CHIPPEWA FALLS, Wis. (WEAU) – Starting Tuesday, the health insurance exchange opens as part of the Affordable Care Act.
The federal government is providing navigators and counselors throughout the nation. Those trained individuals would go to libraries, senior centers and job centers to host group sessions on the marketplace.
But there are also insurance agents that have been studying the health care law for the last three years. Agents say they can help people individually compare plans on and off the exchange and walk them through the sign-up process.
Karen Hebert is a group benefits agent at Spectrum Benefit Solutions in Chippewa Falls. She said among the most important things to remember is the deadline.
“So the deadline for enrolling for the January 1st effective date, which is the first possible effective date, is December 15th. So between October 1st and December15th people, can enroll in the marketplace,” said Hebert.
You also have until March 31st to get health care through “Obamacare” in 2014. If you don’t buy coverage by the end of March, you’ll have to wait until next year to purchase plans.
Once the marketplace and exchange opens up online at Healthcare.gov, agents and brokers can help individual’s one step at a time.
“So we have this conversation about this person’s circumstances and then we would either go in through the marketplace or through individual company’s websites and do electronic enrollments and pick a plan that suits a person best,” said Hebert.
Hebert said insurance agents can advise people instead of just helping them understand how the marketplace works. They can recommend plans and figure out whether people should go on or off of the exchange.
“If somebody came into my office, we'd sit down; we'd have a conversation about their medical history, about what they see going forward, not because that's going to affect their health insurance options anymore. It won't,” said Hebert. She’s referring to a big change where the application process will not examine your health and will not include questions about pre-existing conditions like cancer or diabetes.
Hebert said agents would ask about medical history to understand people’s circumstances and what they are comfortable with purchasing for health coverage.
“How much cash they have available to fund their own claims verses buying insurance, that kind of a situation. Find out about their families, whether or not they're smokers, that kind of story,” she said.
So who should be shopping on the marketplace? Hebert said shoppers fall into two categories: those that are uninsured and those that have private insurance and feel that it’s very expensive. Agents would then ask the question of whether or not they’re eligible for a subsidy.
“The federal government, through the Affordable Care Act, is providing subsidies to families and individuals who have incomes of less than 400 times the federal poverty limit. If somebody isn't eligible for a subsidy or for a small subsidy, they'll want to give very serious consideration for plans that are off of the exchange because there are going to be so many more options,” said Hebert.
She said if somebody is eligible for a very high subsidy, they're probably going to want to give a lot of effort in figuring out which plan they want from the exchange.
As for those who have Medicare, Hebert said they won’t be affected in anyway. However some people are going to lose eligibility on Badgercare and will want to make sure they check out their options in the marketplace or the exchange.
The new plans will be categorized by metals; bronze, silver, gold and platinum. Bronze would be the lowest paying plan and platinum would be the best plan.
You can also use your own computer to enroll. Just log onto Healthcare.gov and live chat option is available if you have questions. There is also a Spanish site at http://www.cuidadodesalud.gov. You can also call 1-800-318-2596 to enroll through telephone or you can call and request paper enrollment as well.
Hospitals like Mayo Clinic Health System also have financial planners on site to help patients with questions on the Affordable Care Act.
In order to enroll, you'll need to know your income to find out costs and whether you qualify for subsidies.
“Bottom line best advice for everyone is to take a deep breath and understand that step by step we'll figure this out,” said Hebert. “Maybe have the expectation that you won’t be able to make your choice in one day or one hour. You might have to come in and learn and then come back and make a decision. So work with somebody that you feel can really communicate, understand and be patient and I think patience all around is good advice.”