HCC Helps Consumers Enroll in ACA Marketplace

The Patient Protection and Affordable Care Act (ACA) Health Insurance Marketplace is once again open for business. Open enrollment runs from November 1, 2016 through January 31, 2017. Missouri operates a Federally-facilitated Marketplace (FFM) at HealthCare.gov. The Marketplace allows individuals and families the option to purchase insurance and potentially receive discounts. Those who qualify can receive tax credits and cost-sharing subsidies to reduce out-of-pocket costs. Individuals who don’t shop on the Marketplace will not be eligible for these tax credits or subsidies. Low income families and individuals with household incomes below 100 percent of the Federal Poverty Level (FPL) will receive an exemption and will not have to purchase insurance. However, individuals and families at or above 100 percent FPL who don’t purchase insurance may be penalized.

Help for Consumers

  • Consumers may shop for plans, enroll or re-enroll in a plan at HealthCare.gov. Remember: Plans for 2016 will end December 31, 2016. Consumers have until December 15, 2016 to purchase insurance for an effective date of January 1, 2017.

  • Free, in-person assistance is available to help consumers navigate the Marketplace. This includes help with changing insurers, plan options and finances. Certified assisters will also help consumers re-enroll for 2017.

  • CoverMissouri.org provides a Find Local Help tool and call center at 1.800.466.3213.

Spanish consumers may call 1.855.284.3236. The site also provides a Plan Comparison Tool, as well as many resources to educate consumers about ACA.

Help Close to Home
For those looking for local support, contact Iva Eggert at 1.877.344.3572. She serves as the Marketplace coordinator for Lexington, Mo.- based Health Care Collaborative (HCC) of Rural Missouri. Additionally, enrollment support for Medicare and Medicaid is available for those who qualify.

Marketplace Essential Health Benefits
As for Missouri, Health and Human Services (HHS) reports that last year 290,201 individuals purchased plans through the Marketplace, which covers the following essential health benefits: preventive care, lab tests, prescription drug coverage, care for pregnant women and babies, health, dental and vision care for children, inpatient and outpatient care, emergency room (ER) visits, mental health and substance (alcohol or other drugs) use, and daily living support (for people with disabilities or long-term health issues).

There are four “metal” categories for Marketplace health insurance plans: Bronze, Silver, Gold and Platinum. These categories show the degree in which consumers and insurers share costs. According to HealthCare.gov, plan categories have nothing to do with quality of care.

Consumers will pay a monthly premium (bill) to their insurance company. Because out-ofpocket costs may still be required, including a deductible, it is important to think about both kinds of costs when shopping for a plan. Some plan types allow use of any doctor or health care facility. Other plans limit choices or charge if providers are used outside of the network.

Impending Rate Hikes
Although the ACA contains key provisions to improve health care like prohibiting individuals from being denied insurance due to pre-existing conditions, allowing young adults to remain on their parent’s insurance plan until age 26 – among other provisions – premiums are slated to increase.

Missouri will see, on average, a 25 percent premium increase. However, premium tax credit discounts continue to hold down the cost of premiums for most people who shop the Marketplace. Last year, almost 90 percent of Missourians who enrolled in a Marketplace plan qualified for premium tax credits. According to CoverMissouri.org, even more people will qualify in 2017. Consumers are advised to be “careful” shoppers and be willing to change insurers to find the most affordable plan.

Don’t Forget to Prepare for the 2016 Tax Season (April 15, 2017)
To avoid paying a penalty, consumers will need to provide proof of insurance. Health insurance tax forms report the type of insurance covered through an insured’s policy. Along with the tax return, these forms are used to verify that the policy holder and their dependents had at least minimum essential health coverage during 2016.

IRS Form 1095-A is also known as the Health Insurance Marketplace Statement, and is filed by the Marketplace. This form is for consumers who have purchased insurance through HealthCare.gov. As for consumers who received tax credits, the form helps them reconcile the tax credits received and file an accurate return. The forms can be downloaded from the consumer’s Marketplace account at HealthCare.gov (or could be sent by mail) and is expected to be available after February 2017. Individuals who do not file a tax return will not be eligible for tax credits during the 2018 enrollment period. According to the IRS, consumers expecting a 1095-A form should wait until they receive the form before filing taxes.

IRS Form 1095-B and 1095-C are filed by the insurer or the employer. Consumers can expect to receive these forms by March 31, 2017. According to the IRS, taxpayers may go ahead and file their taxes even if they do not receive the form.

About the Penalty…
For tax year 2016, the penalty will be 2.5 percent of total household adjusted income or $695 per adult and $347.50 per child – or a maximum of $2,085 per household. People without insurance who do not qualify for a waiver may be assessed this penalty.

To learn more about Marketplace enrollment assistance, contact Marketplace Coordinator Iva Eggert at 1.877.344.3572, or visit HCCNetwork.org/aca.

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