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State's health insurance exchange opens Oct. 1 | The Affordable Care Act
By SHARON SALYER
Starting this week, about 25,000 people in Kitsap County who don't have health insurance can sign up for it, part of the federal Patient Protection and Affordable Care Act, commonly known as Obamacare.
According to Kitsap Public Health District, 24,874 adults and 2,400 children in Kitsap County currently don’t have health insurance.
Consumers can begin shopping for health insurance online Tuesday. Signups continue through year's end for coverage that begins on Jan. 1.
"For the first time, people will be able to buy health insurance regardless of their health condition. No one will be denied health insurance," said Stephanie Marquis, a spokeswoman for the state Insurance Commissioner's Office.
Until now, most people who bought their own health insurance were buying catastrophic coverage to protect themselves from medical bankruptcy, hoping they didn't have an accident or a cancer diagnosis, she said.
The Kitsap Public Health District and several community agency partners will have certified assisters to help you sign up beginning Oct. 1. On your own or with an assister, you can buy a health insurance plan online at www.wahealthplanfinder.org, the website of the Washington Health Benefit Exchange. When you sign up, you will be asked for your Social Security number, address, phone number, and estimated household income.
To talk to an assister:
— Call the health district, 360-337-5235, Monday through Friday, 8 a.m. to 4 p.m., or ...
— Call the Washington Healthplanfinder Call Center, 1-855-WAFINDER (1-855-923-4633) or at TTY/TTD 1-855-627-9604, Monday through Friday, 7:30 a.m. to 8 p.m.
It's part of a historic effort to provide health insurance to people who haven't had it for any number of reasons: students who have turned 26 and can no longer be included on their parents' health plan; people who are working but whose employers don't provide health insurance; or people who have been laid off or are unemployed.
And then there's the group sometimes being called "young invincible" — those who think they're young and healthy and don't need it, or who think they can't afford it.
At www.wahealthplanfinder.org, people can compare the costs and benefits of health insurance plans. Depending on which plan is picked, insurance will cover between 60 percent and 80 percent of medical costs. The rule of thumb is: the more health care expenses a plan pays for, the more it will cost in monthly premiums.
There's another factor in how much consumers will pay: household income. Single adults with annual incomes up to $15,856 will be covered through an expansion to Medicaid, the federal-state health care program, called Apple Health. A family of three can make $26,952 yearly and qualify for Medicaid.
"Over the first couple of years, we expect about 250,000 adults to qualify for health care under the expanded Medicaid rules," said Jim Stevenson, spokesman for the state's Health Care Authority, which oversees the program.
"This is a major step," he said. In the past, there was never a way for adults without children to qualify for Medicaid coverage. The program initially was designed to provide health care for low-income children, seniors and people with disabilities, Stevenson said.
Those who don't meet low-income guidelines can still qualify for tax subsidies to help pay for insurance. It's estimated that 477,000 people in Washington will qualify for this type of financial help to pay for health insurance.
For example, a 27-year-old making $25,000 a year would pay $144 a month for insurance with good, but not the most comprehensive and expensive, medical coverage. This cost includes a monthly federal tax credit of $98.
A single adult can earn up to $45,960 and get help paying for insurance. A family of four can make up to $94,200 and get a tax subsidy.
People who don't have health insurance next year will pay a $95 tax penalty per adult and $47.50 per child for a maximum of $285 per family. Those rates increase in 2015 and 2016.
The sign-up process for buying insurance through the state's exchange is online only. Consumers can also buy individual insurance plans directly from companies, but they won't qualify for tax subsidies.
Applicants need to have or need to sign up for an email account. People can expect to spend about an hour signing up for health insurance. Individuals and families signing up for health insurance and paying monthly premium costs will need to prepay the first month's bill with a debit or credit card when they enroll.
Medicaid patients do not pay monthly premiums.
It's complicated, but help is available. Although people can sign up themselves, "it's free assistance; that's really key," said Wendy Nelson, who is helping coordinate the in-person assistant program in Snohomish County.
Some scammers are trying to take advantage of consumers by charging $50 or $75 to help them, she said.
The state also has a toll-free hotline, with a staff of 80 people, to help consumers sign up or answer questions. The hotline — 1-855-923-4633 — is open 7:30 a.m. to 8 p.m. Monday through Friday.
"We want to make sure people know that they're not alone," Nelson said.
WHERE TO GET INFORMATION
— A toll-free hotline for information on buying individual health insurance plans in Washington is available at 1-855-923-4633.
— A map listing the organizations and addresses for help and information is available at www.wahealthplanfinder.org/map.php.
Oct. 1: Consumers can begin comparison shopping and signing up online for individual health insurance plans.
Jan. 1, 2014: Insurance coverage begins for those who have signed up.
March 31, 2014: The deadline to sign up for individual health insurance plans for 2014.
For a chart to help you compare insurance plans, go to http://tinyurl.com/healthplanchart.
Starting Jan. 1, no adult can be denied health insurance because of a medical problem, sometimes called a pre-existing condition. The rule already is in place for children.
All health insurance bought by individuals and small employer health plans that go into effect on Jan. 1 must include coverage for the following:
— Outpatient services
— Emergency services
— Maternity and newborn care
— Mental health and substance abuse disorders
— Prescription drugs
— Rehabilitative services, such as physical therapy, speech therapy and occupational therapy
— Laboratory services
— Preventive and wellness services and chronic disease management
— Pediatric services, including oral and vision care
Sources: Washington State Insurance Commissioner's Office and Washington Health Benefit Exchange
— Sharon Salyer is a staff writer for the Everett Herald. 425-339-3486 or firstname.lastname@example.org