistance make over 400 percent of the federal poverty line. The 2018 poverty guidelines at 400 percent are $48,560 for an individual; $100,400 for a family of four; and $134,960 for a family of six.
Those who are under 100 percent of the poverty guidelines don’t qualify for assistance either. Williams said they fall into the Medicaid gap.Because Missouri hasn’t expanded Medicaid to receive federal funds to cover families with incomes below 100 percent of the federal poverty guideline, Williams said, Cover Missouri connects them to other safety net programs, like Gateway to Better Health program. The 2018 poverty income guideline at 100 percent would be $12,140 for an individual; $25,100 for a family of four; and $33,740 for a family of six.
The Centers for Medicare and Medicaid Services and the U.S. Treasury recently issued a new guidance called State Relief and Empowerment Waivers, which grants states more flexibility to design alternatives to the Affordable Care Act. Health and Human Services Secretary Alex Azar said, “Now, states will have a clearer sense of how they can take the lead on making available more insurance options, within the bounds of the Affordable Care Act, that are fiscally sustainable, private sector-driven, and consumer-friendly.” This new “flexibility” allows for more coverage options, including short-term plans. But just how this will be used by Missouri and other states remains to be seen.
Williams said, “Pay attention when you are shopping for those short-term plans that they may not always offer the most comprehensive coverage and will not always offer all of the consumer protections that are offered to the plans on the Marketplace.”
Indeed, many short-term health plans are derided as “junk plans” by health care advocates.
When completing a health insurance application, Williams said, consumers should have handy the birthday and Social Security numbers of everyone that is applying and an estimate of what their pre-tax household income will be in 2019.
“Sometimes it’s recommended to bring recent pay stubs or, if you are self-employed, a self-employment ledger,” he said, “so that we can work together to develop an estimate for your 2019.”
For more information or to find a Cover Missouri assister in your area, visit covermissouri.org or call 1-800-466-3213 for English or 1-855-284-3236 for Spanish.
