By John Hofheimer
Leader senior staff writer
Open enrollment for the Affordable Care Act’s private-option Medicaid expansion starts in 19 days and five enrollment assisters will be available at Lonoke County Health Units to help residents enroll, according to Milton Garris, director of the Lonoke County Health Unit.
Three of those will work out of the Cabot office, two out of Lonoke, he said.
Other groups also will have assisters in every county in the state.
An informational meeting is slated for 1:30 p.m. Tuesday at the Cabot City Annex, Garris said. A similar meeting was already held in England.
Open enrollment begins Oct. 1 and extends through March 31, but to be eligible for coverage at the Jan. 1 start, you must enroll by Dec. 15, according to Heather Haywood, public information manager for Arkansas Health Connector. That’s the entity managing the private option for the Arkansas Insurance Division.
ALL REQUIRED
All Arkansans are required to have health insurance beginning March 31, and there are fines assessed through the IRS for those who don’t.
Beginning Oct. 1, Lonoke County residents needing information about the private option can call the Lonoke Health Unit, 501-676-2268 or Cabot Health Unit, 501-843-7561, Garris said.
The Health Department is one of four agencies in Lonoke that have contracted to provide in-person assisters, according to Haywood.
In Pulaski County, 13 agencies including the health department are contracted to provide in-person assisters.
The state Insurance Division has a large amount of clearly written information available at its Health Connector website, http://www.arhealthconnector.org/homepage.html.
For help enrolling or to find assisters in your area, call 855-283-3483.
GET INSURED HOW
There are three ways to get health insurance:
• Purchase insurance through the Health Insurance Marketplace, also called the Exchange, where you may qualify to have part or all of your premiums paid.
• Purchase health insurance from a private insurance company on your own.
• Get health insurance through your job or through your spouse’s job.
If you already have insurance through work, you won’t have to do anything else.
Enrolling through the marketplace is the only way you can receive financial assistance on your monthly health- insurance premiums. Officials are warning that fraudulent offers are already appearing online and elsewhere.
SECURE CONNECTION
“The Arkansas Health Connector is your secure connection to the Marketplace,” according to Haywood.
You can apply online, in person, by mail or over the phone.
“You’ll need your Social Security number (or document number if you’re a legal immigrant) and employer and income information (pay stubs, W-2 forms, wage and tax statements),” according to information on the official Arkansas Health Connector website.
Financial assistance is available through a new type of tax credit called the Advanced Premium Tax Credit.
The amount of assistance you can get is determined by your household income and size. Some Arkansans will even be eligible to have all of their premiums paid through this financial assistance. Some aspects of the new healthcare law are already in effect. Children can be carried on their parents’ insurance until age 26, regardless of marital status, Haywood said. Children under 19 can’t be excluded for pre-existing conditions and prenatal and some other screenings are free to insured people.
WHO’S ELIGIBLE?
Eligibility is determined by these simple criteria:
• You must live in the U.S.
• You must be lawfully present in the U.S.
• You must not be incarcerated due to a conviction
Five companies have filed letters of intent to provide private-option coverage in Arkansas, but so far the federal government has not notified the Arkansas Insurance Division which ones are approved to provide that insurance.
More than 430,000 uninsured Arkansans — most of them low income — will be eligible, and in fact, required to get the insurance. The Affordable Care Act requires that everyone have health insurance starting on Jan. 1.
PENALTIES
If you don’t have health insurance in 2014, you will pay a penalty of $95 per adult or 1 percent of your taxable income.
By 2015, the penalty will equal $325 per adult or 2 percent of taxable income and in 2016, that increases to $695 per adult or 2.5 percent of taxable income. After that the penalty increases based on the cost-of-living adjustment.
Penalties are noted and collected on IRS income tax forms.
The federal government, through the state, will pay the basic premium for individuals and families earning less than 138 percent of the federal poverty level, Garris said. For a single person, that would be $14,856 for instance, or $30,656 for a family of four. Help with premiums is on a sliding scale, with help available all the way up to 400 percent of the federal poverty level.
HOSPITALS BENEFIT
Individuals and families aren’t the only beneficiaries of the private option.
The private option is expected to benefit Arkansas hospitals in the range of $185 million to $200 million in 2014 alone.
About 28,000 Arkansas hospital patients were uninsured in 2010, costing the hospitals $280 million. Under the private-option Medicare Expansion, about 85 percent to 90 percent of those costs could have been recovered.
But for passage of the private option law by the General Assembly and signed by Gov. Mike Beebe, unpaid cost for uninsured patients would surpass $430 million in 2014 and more each following year, mostly because the percentage of uninsured Arkansans has climbed from 20 percent in 2010 to about 25 percent in 2014.
FOUR LEVELS
There are four levels of coverage, each with a different cost, affecting the percentage of cost that the covered person pays. For instance, bronze level pays about 60 percent, leaving the patient to pay about 40 percent, while at the other extreme — platinum coverage — the premiums is more expensive, but the plan picks up about 90 percent of costs.
All participating insurance carriers are required to provide certain coverages — including free preventative tests
Free coverage include colorectal-cancer screenings, including polyp removal for those older than 50; immunizations and vaccines for adults and children; counseling to help stop smoking; well-woman checkups, as well as mammograms and cervical-cancer screenings; well-baby and well-child exams for children, and cholesterol screenings.
10 REQUIRED COVERAGES
• Outpatient services, including primary-care physician office visits, specialist office visits, outpatient surgical services, outpatient diagnostics, including advanced diagnostic services such as MRIs and CT scans, and outpatient physical and occupational therapy.
• Emergency services, including after-hours clinics or urgent-care center visits; observation services; transfers to in-network hospital and ambulance services
n Hospitalization including hospital services; physician hospital visits; in-patient services including surgical services, physical and occupational therapy, and organ-transplant services
• Maternity and newborn care.
• Mental-health and substance-abuse services, including professional services; diagnostics and in-patient and outpatient care at hospital or other covered facility.
• Prescription drugs.
• Rehabilitative and hab-ilitative services, including physical, occupational and speech therapy and developmental services.
• Laboratory services —testing and evaluation.
• Preventive and wellness services and chronic-disease management, including case- management communications made by primary-care physicians.
• Preventive health services, including routine im-munizations and pediatric services, including dental and vision care.
