Do your homework

Starting October 1, open-access markets for subsidized coverage under Pres. Barack Obama’s healthcare overhaul may change your health insurance — and not necessarily for the better.
According to the Associated Press (AP), there is a new “wild card” which could affect your coverage — your home address.
This is because of “entrenched political divisions” over the Affordable Health Care Act (aka Obamacare), which has driven most Republican-led states to oppose the law.
“If you’re uninsured in a state that’s opposed, you may not get much help picking the right private health plan for your budget and your family’s needs,” reports AP, with the differences “more glaring if you’re poor and your state  rejected the law’s Medicaid expansion. Unless leaders reverse course, odds are you’ll remain uninsured. That’s because people below the poverty line do not qualify for subsidies to buy coverage in the markets.”
According to Sam Karp of the California HealthCare Foundation (a non-profit which helps states deal with practical problems of implementation), there will be “a new environment where consumers may be victims of geography.”
Karp cites as an example:  “If I’m a low-wage earner in California, I may qualify for Medicaid. With the exact same income in Texas, I may not qualify.”
However, AP says there is a new “bottom line.”
“Health insurance marketplaces in every state will provide options for millions of people who don’t have job-based coverage, who can’t afford their own plan or have a health problem that would get them turned down. The feds will run the markets in states that refused to do so.The coverage won’t be free, even after sliding-scale subsidies keyed to your income,” said AP.
Beginning next year, most Americans will be legally-obligated to either get health coverage or pay fines. Those who are paying for “bare-bones individual plans” will find the new ones too costly.
Younger and healthier Americans might begrudge the government for obligating them to purchase insurance which they think they don’t need.
Still, with Obamacare, the number of uninsured people in the United States is expected to drop significantly.
According to AP, “the combination of subsidized private insurance through the new markets, plus expanded Medicaid in states accepting it, could reduce the number of uninsured by one-fourth or more next year. Current estimates of the uninsured range from around 49 million to well over 50 million.”
Most of those who will not be able to avail of  Obamacare will be undocumented immigrants, since they are not entitled to benefits.
For those who are eligible, AP advises them to do their homework, since getting coverage through the Affordable Health Care Act “might feel like a combination of doing your taxes and making a big purchase that requires research.”
Here is a summary of some of the tips and advice shared by AP:
– You will need an accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that’s right for your needs.
– The process involves federal agencies verifying your identity, citizenship and income, and you have to sign that you are providing truthful information, subject to perjury laws.
– After state health insurance markets open on October 1, consumers can apply online, via a call center, in person or by mail. Trained helpers are supposed to be available, but there may not be enough of them.
– The main steps are:
(1) Identify yourself and your family members.
(2) Provide current information on income, jobs and any available health insurance options.
(3) Learn how much financial assistance you’re entitled to.
(4) Shop for a health plan and enroll.
– Many people, ranging from lower-income workers to the solid middle class, will qualify for tax credits to help buy a private plan through the state markets. The government will send money directly to your insurer, and you’ll make arrangements to pay any remaining premium.
– The poor and near-poor will be steered to Medicaid in states that agree to expand that program.
– For those applying online, AP advises non-citizen legal immigrants to prepare immigration documents. You may also need your most recent tax return, pay stubs and details on other kinds of income (e.g. alimony, pensions and rents). You will also be asked about health insurance coverage through your job and may be required to take it, if available.
–  If you’re like most people, you’ll be getting a tax credit to help pay your premiums. The credits are based on your income and keyed to the premium for a benchmark plan known as the “second-lowest cost silver plan” in your area.With your tax credit, you can finally shop for insurance. Beware: you’ll probably have to live with your decision until the next annual enrollment period.
– There will be four levels of coverage to consider:  bronze, silver, gold and platinum. Plans at every “metal level” cover the same benefits and have a cap of $6,350 a year in out-of-pocket expenses for an individual, $12,700 for families. Bronze plans generally have the lowest premiums, but cover only 60 percent of medical costs on average. Policyholders will pay the difference, up to the annual out of pocket cap. Platinum plans have the highest premiums, but cover 90 percent of costs. Young adults up to age 30 can pick a skinny “catastrophic” plan – but you can’t use your tax credit on a catastrophic plan.
– AP advises to make sure that your doctors and hospitals are in the plan you pick.
– Consumers don’t have to decide on October 1. You have until December 15 to sign up if you want coverage by January 1. And you have until next March 31 if you want to avoid penalties for 2014. Fines start as low as $95 the first year but escalate thereafter.
– Procrastinate beyond March 31, and you’ll have to wait until the next open enrollment period in Oct. 2014, unless you have a life-changing event like job loss, divorce or the birth of a child.
– Three key things to watch for are premiums, choice and the consumer shopping experience.
The whole process may seem complicated and will be probably make your head reel. The key is to be informed and educated at the earliest possible time. It would also be best  to make a checklist of the requirements and to have them readily available, before applying.
It always pays to do your homework.
(AJPress)