You have insurance, now what?

doctor's office

Flickr Photo by Mercy Health

 

Maybe you have never had health insurance. Or perhaps it has been so long since you were last covered that you don’t recall how to use your policy or what to expect when you do.

Enrolling in an insurance plan is just the starting point for your journey through the health system.

To smooth your trip through the medical complex, and to maximize the benefits of your new insurance policy, here are some tips:

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No Foolin’: Enrollment continues if you qualify for Apple Health

Family

If you or your family qualifies for Apple Health, there is no deadline to register for insurance.

A major component of the new Affordable Care Act in Washington state is expanded Medicaid coverage, or Apple Health as it is now called. This allows thousands more people statewide to qualify for free health insurance.

Although the open enrollment period has officially ended to buy into the insurance exchange, individuals and families who are eligible for Apple Health may continue to enroll throughout the year. In other words — there is no deadline.

Who qualifies? It depends on family size and household income

  • Individuals who earn less than $15,857 annually qualify
  • A family of four with a combined income below $32,500 will qualify
  • The more children or dependents in your family, the higher your household income level can be.

To find out instantly if you qualify, enter your income level, age, and household size using the calculator on this webpage.  Then, to sign up, go to Washington Healthplanfinder (click “OK” to the warning, and select “Apply for Coverage”). You’ll need your monthly household income, the social security number and date of birth for each member of your family seeking health insurance and any relevant immigration information. You should receive notification of your coverage options within the hour.

No matter what your income, anyone who experiences a “qualifying event,” such as getting married or changing jobs, can also sign-up outside the enrollment periods. Healthplanfinder offers some advice on how to qualify under these criteria.

While the federal deadlines do not apply to those who qualify for Apple Health, why wait? The sooner you apply, the sooner your insurance kicks in and you can better manage your and your family’s health.

Enrollment troubles may allow for extensions

For those who faced online frustration in the final days and hours of the open enrollment period, an extension might be an option.

  • If you completed the entire application before 11:59 pm on March 31 but received a payment or eligibility error, you may qualify for a deadline extension.
  • The state Exchange staff is assessing these instances on a case-by-case basis.
  • Requests for review could lead to retroactive coverage if technical issues prove to be associated with your application.

Before the deadline, if you’ve encountered a problem, try contacting the Customer Support team immediately—you’ll find a link to their number (1-855-923-4633) and a set of frequently asked questions in the upper right corner of Washington Healthplanfinder’s site. Additionally, King County staff are answering questions on March 31, by phone at 1- 800-756-5437, or in-person at several locations.

Chinook Event

In-person assisters offer last-minute enrollment help on March 31, the open enrollment deadline.

Process for getting an extension

Starting on April 1, 2014, the Exchange will contact customers who are not able to complete their applications due to technical problems and send them information about receiving coverage.

Customers also can request a review of an application that got stuck; call 1-855-923-4633 or email customersupport@wahbexchange.org.

This does not include customers who submit incomplete or incorrect information, or did not take steps to finish their current application in the system.

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Between jobs, the state exchange bridges the insurance gap

Alasia Canares

Alasia Canares was able to find insurance on Washington Healthplanfinder when her employer didn’t offer her coverage.

Substitute teachers always have it tough. Students rarely behave as well for the temporary instructor, who is rushing to figure out, or create, a lesson plan, and learn the names in a classroom. The work is sporadic, the benefits non-existent.

And when they do get longer-term work, it’s often a temporary contract. What happens when your health benefits start and then stop again within a year?

Alasia Canares had been working as a substitute teacher in various school districts throughout the state — and paying $500 a month for health insurance. The burden of these bills paired with her rent had become unbearable for her and her husband.

Yet Canares wanted insurance coverage.

From the time she turned 18 until she began teaching at the age of 28, Canares was uninsured. Now 35, she didn’t want to re-experience the anxiety that had dogged her during her youth.

So with help from one of King County’s in-person assisters, Canares enrolled in a subsidized plan on Washington Healthplanfinder.

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STD warriors see insurance can save lives, prevent epidemics

Clinic IPAs

Kathy Silverman, Michal Blum and Hal Garcia-Smith assist patients enroll in health insurance at the STD Clinic at Harborview.

There’s been a double-good news story on AIDS in recent years — that it can be effectively treated using medications, and the treatment reduces the risk for transmitting HIV through sex.

The trouble is that the population at highest risk for HIV is often low-income and uninsured. That makes it hard for them to take an expensive mix of pills, on an ongoing basis.

