Essential tips for Ohioans who need individual health insurance

If your job doesn’t provide health coverage and you are appalled by the cost of insurance, read this column now.

The Affordable Care Act’s (ACA) subsides for eligible families are all still in place, but only through the federal website HealthCare.gov (“Obamacare”) or its telephone line 800.318.2596.  You must enroll by Dec. 15 to receive the benefits you qualify for. Open enrollment for 2019 coverage ends Dec. 15.

The vast majority of low-income, working Ohioans qualify for free coverage under expanded Medicaid. At higher incomes, Ohio families are saving thousands of dollars a year on private plans that comply with the ACA, as the example below illustrates.

Find out if you qualify:  It is easy to find out if your family can save money by going to Healthcare.gov, clicking on the green button “Preview 2019 Plans and Prices,”and following the prompts. This will show you plans in your county, with premiums reduced by any federal tax credit you qualify for. It will also tell you if you are likely to qualify for “cost-sharing reductions” to reduce what you pay for care.  Cost-sharing reductions are only available to people choosing silver plans.

Self-employed people should check their options, as their eligibility is based on net business income. A number of small business owners in Southwest Ohio qualify for free or very low-cost plans with low deductibles.

After looking over your options you can enroll by calling 800-318-2596 or by completing an application online via Healthcare.gov and selecting a plan.  See the end of the article on how to find free, in-person, unbiased assistance in making an informed choice.

Here’s an illustration of how Obamacare financial help saves money for a Hamilton County family of four. These figures are based on the lowest-cost silver plan available in the county through the Federal Exchange (Healthcare.gov). Premiums are based on family size, age, and whether anyone smokes.  In this example, no one smokes, the father is 40, the mother 38, the children 12 and 8.

This plan’s premium sticker price for this family is $1,079.48 a month, or $12,953.76 a year.
Example of Obamacare savings for 2019, family of four
income            monthly premium       deductible       out-of-pocket max      notes
$30,000           $0                                $0                    $0                    all eligible for Medicaid
$40,000           $107.25                       $0                    $5,200             children Medicaid-eligible
$50,000           $224.91                       $0                    $5,200             children Medicaid-eligible
$80,000           $605.97                       $12,000           $15,800           no cost-sharing reductions
$100,000         $770.31                       $12,000           $15,800           no cost-sharing reductions

At $50,000 in income, this family would save over $10,000 in premiums alone, as well as the entire $12,000 deductible and up to $10,600 on the out-of-pocket maximum. Even at $100,000 a year in income, this family qualifies for a tax credit that would save them $3,710 a year in premiums. That’s a 28.6% discount.

The Healthcare.gov exchange includes plans ranging from “bronze” (covering 60% of your medical costs) to “gold” (80%). The best plan for you depends on how likely you are to need care in 2019, so a lower deductible and copays may be crucial to your household budget. Remember that you can only receive federal assistance to reduce these costs if you choose a silver plan.

The screen showing plans has two consumer empowerment tools on the upper right: buttons for“estimate total yearly cost” and “see if providers & drugs are included.” The first enables you to compare your family’s total annual health care outlay (premiums + deductible + copays) depending on whether you anticipate low, medium or high health care use. The second lets you put in your prescriptions, doctors and hospital so you can see if the plans you are considering will cover them.

Free, unbiased in-person assistance: Even though the Trump Administration has slashed outreach funding by 84% in Ohio since 2016, you can still get free, unbiased local help to find a plan that best fits your needs from certified assisters in local health departments, federally qualified health centers, and non-profits.  Click on “Find Local Help” on Healthcare.gov and select “assisters” to find one near you.

Buyer beware:  Consumer advocates are reporting a huge uptick in health insurance scams and robocalls. Do not provide your private information to any cold caller: you risk identity theft.  Also beware of “short term” plans, many of which are cheaper because they do not include the protections mandated by the Affordable Care Act, such as covering pre-existing conditions, prescriptions or mental health care. Be sure to check your options on Healthcare.gov and to find an assister through its “Find Local Help” button if you need help discerning which plan is best for you.

Even people who don’t qualify for subsidies benefit from the law’s consumer protections: The Affordable Care Act sets annual limits on out-of-pocket costs and deductibles, and mandates that plans on the Exchange cannot charge you more or deny you coverage if you have pre-existing conditions.

Ariel Miller has five years experience as a Certified Application Counselor authorized by the federal government to help consumers apply and choose individual plans through the ACA Marketplace. Now retired, she volunteers at HCAN, a Cincinnati non-profit, and holds a master’s degree in health planning from Johns Hopkins.

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