COLUMBIA — With the deadline just days away, many Missourians still have yet to buy a health insurance policy through the Health Insurance Marketplace.
According to a March 11 report from the U.S. Department of Health and Human Services, online marketplace plan enrollment rose 29 percent nationally in February, with a total of about 4.2 million people enrolled nationwide.
Missouri residents need to enroll in an insurance policy by March 31 to avoid penalties enforced and collected by the Internal Revenue Service.
These penalties increase each year. This year, the penalty for a single person is 1 percent of income or a minimum of $95. Next year, the penalty is 2 percent of income or a minimum of $325. In 2016, the penalty rises to 2.5 percent of income or a minimum of $695. The rates will adjust for inflation after 2016.
More information about the Affordable Care Act:
- covermissouri.org — Includes information such as local navigators, new provisions under the law or how to calculate tax credits.
- www.healthcare.gov — There is additional information about the law here, but this is also the website where Missouri residents can enroll for coverage through the online marketplace.
- www.healthcare.gov/what-does-marketplace-health-insurance-cover/ — List of 10 essential health benefits, including the services all health insurance plans will cover.
- kff.org/interactive/subsidy-calculator/ — The Henry J. Kaiser Family Foundation subsidy calculator determines if a consumer is eligible for tax credits on insurance.
Agencies that can help with the enrollment process:
- Family Health Center
1001 W. Worley St.
817-8300, ext. 530
200 N. Keene St., Suite 101
- Coyne Agency Inc.
2100 E. Broadway, Suite 304
Find out how many people need to sign up per minute for the Obama administration to reach its goal of 6 million people enrolled.
But the number of people enrolling is decreasing as the March 31 deadline approaches. Between Feb. 2 and March 1, the marketplace plan added 942,833 people, an 18 percent decrease from the month before, when more than 1.1 million enrolled.
March 31 is the last day to buy some kind of policy without penalty under the Affordable Care Act. For coverage beginning on April 1, Missouri residents need to enroll by March 15. After the deadline, uninsured people will pay fines that increase each year.
Stephene Moore, regional director of Health and Human Services, said there has been a big push in Missouri to get people enrolled and the numbers are up in the state.
According to the March 11 report, about 170,000 Missouri residents who are eligible for a marketplace plan had submitted an application for enrollment. But of those eligible residents, less than half — approximately 74,000 — had completed enrollment by selecting a plan through the marketplace.
Problems with the website when it was launched Oct. 1 and other implementation snags contributed to the enrollment's slow start.
And it always take the public a while to understand a major policy change, Moore said. A Jan. 30 poll by Kaiser Health found that 44 percent of the public still did not understand the Affordable Care Act or how it will impact their families.
Here are some of the most common myths about the law and some clarification:
Myth No. 1: The Affordable Care Act is an insurance company run by the federal government.
The online marketplace is a federal government-operated website where consumers can purchase health care plans through private insurance companies. In Boone County, the insurance policies provided on the marketplace are by Anthem BlueCross BlueShield and Coventry Health Care.
"The marketplace is simply a government website to facilitate and help people find health coverage," Moore said. "Then they make their agreement to purchase health insurance through the individual health insurance company."
There are multiple plans available through the online marketplace. Both Anthem BlueCross BlueShield and Coventry Health Care offer several plans within each bronze, silver or gold category. The gold-level plans, which are more expensive than the others, often have bigger physician networks than silver- or bronze-level plans, so consumers have more choices about where they go for health care.
But the plans, regardless of category, all cover the same 10 essential health benefits, including emergency services and prescription drugs. The biggest difference between the plans, HHS Communications Director Kit Wagar said, is the premium prices and out-of-pocket payments.
"If you choose a bronze-level plan, you have to pay out-of-pocket more than somebody who buys a silver or gold plan," he said.
Myth No. 2: Health care through the online marketplace is free.
The online marketplace is a website where consumers can compare insurance policies — but all have an associated cost to purchase.
