The Duncan Banner

Local News

October 25, 2013

Affordable Care Act impacts world of health insurance

DUNCAN — As of Jan. 1, 2014, much will change in the health insurance world. The Affordable Care Act, which was signed in 2010, will take full effect after the new year. The window to apply to get insurance in the ACA Marketplace is from now until March 31, 2014.

“I encourage people to apply to enroll now,” said Tanya Case, executive director for the Oklahoma Temporary High Risk Pool, who proved two seminars detailing how to enroll in the Marketplace Thursday at the Duncan Public Library.

“If they want to already be covered on Jan. 1, they need to be enrolled by Dec. 15 and have paid their first month’s premium.”

Beginning next year, those with pre-existing conditions cannot legally be turned down for health insurance, nor can women be charged a higher premium than men. Already, the law prevents insurance companies from applying lifetime maximums to insurance policies.

Within the Marketplace, there are five different plans. The catastrophic plan is for people under 30, or those over 30 with a hardship exemption. It only covers three primary visits per year and free preventative health benefits.

Bronze covers 60 percent of the total average costs of care; the silver 70 percent; the gold 80 percent and the platinum 90 percent.

“When choosing a plan, it’s important to know how often you visit the hospital,” said Case. “You also want to look at what medications are covered and if your doctors, hospital and other providers are in that plan’s network.”

For some families and individuals, they may qualify for financial assistance for health insurance within the Marketplace through tax credits based on income. Case suggests only going through the Marketplace for health insurance if you qualify for this assistance.

Individuals who make up to $46,000 and families of four who make up to $94,000 will qualify. The best way to find out if you qualify is to call the Marketplace toll-free number at 1-800-318-2596. While there is a website to enroll, it is experiencing technical difficulties, therefore, it is best to call.

There are five companies that are providing Marketplace plans in Oklahoma: Aetna, Blue Cross Blue Shield of Oklahoma, Community Care, Coventry and Global Health. However, only Blue Cross Blue Shield of Oklahoma and Coventry cover Stephens County.

Case said it is best to call each company to find out what their premiums and networks are for each Marketplace plan in order choose the company and plan is best for you.

“I’ve called all the companies myself and they usually answer promptly and are helpful,” she said.

Once you have chosen your company and plan, call the Marketplace toll-free number to enroll. The phone is usually answered within 90 seconds and it takes an average of 30 minutes to enroll.

If you need help with choosing a plan or enrolling, there are at least three places in Duncan with people willing to help. They are Peters Agency Care Management, Duncan Regional Hospital and Legal Aid.

Case did suggest if you know your own health care insurance agent, to visit with them if you’re needing advice. In addition, she advised if you are certain your income is too high to qualify you for assistance with your premium payment, you can buy coverage directly from a health insurance company, either on your own or with the assistance of an insurance agent, without applying through the Marketplace.

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