Juneau residents took their questions to healthcare experts Monday night and got them answered by Alaska Native Tribal Health Consortium navigator Monique Martin, United Way navigator Crystal Bourland, chief operating officer for Enroll Alaska Tyann Boling, and chief administrative officer for Enroll Alaska Chanel Moesh.
1. What is the difference between a healthcare navigator and a healthcare broker?
As a navigator we are really just sort of there to help people navigate healthcare.gov. Brokers can really help people to give them specific direction and suggestions on what plans might best fit their situation, versus a navigator, we’re there to just help them through the process and couldn’t direct them to a plan that might best fits their needs.
2. Will I get the same information about healthcare plans from a navigator and a broker?
Yes. Brokers and navigators are both able to help people on the marketplace. A broker might have more options outside of the marketplace. For instance, I believe Aetna is one that’s really offering a lot of plans. But they don’t offer plans on the marketplace. So a broker would be able to give you more options whereas a navigator just helps you on those plans that are available at healthcare.gov.
3. When will the healthcare.gov website start working?
Currently the federal government has stated that by November 30, they expect to have the website up and functioning. Once we are confident in the subsidy calculation and the functionality of the marketplace, we will deploy in full force to get individuals enrolled.
4. Since the website isn’t working properly, I keep hearing that I can enroll by phone or mail. Is this true?
The bottom line is no. The website, healthcare.gov is the one location where individuals can enroll into the federally facilitated marketplace. If the website is not functioning, individuals cannot enroll over the phone.
5. What’s the difference between enrolling for an insurance plan through healthcare.gov and enrolling straight from a provider?
If you qualify for a government subsidy, the only way to enroll into a health insurance policy and have that subsidy apply to your premium is through healthcare.gov. If you do not qualify a government subsidy, you can go direct to a carrier.
6. How do I qualify for a government subsidy?
You qualify for a subsidy really based on your household income, so for household income, we use the federal poverty guidelines. If you’re somewhere in between 100-400% of the federal poverty line in this state then most likely you’re going to qualify for financial assistant – aka, a subsidy – to help you pay for your health coverage.
7. What is Alaska’s federal poverty line?
For an individual, it would be $14,350 all the way up to around $57,000. So 100% of the federal poverty line in Alaska is that $14,350 and then four times that is at that $57,000. So if you’re an individual and you are somewhere in between that income level, then most likely you’re going to get financial assistance in the marketplace and you should definitely pursue that.
8. If I’m Alaska Native and I use the tribal health options that are available to me in my community, do I have to enroll in a new health plan?
No, if you go to a tribal health facility, you can keep going there just like you’ve been doing, that stays the same, but you do need to sign up for that exemption called the Indian Status Exemption so you aren’t subject to a tax penalty at the end of the year.
9. Do military have to apply for an exemption like Alaska Natives do?
No, if you get benefits, VA benefits or any sort of veteran benefits, then you don’t need to prove or apply for an exemption. And then in addition, if you’re on government programs like Medicaid or you have Medicare then you don’t need to apply for an exemption. You’re considered someone who has health insurance.
10. And finally, I keep hearing about bronze, silver, gold packages. What are they?
All plans have to offer what are called ten essential health benefits. So if they are really offering the same coverage, they’re going to differ in this metallic rating of bronze, silver, gold. If you have a bronze plan you’re probably paying less per month but maybe more in your out-of-pockets expenses when you go to the doctor for your copays or deductibles. Compared to someone who has a gold plan, they’re probably paying more per month for their premium, but then when they go to the doctor, they might have a smaller copay or deductible as part of that plan.
Additional questions:
Where can I find prices of different healthcare plans so I can start shopping around by myself?
On the bottom of healthcare.gov, there’s an option to preview plans that are available in your state. You just select Alaska and then you’ll see 36 different plans available on the marketplace, and you can start to see what your monthly payment will be. If you’re just shopping around, it won’t calculate or tell you what your premium subsidy would be to offset your costs, but it will start to give you an idea of what is available out there for Alaskans.
What do the acronyms ACA, FFM, and QHP mean? Are there other healthcare acronyms that I might need to know?
ACA refers to the Affordable Care Act, which is the health reform law, also known as Obamacare.
FFM refers to the Federally Facilitated Marketplace, and that includes Alaska. Alaska chose not to partner as a state with the federal government so we’re what’s called a federally facilitated marketplace and we’re using healthcare.gov as our route to apply for marketplace coverage.
QHP refers to Qualified Health Plans. They are covering essential health benefits, which make them qualified to be sold in the marketplace.
Besides acronyms, there’s a lot of health insurance speak, things like, ‘deductibles,’ ‘copays,’ ‘cost-sharing.’ If you’re not in the world of health insurance or if you haven’t gone through the process of finding a plan on your own before, that’s confusing. There’s a lot of insurance speak and jargon. If you’re someone who needs a breakdown of those, there are resources on Premera and Moda’s website as well as healthcare.gov, but seek out help whether through a navigator, an agent, an in-person assistor and ask those questions. Those are fundamental terms that you want to know to help you make an informed decision on your healthcare needs.
What information should I have prepared for when healthcare.gov does work?
Some things people should get together is – if you’re a family and you may have children – social security numbers, dates of birth, tax forms from the previous years, maybe pay stubs from 2013 to get an idea of what your income might look like for 2014. You might want to have a list if you have any special prescription drugs that you have to take so that we can compare plans and make sure the plan you select covers those prescriptions. Bring your list of doctors as well.
How can I find out what my subsidy might be?
There are different tools available to calculate your subsidy or what you might qualify for. On healthcare.gov, there is the Kaiser Family Foundation subsidy calculator and we’ve found that to be a pretty good guess. However I’d say that navigators, as well as licensed agents and brokers, do have some other tools that are more manual and include percentages, so they’re probably going to be a little more accurate. But if you’re just curious, you can definitely go to Kaiser Family Foundation calculator or go to healthcare.gov, type in subsidy calculator and you will find it. There are ways to get it online, but know that it’s probably not exact; it’s just a rough calculation.
What if I buy insurance in Alaska but move to another state?
You’ll have to change your policy to the state where you reside at that point in time. You’ll have a certain time frame that you can switch over that insurance and it should be a seamless transition of coverage. It ends on the 30th of the month and starts on the 1st of the next month. In your new state exchange or federally facilitated marketplace, they have to recalculate the subsidy based on where you are residing at that time.
Why did my insurance plan get cancelled?
Individuals are getting cancellation notices because those individual insurance policies do not meet the requirements of the Affordable Care Act and, therefore, they are being cancelled. Individuals will then have to go out and purchase new insurance. If they qualify for a subsidy, they need to purchase an insurance plan on the marketplace, which is healthcare.gov. If they do not qualify for a subsidy, they can purchase a plan on the marketplace or outside the marketplace.
So if my insurance plan got cancelled, I have to shop for a new one? My insurance company won’t just automatically enroll me into a new plan?
Insurance carriers will map your coverage over, but they won’t determine if you’re subsidy-eligible or not, so they’re encouraging individuals to see if they are subsidy-eligible when they go pick a new plan. Insurance carriers won’t just outright cancel you. For Moda and Premera – the two insurance carriers we have within the Marketplace – they will map you over to a new plan. They will send out the new plan and tell you at that point in time, ‘This is your time to make a plan choice. Stick with the one we’ve given you and take the premium increase, or go to the marketplace and determine if you’re subsidy-eligible.’
Lisa Phu is a reporter at KTOO in Juneau.