"Some people think that this is simply going to be free," Moore said. "But that's not true. There will be a cost associated with it, unless you qualify for the discounts, and then you might see a policy for a low, low cost."
These tax credits, which are discounts on the price of insurance, are determined by a sliding scale based on the poverty level, particularly income and family size. According to The Henry J. Kaiser Family Foundation, an estimated 386,000 Missouri residents were eligible for tax credits as of Nov. 5, 2013.
"If your (a single person's) income is above the poverty level and your income is about $11,500 or more, you can be eligible for a discount on the price of insurance to help you afford it," Moore said.
Wagar said that once an individual earns a yearly income of about $46,000, which is 400 percent of the poverty level, the consumer becomes ineligible for discounts through the marketplace. However, he or she can still compare plans and enroll in health insurance using the website.
The discounts are set by an inverse relationship — as income increases, a consumer receives less aid, and as income decreases, a consumer receives more aid.
Wagar said a single person with no children who earns a yearly income around $26,000 would pay 7.18 percent of his or her income for insurance, which is $155 per month.
But a single person with no children who earns a yearly income just over $20,000 would pay 5.15 percent of his or her income toward insurance, equaling monthly payments of $86.
The Henry J. Kaiser Family Foundation's subsidy calculator determines the amount of tax credits one is eligible for by entering the state of residence, the person's income, ages and family sizes.
Myth No. 3: There is no penalty for not having health insurance.
Although people are not required to purchase insurance, there are penalties, enforced and collected by the Internal Revenue Service during tax season, for not purchasing a policy by March 31. And those penalties grow larger each year.
- This year, the penalty for not being insured is 1 percent of total income or a minimum of $95, whichever is more.
- Next year, the penalty is 2 percent of total income or a minimum of $325.
- In 2016, the penalty rises to 2.5 percent of total income or a minimum of $695.
These costs are for each uninsured person — so, this year, for a family of two, the minimum penalty would be 1 percent of total household income or $190.
After 2016, the rates will adjust for inflation, Wagar said. This means that the minimum values will likely increase in the future, but the income percentages will remain constant.
Myth No. 4: Family practitioners and health centers such as Boone County's Family Health Center do not accept insurance from the Affordable Care Act.
Family Health Center is within both Anthem BlueCross BlueShield and Coventry Health Care's networks. The center is one of two places in Boone County that accepts uninsured and low-income people, the other being MedZou, which is a free clinic run by the MU School of Medicine.
There are several other health centers in Boone County that accept policies from Anthem BlueCross BlueShield and Coventry Health Care.
"The insurers are required by law to have a network of providers that's wide enough to serve their clients," Wagar said. "Most of the (Boone County) hospitals are in those plans."
At Family Health Center, patients are accepted at a discounted rate, outreach and enrollment specialist Aaron Swaney said.
"We can only accept a certain number of uninsured patients every month, so we have a really long wait list," he said.
Family Health Center is a primary care clinic, Swaney said, so it doesn't provide specialized services such as chemotherapy. Instead, they see patients for regular checkups and help get chronic issues under control.
"We serve as a first point of contact," he said.
But one of Family Health Center's main goals is to help people enroll in insurance policies under the law. Swaney and his colleagues work as an outreach team.
"Several people are trained to walk people through applications for insurance and figure out what (a patient's) options are going to be in terms of getting insurance," Swaney said. "Enrollment has been going pretty well."
Myth No. 5: People are required to enroll in health insurance through the online marketplace.
Using the online marketplace to enroll in an insurance policy is not mandatory. People may choose to use companies apart from Anthem BlueCross BlueShield and Coventry Health Care.
But browsing health plans through the online marketplace offers some advantages, Moore said.
"Everything is here, side-by-side with a comparison tool," Wagar said. "Even if you don't qualify for discounts, you still benefit from greater competition."
The only place discounts on health insurance policies are offered, he said, are through the online marketplace.
As long as consumers enroll in a health insurance plan — regardless of whether they used the online marketplace for assistance — they will not face the tax penalty.
Supervising editor is Katherine Reed.