Shutdown doesn’t deter Affordable Care Act

It’s a crazy time as Americans shop for health care insurance

By FINN M. BULLERS

Scanning the Infosphere after a crazy day on Capitol Hill to seek some health care clarity, I came away with a few thoughts on the first day of shopping for federally subsidized health care plans.

1. It’s smart to start shopping now, but wait awhile to push the “buy” button. There are still details to be worked out and information to be gathered.

2. Residents of states that opted out of the federal health exchange will have a more difficult time gathering information, but if they are persistent they can find it.

3. The devil is in the details. What results in lower health care costs for  one family on the neighborhood cul de sac may result in higher costs for another.

Let’s scan the Internet for perspective, guidance and maybe even a few gold nuggets of information to make our shopping less painful.

THE SHUTDOWN: A CNN poll just released pointed to a congressional approval rating so awful, it was tempting to think there was a typo. The national survey found that only 10 percent of Americans approve of Congress, while a stunning 87 percent disapprove.

Since the dawn of modern polling, the legislative branch of government has never been this unpopular. Worse, this poll was taken before Republicans shut down the government.

POLITICO POLL: Most Americans will get health insurance. Asked whether they plan to get insurance when the requirement takes effect or pay the fine for not doing so, 65 percent of uninsured Americans said they would get health insurance, according to a Gallup poll out Monday.

Twenty-five percent said they would pay the fine. Gallup also asked about whether those individuals planned to use the exchange markets that launch Tuesday to buy their insurance. Almost half, 48 percent, said they planned to use the exchanges, 36 said they did not and 17 percent weren’t sure.

ASSOCIATED PRESS: Consumers will need personal details, financial info, basic insurance knowledge to get covered. Getting covered under President Barack Obama’s health care law might take you more than one sitting. In a media preview, it felt like a cross between doing your taxes and making an important purchase that requires research.  “Nothing like this has ever existed before,” said Health and Human Services Secretary Kathleen Sebelius.

THE WASHINGTON POST: White House shows off web site to buy health insurance. The Obama administration on Monday showed off the federal Web site — Healthcare.gov — promising it will be open for business despite congressional battling and widespread reports of computer problems.

People seeking to buy health insurance on the federal marketplace will be able to enter personal information, including their incomes and Social Security numbers; learn how much government assistance they might qualify for, if any; search for plans by price and coverage level; and then purchase a plan directly from the insurance company.

ASSOCIATED PRESS: Health insurance marketplace success far from assured. Millions of Americans can shop for the first time on the insurance marketplaces that are at the heart of President Barack Obama’s health care reforms, entering a world that is supposed to simplify the mysteries of health coverage but could end up making it even more confusing.

KAISER HEALTH NEWS | SHOP EARLY, BUY LATE:  In recent months, all eyes have been focused on today, the day health insurance marketplaces open for business. While Oct. 1 is a milestone in the implementation of the health law, other dates are likely more critical for consumers planning to shop for health insurance on their state marketplaces

Experts say they expect few consumers to enroll in a plan right away in October—and that may be wise. They advise that it’s a good idea to start looking at the options early and to give yourself plenty of time for the application process. “Expect glitches” has become the catchphrase for officials who are working on implementation of the marketplaces, as well as politicians of every stripe, including President Barack Obama.

That’s not all. Health insurance is a complicated product. Understanding how the plans work and picking one that suits someone’s needs will take time, perhaps several visits to the marketplace website or conversations with those trained to help with enrollment.

“I think it’s going to be a pretty thoughtful process for most people to make a decision,” says Mila Kofman, executive director of the DC Health Benefit Exchange Authority.

The open enrollment period for 2014 marketplace coverage runs through March. The uninsured and people who don’t get insurance through work and purchase their own policies on the individual market will make up the bulk of the 7 million people expected to buy coverage on the marketplaces, also called exchanges.

The health law’s mandate that most people have coverage goes into effect Jan. 1. But consumers can’t wait until New Year’s Eve to meet that deadline.

In general, consumers who want insurance to begin on the first day of any month have to enroll by the 15th day of the previous month. So someone who wants coverage to start on Jan. 1 should buy a plan by Dec. 15. If someone signed up from Dec. 16 to 31, coverage would begin Feb. 1 at the earliest.

Experts say they expect a rush of activity around Dec. 15 before the Jan. 1 coverage requirements kick in and again in mid-March before the open enrollment period ends.

Second Thoughts Are OK

If people sign up for a plan but then decide during the annual enrollment period that they want to switch, they can do so as long as their policy hasn’t yet become effective, according to the Department of Health and Human Services.

If someone signs up in November for a plan that starts Jan. 1, for example, she could switch to another plan until Dec. 31. If she waited until after Dec. 15 to make a change, however, the new coverage wouldn’t begin until Feb. 1 and she would be without coverage in January.

Once a consumer’s plan actually becomes effective, in general no changes may be made until the following open enrollment period. Next year that will be between Oct. 15 and Dec. 7. There are exceptions if someone experiences a significant change in life circumstances, such as a birth, divorce, job loss or permanent relocation.

Three-Month Reprieve

Although the law requires most people to have insurance starting in January, people are allowed to be uninsured for a three-month period once a year without penalty.

The latest date that someone could generally buy a plan and avoid facing a penalty for being uninsured next year would be March 15 for coverage that starts on April 1, three months after the coverage requirement kicks in, says Carrie McLean, director of customer care for ehealthinsurance.com, an online vendor that has received approval from the federal government to sell exchange plans on its site.

Federal officials estimate that most people who enroll in an exchange plan will be eligible for subsidies to help cover the cost of premiums. These subsidies, which will come in the form of tax credits, will be available to people with incomes up to 400 percent of the federal poverty level ($45,960 for an individual or $94,200 for a family of four in 2013).

To help determine eligibility for subsidies or health insurance programs for people with lower incomes, such as Medicaid and CHIP, consumers will need income information such as pay stubs available for everyone who is seeking coverage.

Subsidies will be based on an estimate of income for the coming year. If a consumer expects a bonus or raise, it’s important to factor that in, say experts. Otherwise, consumers may receive a bigger premium tax credit than they’re entitled to and have to repay it in their 2014 taxes when the IRS reconciles their actual income with the amount they projected.

“If you anticipate an increase in income over the course of the year, people can choose not to take the full tax credit up front,” says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.) “They may be better off paying a little more up front [themselves] toward the premium, so they’re at lower risk of having to repay at the end of the year.”

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