By Teresa McUsic
Tools for Understanding Health Exchanges
- Healthcare.gov or CuidadoDeSalud.gov.
- National toll-free call center at 800-318-2596 or 855-889-4325 (for hearing impaired) for phone assistance.
- Consumers with questions or who have special needs, (such as disabilities, literacy and language challenges) or transportation and mobility needs, may call 817-258-8188 to reach a navigator who will help explain your options, or email: email@example.com.
- Online tax credit calculators. Available for free on The Henry J. Kaiser Family Foundationís website. . After answering a few basic questions about their household, consumers can find out if they qualify for a government healthcare subsidy. Families that earn up to 400 percent of the federal poverty level, which was $94,200 for a family of four in 2013, may qualify for subsidies. Other calculators are offered by TurboTax at and Liberty Tax Service.
The health insurance marketplace is now open for millions in the state—and 341,149 people in Tarrant County.
The online exchange offering a variety of health insurance plans, giving people either uninsured or with their own private plan their first glance at what health insurance premiums will cost them next year, what subsidized they may qualify for to help pay for it or what taxes they will pay if they don’t get health insurance.
Overall, Americans are fairly clueless in understanding the process. Polls state that most have yet to grasp the basics of healthcare reform, said Stacey Pogue, senior policy analyst for the Center for Public Policy Priorities (CPPP) in Austin.
The first thing to know is that people already signed up for Medicare or Medicaid will continue the coverage they have and will not use the new online marketplace or exchange at all, she said. The same is true for most people who have health insurance through their companies.
“You can jump that firewall if your company’s insurance isn’t affordable or adequate,” she said. “So if just the employee’s coverage costs more than 9.5 percent of his household income, they can use the marketplace. Or if the job has skimpy benefits that are not at least at the bronze level of the marketplace, they can go to the exchange.”
Anybody can go on the exchange and purchase insurance, she said, but it is designed for those who have private insurance for their families or who have no insurance at all.
While October 1 was the first day of the federal marketplace, consumers have until March 31, 2014, to purchase coverage on the exchange during its first open enrollment period, Pogue said. To get a policy that is effective Jan. 1, 2014—the first date for any policy from the exchange—you must purchase by Dec. 15, she said.
The Kaiser Family Foundation has an easy calculator where you can see how the exchange would play out based on your family size and income level. You do not have to enter any personal identification to use the free calculator.
The calculator will then give you an estimate of your annual insurance premium and how much of a tax credit you may qualify for.
For example, a family of four with an annual income of $65,000 would have an annual premium of $9,869 of which they would pay $5,723 out of their own pockets and receive a tax credit of $4,146 for the remaining cost of the plan. The tax credit would cover 46 percent of the total cost of this plan, which is in the “silver” category. Plans on the exchange come in bronze, silver and gold, all with different annual premiums amounts depending on how much cost-sharing the consumer wants to do.
There are two tax consequences for those who qualify for buying insurance on the exchanges: credits for many who buy and penalties for all who don’t.
Turbotax has a new healthcare calculator that will tell you how much you may qualify for in credits, but also will tell you how much you will pay in extra taxes if you choose not to have health insurance.
The Turbotax calculator asks your age, state, annual income and number of kids, then gives an estimate of how much you will pay in insurance premiums, how much of a tax credit you could get to pay for those premiums and how much a penalty you will pay if you stay uninured.
For the family of four described before, Turbotax says that family will pay an extra tax of $450 for the first year that they continue to remain uninsured. By law, that number will increase over the years.
Pogue said that those who qualify to receive the tax credit can either get it in a lump sum when filing for their taxes—like most other tax credits—or can turn the credit directly over to their insurer when they sign up for a policy and receive lower monthly premiums beginning with their first month on the policy.
For those with questions or who are unable to use the online exchange, there will be help in the form of “navigators.” There is already a network in place at hospitals and clinics of benefit counselors for Medicare and Medicaid and most of them have been trained to work with the new healthcare marketplace as well, Pogue said.
In addition other nonprofits, including United Way of Tarrant County, have received grants to hire and train additional navigators.
United Way will have six full-time navigators for Tarrant County, said Tim McKinney, president and CEO of the local agency.
“Navigators we be available for face-to-face assistance at enrollment events throughout Tarrant County and also via appointments,” he said.
Individuals can also call a national toll-free call center for assistance, (800-318-2596), he said. United Way has also set up a special phone line for those with disabilities, or issues with language or literacy, (817-258-8188), he said, as well as an email for submitting questions (firstname.lastname@example.org.)
McKinney said navigators are required to complete 20 hours of online training provided by the U.S. Department of Health and Human Services.
“The training includes 14 courses, and navigators must pass all 12 exams to be certified,” he said. “Navigators also complete additional training required by the Texas Department of Insurance. And, United Way of Tarrant County is requiring additional training hours related to the Health Insurance Portability and Accountability Act (HIPAA) and consumer confidentiality.”
Consumer questions to the navigators is free.