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Have the courage to learn

Register • Nov 6, 2013 at 11:50 AM

Take the fear out of the Affordable Care Act


My friend and colleague, the Rev. Herman Robinson says it best: “We have to help others to have the courage to learn about the Affordable Care Act (ACA)/ (“Obamacare”); otherwise, they will be overcome by fear and lack of understanding.” His point was that those who stand to be helped by the Affordable Care Act are likely to not opt for the health care insurance because they didn’t know better.

Whether you are for ACA/ Obamacare — or against it — isn’t what matters.

What matters is your level of understanding of it as it affects you. I’m the farthest thing from being an authority on the matter, but I did have the good fortune of hearing Josh Mesenburg, senior account executive with United Insurance Services, speak on two occasions about the ACA and how it works. I’ve also invested time reading and using the Healthcare.gov website.

Space limitations cause me to be brief.

Therefore, what I am about to share is not all-encompassing, it is simply some “nuts and bolts” information I hope will motivate you to find the courage to develop your working knowledge about the ACA as it pertains to you and your household. Then you will have a basis for opinion.

• Because of the ACA, your insurance company can no longer deny coverage of a pre-existing condition; nor can it jack up the price of the policy because of the existing illness/condition.

• If you do not have health insurance and you do not take advantage of the ACA, you will be fined $95 or 1 percent of your household income for 2014. That penalty fee increases in 2015 and again in 2016.

• Learn if you/your household is: A) earning between one and four times the federal poverty level; and B) if you have to pay more than 9.5 percent of your household income for your own coverage through the insurance offered by your employer. If the answer is yes to both, you do qualify for a subsidy (aka financial assistance) to buy insurance through the health exchange. (familiesusa.org)

• The Henry J. Kaiser Family Foundation has a calculator on its website. If you answer the questions, it can calculate what you would pay if you were to buy health insurance through the health exchange. The calculator is available at kff.org/interactive/subsidy-calculator/. Even if you don’t need health insurance, I encourage you to use the calculator, just so you can be better informed about the ACA subsidies and how they work.

• There are four types of plans to choose from. Platinum Plan: The insurance pays 90 percent of the bill, and you pay 10 percent. Gold Plan: The insurance pays 80 percent of the bill, and you pay 20 percent. Silver Plan: The insurance pays 70 percent of the bill, and you pay 30 percent. Bronze Plan: The insurance pays 60 percent of the bill, you pay 40 percent.

• The maximum out-of-pocket costs for any marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan. This is an important point to understand. For example, if you were in an awful car accident and your care costs $500,000, the maximum you would be responsible for paying — regardless of what type of plan you were on — would be $6,350 for an individual and 12,700 for a family.

Family Health Services of Erie County has hired a “Navigator,” someone who is trained to help people and organizations look through the plans — without any bias — and completing the necessary forms to help the consumer purchase the desired health insurance.

Their services are free.

For information, call Family Health Services of Erie County at 419-557-7072.

Help is also available by calling Jennifer Leonard, certified application counselor, at Community Health Services in Fremont at 419-208-5178.

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