Toledoan Antonia Battle, who works part-time for the U.S. Postal Service, is hoping to find affordable health insurance once the marketplace opens.
One in a series
Antonia Battle isn’t insured, and that stresses her out.
The 46-year-old Toledo woman was rushed to the emergency room in March after feeling lightheaded, and she’s dealing with those medical bills months later.
She has a part-time U.S. Postal Service job but no health coverage through work.
For about a year, she’s received help from Toledo/Lucas County CareNet, a local agency that assists those with low incomes who aren’t eligible for public or private insurance.
Health coverage would make life easier, better, a little less stressful.
“You get things taken care of,” Ms. Battle said. “I like to have my mammograms done, my yearly checkup to make sure everything’s OK.”
Uninsured residents like her and others interested in exploring their options will have another way to get coverage come Tuesday.
That’s when the Health Insurance Marketplace opens for enrollment through March 31. Consumers must sign up by Dec. 15 for coverage to begin Jan. 1.
The marketplace, which offers plans from private insurers, is a major feature of the Affordable Care Act. The health-care reform package, commonly called Obamacare, requires people to carry insurance next year or pay a penalty, with some exceptions.
The lead-up to the marketplace launch has been marked with bitter politicking, uncertainty, and confusion.
Count Ms. Battle among the interested but confused.
“I have no information right now,” she said. “I don’t know what’s going on.”
Seven insurance companies are expected to offer a total of 66 individual and family plans on the marketplace in the six-county rating area that includes Lucas, Williams, Fulton, Defiance, Henry, and Wood counties.
Companies offering coverage options within that region are Anthem, Buckeye Community Health Plan, CareSource, HealthSpan, Medical Mutual of Ohio, Molina, and Paramount, according to the Ohio Department of Insurance. Three — Anthem, HealthSpan, and Medical Mutual of Ohio — also will offer marketplace plans to small businesses.
■ Marketplace Web site: www.healthcare.gov
■ Marketplace hot line: 1-800-318-2596
■ Ohio Department of Insurance Web site: www.insurance.ohio.gov
■ Michigan Department of Insurance and FinancialServices
Web site: www.michigan.gov/difs
■ A list of organizations providing enrollmentassistance: LocalHelp.HealthCare.gov
■ A list of Michigan groups providing enrollmentassistance: www.enrollmichigan.com
■ Estimate tax credits using the Kaiser FamilyFoundation subsidy calculator: www.kff.org
The area that includes Ottawa, Sandusky, Erie, Seneca, Huron, and Wyandot counties will have a total of 32 plans from four insurers — Anthem, HealthSpan, Medical Mutual of Ohio, and Paramount. The state insurance department said Anthem, HealthSpan, Medical Mutual of Ohio, and Summa will offer plans for small businesses in this region.
An insurer can decide to sell plans in just parts of an area, Ohio insurance department spokesman Chris Brock said.
The Michigan rating area consisting of Monroe and Wayne counties has a total of 11 insurers offering 56 different individual plans. The Michigan Department of Insurance and Financial Services didn’t release a list of the companies offering plans in that region.
Cost of coverage
Details about the cost of coverage are trickling out, and consumers won’t have a complete picture of how much they will pay until the marketplace opens.
The U.S. Department of Health and Human Services last week released limited data on the lowest-cost plans.
Price depends on age, geography, tobacco use, and the number of people the policy covers.
Tax credits can reduce premiums for those earning between 100 and 400 percent of the federal poverty level, or $11,490 to $45,960 for an individual and $23,550 to $94,200 for a family of four.
Beginning Tuesday, residents can enter income and other details at www.healthcare.gov to determine if they will receive a tax credit and the amount.
The marketplace offers four coverage levels. Each plan must include the same minimum benefits (such as hospitalization, emergency and laboratory services, and maternity and mental health care), but premium payments and out-of-pocket costs differ at each level. Bronze plans, for example, offer lower monthly premiums but cover an average of 60 percent of medical costs. Platinum plans pay, on average, 90 percent.
In the region that includes Lucas County, the monthly cost (before tax credits) for the lowest-cost bronze plan is $162 for a 27-year-old, $223 for a 45-year-old, and $420 for a 60-year-old.
The federal government released statewide averages for family premiums but not specifically for the local area.
