By Jeanne Starmack
Anyone who still intends to sign up for insurance through the Affordable Care Act had better hurry.
Today is the last day to apply on healthcare.gov, where people who are uninsured can choose a company with a plan that suits them. The next open enrollment is Nov. 15 to Feb. 15, 2015.
With some exceptions, everyone must have insurance or pay a tax penalty. The penalty cap is $285 for the first year, but will go up substantially, said Charlene Allen, a “navigator” who helps people sort through the application process on the insurance Marketplace.
She was working nonstop up to the deadline at sign-up sites and at private appointments in her office.
Allen works for Access Health Mahoning Valley, a nonprofit agency in Warren, which paid for her training and services through a grant. She began working in November, and another navigator was hired in December. Together, they have counseled 500 people and taken 1,000 phone calls, she said Friday.
More than 5 million Americans, including 106,000 Ohioans, have obtained private insurance through the federal and state marketplaces. However, many Ohioans still remain eligible for insurance, according to information from the office of U.S. Sen. Sherrod Brown, D-Ohio.
Most people Allen has helped are eligible for Medicaid, she said. Ohio expanded its Medicaid qualification to include more low-income people after the U.S. Supreme Court ruled that each state could decide for itself whether to do that. The ACA originally included expansion for the whole country.
Other people are able to qualify for government subsidies.
Consumers earning less than 400 percent of the federal poverty level (about $46,000 for a single person or $94,000 for a family of four) may be eligible for a government subsidy to help them buy coverage, according to the website www.ehealthinsurance.com. Whether they get a subsidy and the amount of that subsidy depend on the cost of coverage in their area.
“Some people will fall through the cracks,” Allen said, because they make too much money for Medicaid but still don’t qualify for subsidies.
One person Allen dealt with was in that situation, and she advised him to appeal at healthcare.gov.
Of everyone she’s advised, four people “fell through the cracks,” she said. Of those, two people simply decided they couldn’t afford the premiums and opted to pay the penalties.
Allen also has tried to counsel people who were lured by the idea of a cheap plan.
“I had one woman paying $8.55 a month,” she said. “I make sure that people understand — with the cheaper plans, you have higher deductibles.”
She also cautions that people who’ve signed up for a plan won’t be covered until they make a premium payment.
“A lot of insurance companies are extending the deadline for people who are already in the system,” she said.
Allen has even acted as a mediator.
“A young man picked his plan and sent in his premium,” she recalled. “And he never heard from [the company], and he never got his card. His check wasn’t cashed.”
“I finally got a live person on the phone,” she continued. “We got it ironed out. We found out he had a post-office box number and they wouldn’t accept that.”
That was March 7, she said. The man called her last week to say he still doesn’t have his card.
In spite of some problems, Allen said, the average Medicaid application takes about 15 minutes and the average Marketplace application takes an hour.
“It is not as involved or as difficult as people make it out to be,” she said.