Navigating the Health Care Exchange
With the implementation of the Affordable Care Act, individuals who meet eligibility requirements must carry health insurance. Each state has a marketplace where individuals can enroll and determine if they qualify for a health insurance plan.
Kootenai Health’s Social Services department can help anyone who wants assistance navigating the marketplace. Last year alone, Kootenai Health social workers assisted more than 1,500 individuals.
“We are trained to know the registration process and the plans well,” Pam Thompson, director of Kootenai Health Social Services, said. “We meet with people one on one to go over the different plan options, answer questions and help get them enrolled.”
Exploring Your Options
If a person does not qualify, Kootenai Health social workers can help explore other financial programs that might help meet health care needs. Even if income requirements are not met, individuals should still enroll so the system can check eligibility for state Medicaid or the Children’s Health Insurance Program (CHIP).
“Many individuals believe that plans on the marketplace have high premiums or high deductibles,” Deanna Brunk, Kootenai Health Social Services, said. “However, each individual and family is different, so each household will receive a plan based on their circumstances.”
Your Health Idaho offers four health plan categories: Bronze, Silver, Gold, and Platinum. The category you choose affects the total amount you will likely spend for essential health benefits during the year.
Planning for Health Care Costs
Once a plan is selected, it is important to understand how to use your benefits and plan for potential health care expenses.
“When considering an elective or scheduled procedure, consider where you are with your deductible,” Mark Woodworth, consultant at Helbling Benefits Consulting, said. “If you have not met much of your deductible late in the year, it may make sense to postpone care until the next plan year.”
Many preventive services such as mammograms, PSA tests and annual exams are covered at 100 percent and do not require a deductible to be met, even with a Health Savings Account (HSA) plan.
If you have a planned procedure in the upcoming year, you can call to receive a personalized estimate. Like many health care organizations, Kootenai Health offers cost estimates based on upcoming services, your insurance provider and the specifics of your coverage plan.
Frequently Asked Questions
When is the open enrollment period?
Open Enrollment is November 1, 2015 to January 31, 2016. Medicaid, CHIP and Small Business Health Options Program (SHOP) participants may apply at any time.
Can I apply for a plan prior to the enrollment period?
There are several circumstances in which an individual or family may apply outside of the enrollment period. These include (but are not limited to) moving from another state, loss of insurance coverage, marriage, or income changes that may affect your eligibility in the program.
I have a pre-existing condition. Can I still qualify for a health insurance plan?
Yes, the Affordable Care Act indicates an insurance provider cannot look at pre-existing conditions as a determination for coverage or premium price.
My spouse has health care coverage through their employer; can I still get a plan on the Marketplace using his income?
Yes, if you are in the household together and meet the income requirements you can use your spouse’s income to determine eligibility.
If I already have Medicare, will I get a penalty for not enrolling in a health insurance plan on the Marketplace?
No, Medicare Part A or Part C and Medicaid are considered minimal essential coverage.
Once I have health care coverage, how can I find a physician?
Kootenai Health has an Appointment Center that can help you find a primary care physician. Call (208) 265-6767 or toll free at (844) 627-9411
