An Urban League navigator helps PCC student sign up for healthcare through the Affordable Care Act in 2013. Photo by Helen Silvis
Pacific Northwest the time is now for a healthier, more secure you, literally.
Nov. 15, marks year two of the Affordable Care Act's open enrollment season ensuring every U.S. citizen has healthcare coverage.
So who does this four month open enrollment period, ending Feb.15, 2015, apply to? If your employer already offers health insurance or you were one of the more than 240,000 Oregonians or 450,000 Washingtonians who enrolled for coverage last go-around, you should be good.
If you’re happy with the coverage you’re receiving now, your dependants can also stay on your plan until age 26. Lastly, businesses with up to 50 employees can apply for plans year-round.
Medicare is not a part of the health insurance marketplace established by the ACA so you don't have to replace your coverage with something new, and you'll still have the same benefits and security you have now. In fact, the law has expanded the cost of preventative services and may reduce the price of name-brand drugs and offer increased doctor support for those on Medicare.
As for Medicaid, both Oregon and Washington opted to adopt the provision of the ACA expanding the programs benefits to low-income adults.
The rule of thumb is that if your family income is less than four times the federal poverty guideline and you're not eligible for employer or public assisted healthcare (i.e. Medicare or Medicaid) you'll be eligible for premium subsidies to help you purchase coverage.
If you're one of the hundreds of thousands of Pacific Northwesters who remain uninsured, here are the basics of what you need to know.
Last enrollment, Oregon was exclusively a state-based marketplace and it performed dismally.
In, April, the Cover Oregon board voted to switch from an exclusively state-based marketplace, to a hybrid that includes the federal government. Note that customers who enrolled in a 2014 private plan through Cover Oregon, as well as anyone else who would like private coverage to begin Jan. 1, 2015, need to enroll in a 2015 planbyDec. 15, 2014.
That switch means, come Nov. 15, instead of heading to the Cover Oregon site, Oregonians should head to the federal government run interface Healthcare.gov to shop for the plan that best fits their lifestyle.
“Oregon is moving to a better way to enroll in health insurance,” says Cover Oregon spokesperson Ariane Holm. “It will be easier because people will be able to enroll in one sitting.
“Based on what our federal partners atHealthCare.govhave shared with us, they are making good progress to ensure they’re ready for a successful second open enrollment.”
Holm reminds that the site has been up year round processing special enrollment periods and changes in circumstances. She also notes those eligible for Oregon Health Plan can sign up for coverage any time throughout the year.
Though Healthcare.gov made national headlines for months, due to its own glitches and limited functionality initially, the site is now reported working properly with President Obama affirming that the site "works great now," back in May this year.
Washington Health Benefit Exchange (Wahexchange.gov) will continue to be the official site for consumers in Washington State to shop and compare plans. Unlike Oregon, this marketplace performed extremely well from the beginning, and on the whole the Evergreen State's state-based exchange has served as a national model of how to successfully utilize the open enrollment period. Note, 46 plans are available in Washington exchange while Oregon holds a notably 11 to shop and compare.
Many will be seeking out help with this enrollment period, and there are people designated to help you; they're called 'navigators.' Trained and certified specifically to assist people through the enrollment process, navigators come at absolutely no cost to consumers.
In October it was announced that Health and Human Services would be awarding $60 million in navigator grant monies to 90 organizations in states with federally and state-based marketplaces.
Washington utilized its navigators extremely well, staging events in public places like libraries and shopping malls, and hosting various informational and enrollment sessions targeted at specific ethnic groups, especially in King County the state’s most populated region.
In Oregon just over 20 groups have been tapped as navigators including but not limited to Urban League of Portland, NAACP, Self Enhancement Inc., and Native American Youth Association.
Self Enhancement Inc., president Tony Hopson Sr. says the success of the ACA will depend on education, outreach, and accessibility.
“The right people and agencies need to be involved in all three areas to make sure all families are engaged in the process.”
Michael Alexander head of Urban League of Portland, says his staff has been in intensive trainings learning the ins and outs of the state’s new exchange so as to be of optimal help to the community.
“We walk people through [the process of getting coverage], not only sending them information that only ‘demystifies’ it. It’s a very hands on approach,” he says.
Those who don't get insured this open enrollment session will more than likely receive a penalty fine, calculated as 2 percent of your yearly income or $325 per person for the year; whichever is highest. In fact, the fine raises every year; by 2016 it will be almost $700 or 2.5 percent of a family income.
Coupled with the fact the reality of a rising penalty fee, and that open enrollment sessions will continually get shorter (the first one was 6 months, compared to the four for the upcoming session) it's all the more important that Americans get insured.
The deadline to get health insurance this open enrollment period is Feb.15. For more information on designated navigators in your area Oregonians should visit CoverOregon.com and Healthcare.gov while Washingtonians should just head to www.wahealthplanfinder.orgwww.wahealthplanfinder.org.