Now, the expansion of Medicaid under the Affordable Care Act can make these medications far more accessible to those infected with HIV, in addition to increasing the likelihood that this group gets tested in the first place.

This is one reason why Public Health’s STD Clinic at Harborview has embraced the new role of health insurance advocacy, integrating enrollment into the daily operations of the clinic.

“The population that we see at the clinic is here because we offer services regardless of ability to pay,” said Michal Blum, a full-time In-Person Assister at the STD Clinic. “So that brings in populations that might not be working, that might not have access to regular care, more high-risk populations and people that we know could benefit from having personal assistance enrolling in health insurance.”

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Cartoonists tell true stories about life (& angst) w/o insurance

by Meredith Li-Vollmer

David Lasky

“I’ve been uninsured for 7 years…” comic by David Lasky

David Lasky has every reason to be excited these days. He’s had steady work as a comics artist (you may have seen his recent poster design for the Jewish Film Festival or one of his covers for The Stranger).  He also won the prestigious Eisner award for his graphic novel with Frank Young, The Carter Family: Don’t Forget This Song.

And right now, he’s excited to have health insurance for the first time in seven years.

“I know how stressful it is when you don’t have insurance,” said Lasky. “And it’s a common experience for creative people. It’s a subject that comes up often when we get together.”

What it means to have insurance, in a four-panel cartoon

Lasky and other local comics artists and writers have created Comics 4 Health Coverage, to raise awareness that health coverage is now affordable, thanks to the Affordable Care Act.It’s a call to artists, writers, and anyone with a story to tell about what it means to have health insurance.

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Broad agency involvement helps boost King County enrollment

County enrollment now totals more than 140,000, in private and Medicaid plans.

Healht PSA

A “Coverage is Here” PSA at a King County Transit sales office.

Reaching the uninsured in King County requires efforts that go beyond individual agencies like Public Health or the Department of Community and Human Services.

The county’s goal of enrolling as many uninsured people as possible and its dedication to the Equity and Social Justice Initiative require various — sometimes unlikely — King County government branches to get creative when encouraging enrollment in Washington Healthplanfinder.

For instance:

  • The Assessor’s office has been including health care enrollment information in its annual mailings to all King County property owners.
  • The Department of Transportation rolled out a number of ads for Washington Healthplanfinder on its buses’ interiors and exteriors. Additonally, Transit Sales Offices display health care PSAs on TV monitors and offer literature on the enrollment process.
  • The Department of King County Information Technology has made enrollment more accessible through the county’s various web pages. By providing more links to Washington Healthplanfinder and a health care reform footer display on all King County government web pages, residents can easily find the information they need to enroll in the health exchange.

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For women, especially, insurance equals savings

Young Woman

Free preventive care and birth control coverage add up to big savings for women.

Prior to the Affordable Care Act, pregnancy could be treated as a preexisting condition and insurance could be denied. Insurance providers routinely “gender rated” plans, which resulted in higher-priced premiums for female customers. In a 2008 study, the National Women’s Law Center found that just 12 percent of some 3,500 insurance plans provided comprehensive maternity coverage.

Perhaps because they know what’s good for them, nationally women have been enrolling in health exchanges such as Washington’s Healthplanfinder at higher rates (55 to 45 percent) than men.

Under the new legislation, women cannot be charged more for insurance than men. All health plans must offer comprehensive maternity care and cover contraception, along with at least one free annual checkup.

According to some number crunching by NerdWallet, these new stipulations make purchasing insurance cheaper for women than paying out of pocket for routine and recommended medical expenses.

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What could the penalty cost you?

Tax penalties for failing to purchase health insurance go into effect this year.

Avoid fees

Avoid penalties, enroll in health insurance by March 31.

If, by April 1, you are without coverage and don’t meet the law’s exemption status, you face a fine based on your household income.

Here’s how the penalties (officially called “individual shared responsibility payments”) break down.

Exemptions may apply

If the lowest priced plan available to you on the marketplace (Washington Healthplanfinder) would cost more than eight percent of your household income, you are exempt from purchasing health insurance.

If you are facing a major financial hardship such as bankruptcy or eviction, you might avoid the penalty, too. Other exemptions, such as religious objections, apply.

Most penalties will cost more than $95

The most commonly cited figure, a $95 penalty, is a minimum. It applies specifically to unmarried individuals with no dependents making less than $19,650. Higher income-earning individuals will face higher penalties. Forbes gives the example of a single person making $30,000 a year, who would pay a tax penalty of $200, in addition to the cost of all of her own health expenses.

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