Special to the Enterprise
What do you do to meet the requirements of the Affordable Care Act ACA? How can you find out?Thousands of uninsured residents of Wayne County simply have no answer. The size and scope of the new health system can be intimidating, and as many businesses and individuals have found, up until now there has been little to no information about what to do.
The federal website, Healthcare.gov, provides the most comprehensive information for Wayne Countians, since Georgia Gov. Nathan Deal opted not to provide a state Exchange. Problems continue for users of this federal site when they attempt to sign up for insurance coverage. Although the Obama Administration continues to assure the public that the problems will be fixed, as of this week, glitches continue to create problems. However, the site can still be accessed for information to assist in making decisions about the law. Although there are some exemptions, those who do not have coverage beginning in January, 2014, will have to pay a penalty of $95 per adult and $47.50 per child, or 1 percent of income whichever is higher. The fee increases every year, and by 2016 it will be 2.5 percent of income or $695 per person, whichever is higher.
If the lowest-priced coverage available for individuals and families here costs more than 8 percent of household income, that household qualifies for an exemption from the fee.
The federal Marketplace, sometimes called the Exchange, was begun in October and will continue at least through March 31 next year. This is the place to find what coverages are available and what the cost of each is.
In Georgia only Humana and Anthem Blue Cross and Blue Shield are listed as companies that presently offer plans for those in Wayne County. Residents in other parts of the state may find other companies and prices. Prices within companies also vary according to the location within the state.Insurance providers can offer coverage in any of five plans that qualify for compliance with the ACA. Plans vary from catastrophic, bronze, silver, gold and platinum and provide coverage from 60 percent of average cost of care up to 90 percent of average cost.Most of the insured must use a bronze or better plan, but children and young adults may need to have only catastrophic coverage. Everyone, regardless of health condition, is eligible for at least silver coverage plans.No matter the coverage chosen, the deductibles and copayments vary from plan to plan. Out-of-pocket expenses will vary according to the level of coverage chosen and the health requirements of those covered. Preventive services are covered with no cost sharing required.Using a cost calculator provided on-line by Kaiser Family Foundation http:/kff.org/interactive/subsidy-calculator/, anyone can determine the possible plans and costs. Get Covered America also provides an on-line calculator at www.getcoveredamerica.org/calculator.Using an example of a family of four with an annual income of $50,000, costs vary from a low of $457 for catastrophic coverage up to a high of $1,531 for gold coverage or $867 for the only platinum plan offered.The actual cost to the consumer may be less than the premium quoted from the Exchanges. Subsidies are available in the form of tax credits which are tied to income. Subsidies are available for individuals or families whose income is up to 212 percent of the federal poverty line.