In Ohio, a family of four with a household income of $50,000 will pay an average of $282 a month for a low-cost silver plan after tax credits, which drop the premium from $768. The same family in Michigan also would pay $282 a month after credits.
But premium costs shouldn’t be the only thing consumers consider when picking a plan, said Patrick Paule, an insurance agent in the Bowling Green office of Savage & Associates and the legislative chairman for Northwest Ohio Association of Health Underwriters.
“You need to understand what your out-of-pocket maximums are. You need to know what hospitals and doctors are available to you, how many office visits are covered,” Mr. Paule said.
He’s seen plans at different coverage levels with deductibles that vary by several thousand dollars. He’s encouraging people to take several weeks to evaluate options and seek advice from professionals before enrolling in a plan.
A few Ohio agencies were awarded federal funds to provide “navigator” services, intended to inform people about the marketplace and help them enroll in coverage.
Just one local agency — Neighborhood Health Association — received specific grant funding to hire navigators. But about $250,000 in funds from a roughly $2 million grant to the Ohio Association of Foodbanks will be used to support local services through CareNet.
Note: In Ohio, rating area 1 includes Lucas, Williams, Fulton, Defiance, Henry, and Wood counties.
Rating area 2 includes Paulding, Putnam, Hancock, Van Wert, Allen, Hardin, Mercer, and Auglaize counties.
Rating area 6 includes Ottawa, Sandusky, Erie, Seneca, Huron, and Wyandot counties.
The two Toledo groups are working to hire and train navigators, in part because grant recipients found out about their awards just last month and because they’ve been sorting out how to comply with federal and Ohio regulations.
By late last week, no one had submitted a completed application for Ohio navigator certification to the state insurance department. Local agencies want to have navigators in place in November.
CareNet plans to have four to five navigators at area sites yet to be announced.
Neighborhood Health has begun to hire some of the roughly 30 people who will staff its program funded with about $860,000 from a couple federal grants. About two dozen of those workers will act as navigators, and Chief Executive Officer Doni Miller plans to hold interviews this week for those seeking those positions. Training will begin the second week of October.
Ms. Miller said enrollment helpers will be based at a handful of the Neighborhood Health clinics and at community health centers in Erie and Sandusky counties. She’s working on finalizing a full list of sites.
Michigan Consumers for Healthcare received more than $1.3 million, that state’s largest federal grant, to serve as the only statewide navigator in Michigan. The agency plans to use the funds to reimburse nonprofit groups that provide navigator services. Partner groups will receive $25 from the grant every time they successfully enroll someone in a marketplace plan.
“We are incentivizing the nonprofit community here in Michigan to do this important work,” Executive Director Don Hazaert said.
Note: In Michigan, Monroe County is located in rating area 1.
Lenawee County is in rating area 4.
Hillsdale County is in rating area 7.
The agency expects partners will serve southeastern Michigan counties, but a list of locations offering help will not be released until navigators are certified.
American Indian Health and Family Services of Southeastern Michigan Inc., which covers Monroe County among the seven counties it serves, received a nearly $50,000 navigator grant. It has three navigators ready to help people starting Tuesday from its Detroit office. Plus, several more counselors received training to offer assistance.
While the agency focuses on the Native American population, Executive Director Ashley Tuomi said navigators will help anyone needing it.
In addition to navigators, other community groups can choose to provide enrollment guidance, and local hospitals will offer some direction to uninsured patients.
Insurance agents also can help people enroll in plans.
Several area health centers received federal dollars to provide marketplace outreach and enrollment assistance.
Community Health Services, based in Fremont, will have someone travel to health centers, hospitals, and other locations in Henry, Seneca, Huron, Wood, Sandusky, and Erie counties. The agency hopes to launch its support service by early November.
Health Partners of Western Ohio hired three workers and trained six current employees to provide marketplace help. The helpers primarily will work out of three health-center locations in Lima, Kenton, and New Carlisle, where they will be available to help answer marketplace questions to those who walk in or make appointments.
Family Medical Center of Michigan Inc. has hired three workers who will be ready to help people in Monroe and Lenawee counties starting Tuesday by appointment. The agency primarily will seek to help enroll its uninsured patients at branch locations in Adrian, Temperance, Monroe, and Carleton.