Program sheds light on Affordable Healthcare Act

Published Mar 10, 2014 at 10:04 am (Updated Mar 10, 2014 at 10:04 am)

Finding Health Care through the Health Care Marketplace was the title of a recent program offered at the Peters Township Library. The free program, held Feb. 20 at the library, was attended by more than 20 people and presented by Christina Livingston of Cornerstone Care in Washington, in conjunction with PA Forward’s health literacy series, an initiative of the Pennsylvania Library Association.

Livingston, a certified application counselor and outreach and enrollment specialist with Cornerstone Care, helps people create accounts and determine the best plans for them regarding the Affordable Care Act’s health insurance marketplace.

“I’m trying to see what my options are,” said Nick Johns of Venetia who attended the program.

“It’s just more complicated than ever,” said Paul Dillon of Monongahela who attended to learn more about the Affordable Care Act.

While the healthcare.gov website had notoriously started off on a sour note, Livingston said things have gotten better.

“The new plan requires insurance companies to cover all applicants within new minimum standards,” she said. “Most health plans have to cover preventative care at no cost,” with the new standards, Livingston said. Also, the new regulations would allow children to stay on their parents’ insurance until the age of 26.

A major advantage of having health coverage is the expense, Livingston said.

“The cost of a three-day hospital stay can be $30,000 and to fix a broken leg costs $7,500 to start,” she said. Not having health insurance can create a financial burden on people and also ruin credit, she added.

Livingston stressed that every individual or family plan will be different because several factors must be taken into consideration. The factors include geographic location, previous health care spending, age, household size, income and tobacco use – “You’re going to be charged more if you use tobacco,” she said.

People living in Western Pennsylvania are in Rating Area 4, Livingston said. The area encompasses 10 counties, including Washington and Allegheny. Four insurance companies – Highmark Health Services, Highmark Insurance, UPMC and HealthAmerica – with 38 distinct plans are available in this area.

Essential health benefits included in most plans are outpatient services, emergency room services, hospitalization, maternity and newborn care, mental health, prescription drugs, lab services, counseling and pediatric services. Plans are arranged in terms of amount the patients have to pay. For those with a Bronze plan, 60 percent of their healthcare costs will be taken care of by insurance; those with Silver plans, 70 percent; Gold plans 80 percent; and Platinum plans 90 percent. Premiums go up as the plans and coverage gets better.

Catastrophic plans with a high deductible are also available and are marketed toward younger people.

Livingston also explained that some people may be eligible for tax credits based on income. Tax credits are available for single people earning from $11,490 to $45,960 and families of four earning from $23,550 to $94,200. More tax credit is given to those with lower incomes.

“If you do qualify for those (tax credits), you must select a Silver plan,” Livingston said.

Cost-sharing reductions are also available for single individuals who earn up to $28,725 and families of four earning up to $58,875.

Livingston also talked about the individual responsibility payment in which there is a penalty for those who are uninsured if they don’t meet one of the exemptions.

A single person without health insurance would have to pay a penalty of $95 this year and a family of four would have to pay a $285 penalty, or one percent of the family income, whichever is greater.

The penalty goes up each year, and in 2015 a single uninsured person would owe $325 and a family of four, $975 or two percent of the family income. In 2016, the number increases to $695 for an individual and $2,085 for a family of four, or 2.5 percent of the family income.

“A lot of people have the misconception that they’ll just pay the $95 fee every year, and that’s not the case,” Livingston said.

Right now, open-enrollment is going on at healthcare.gov until March 31. Open enrollment will start again Nov. 15 for next year.

Livingston said her office available to help anyone sign up or who has questions about the Affordable Care Act. The service is free of charge. Those seeking further information on the topic or wanting to make an appointment to talk with Livingston can call 724-825-4411.

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