Tuesday, September 24, 2013

TOP STORY >> Insurance firms to offer private coverage

Leader senior staff writer

With just a week left until an estimated 500,000 Arkansans can enroll for the state’s private-option Medicaid expansion, the state Insurance Department released the names of the four health-care providers and pricing (see related story).

The Qualified Health Plan issuers offering plans are Celtic Insurance Company, d/b/a Arkansas Health and Wellness Solutions; Arkansas Blue Cross and Blue Shield; Blue Cross and Blue Shield Multi-State, and QCA Health Plans, Inc. d/b/a QualChoice Health Insurance of Arkansas.


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 Arkansans are required to have health insurance beginning March 31 and there will be fines assessed through the IRS for those who don’t.


Because of the enormity of enrolling so many people into health insurance plans with so many options, the state Insurance Department has hired 537 in-person assisters across the state to help residents navigate the detailed programs, according to Haywood. And other groups or agencies have hired additional people to help, she said.

The list of types of coverage, broken down by age, spans 223 pages.

The in-person assistance program is designed to provide outreach, education and assistance to Arkansas communities and uninsured Arkansans.

The state got a $17 million grant to help inform and assist private-option clients.

The state Health Department is sponsoring assisters in health units in every county.

In addition, 13 organizations are sponsoring assisters in Pulaski County, three organizations in Lonoke County and two in White County.

Here, by county, are the names and phone numbers of the groups providing assisters to guide residents through the process, beginning Oct. 1:


• Local Health Department Units, including the one in Jacksonville, 501-982-7477

• Arkansas Health Care Access Foundation, 501-221-3033, 501-951-5330.

• Arkansas Minority Health Commission, 501-686-2720.

• Arkansas Voices for the Children Left Behind, 501-366-3647

• Better Community Development, Inc. 501-663-9181, 501-580-4269

• Central Arkansas Library, 501-918-3031

• Central Arkansas Volunteers in Medicine, doing business as Harmony Health Clinic, 501-375-4400

• Community Health Centers of Arkansas, Inc., 501-374-8225

• Future Builders, Inc., 501-897-5566

• Hope, Restoration and Wellness Learning Center, 501-240-2795

• IN Affordable Housing, Inc., 501-221-2203, 501-954-0017 (mobile)

• Mental Health Council of Arkansas, 501-372-7062

• The Living and Affected, 877-902-7448

• Women’s Council on African American Affairs, Inc., 501-372-3800


• Cabot Health Unit, 501-843-7561

• Lonoke Health Unit, 501-676-2268

• Central Arkansas Library, 501-918-3031

• Future Builders, Inc., 501-897-5566

• IN Affordable Housing, Inc., 501-221-2203, 501-954-0017 (mobile)


• Beebe Health Unit, 501- 882-5128

• IN Affordable Housing, Inc., 501-221-2203, 501-954-0017 (mobile)

• Mental Health Council of Arkansas, 501-372-7062

Connector website, http://www.arhealthconnector.org/homepage.html.

For help enrolling or to find assisters in your area, call 855-283-3483.


There are 3 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/partner’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 already are appearing online and elsewhere.


“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 already are in effect. Adult 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 those insured.

The private-option insurance is not expected to have any immediate impact on ARKids First, which covers low-income Arkansans 18 and younger.


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 it.

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 Jan. 1, 2014.


If you don’t have health insurance in 2014, you will pay a penalty — the greater 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.


Individuals and families aren’t the only beneficiaries of the private option.

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 signed by Gov. 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.

Private option is expected to benefit Arkansas hospitals in the range of $185 million to $200 million in 2014 alone.


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 are more expensive but the plan picks up about 90 percent of costs.

All participating insurance carriers are required to provide certain coverage — including free preventative tests.

Free coverage includes 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 screening.


• Outpatient services, including primacy-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 clinic or urgent care center visits; observation services; transfer to in-network hospital and ambulance services.

• Hospitalization including hospital services; physician hospital visits; inpatient services including surgical services, physical and occupational therapy, organ transplant services.

• Maternity and newborn care.

• Mental health and substance abuse services, including professional services; diagnostics and inpatient and outpatient care at hospital or other covered facility.

• Prescription drugs.

• Rehabilitative and habilitative 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 immunizations and pediatric services, including dental and vision care.

The connector website is http://www.arhealthconnector.org/homepage.html.

For help enrolling or to find assisters in your area, call 855-283-3483.