As health law goes live, answers are available from insurers, government
GRAND FORKS -- The government website intended to register millions of uninsured residents for health care under the Affordable Care Act stalled for the second day in a row Wednesday, forcing some North Dakota residents to call state agencies for help.
As deadlines approach for the uninsured to buy coverage through insurance exchanges, questions about the health law are being addressed by providers.
For the estimated 60,000 to 70,000 residents who may not have insurance, Blue Cross Blue Shield North Dakota is holding a series of informative sessions statewide this month to help answer questions on eligibility and coverage. The first event will be from 8:30 a.m. to 10 a.m. and 4:30 p.m. to 6 p.m. Tuesday at the Canad Inns in Grand Forks.
The so-called Marketplace insurance plans offered to the uninsured are placed into four categories -- bronze, silver, gold and platinum -- and cover many basics, said Luther Stueland, director of health policy impact and exchange operations at BCBSND.
Stueland said the uninsured should keep in mind that they'll be fined if they don't apply for health insurance by March 31.
In 2014, adults who don't have insurance will be fined $95 each or 1 percent of household income, whichever is greater. The fine for children is $47.50 or 1 percent of their parents' income, and by 2016, adults will be charged $695 each or 2.5 percent of their household income, he said.
Below are a few commonly asked questions and answers from Stueland and the North Dakota Insurance Department.
Q. Do I have to give up my current coverage?
A. No. With the exception of a small number of employers whose coverage will be discontinued, for the great majority who have affordable health coverage, they don't need to do anything, Stueland said.
Q. How will the law affect my ability to get coverage, even if I have health problems?
A. Insurers cannot reject applicants based on health status once the health plans are operating in 2014. The law has also created a temporary high-risk insurance pool for those who have medical problems, were rejected by insurers and have been uninsured at least six months.
Q. Will my premiums go up or down?
A. Stueland said the answer is yes to both questions -- it depends on what coverage the insured have today. For instance, those who have plans that will be discontinued in 2014 need to sign up for a bronze plan at the very least, and premiums may be higher than what the older plans offered, he said.
Q. The Affordable Care Act has added several taxes and fees to premiums. What does that mean?
A. One of the largest includes the transitional reinsurance fee, which tacks on a $63 cost per member to all health plans in 2014, then declines in cost the following two years, though the cost hasn't been estimated yet, Stueland said. Another is a permanent tax on insurers that's estimated to cost BCBSND members $14 million from 2014 to 2018. It equates to about a 1.4 percent increase in the premium for anybody who is fully insured, he said.
Q. My insurance is too expensive. Can I switch?
A. Maybe. If customers' insurance costs more than 9 percent of their total income, they should be eligible for a more affordable plan and should contact a navigator or customer service representative to check, said Tinka Duran, a navigator who assists customers using exchanges. For those who don't make a lot of money and don't have coverage through an employer, federal tax credits can help reduce the cost of premiums and potentially the cost of out-of-pocket payments, Stueland said.
Premium subsidies will be available only for people and families with incomes between 138 and 400 percent of the federal poverty level.
Q. Can I sign up for a premium subsidy through my local provider?
A. No. But customer service representatives for the insurance marketplace can be reached by calling 800- 318-2596. The hearing impaired can call 855-889-4325.
Navigators, who can also help determine insurance eligibility, can be reached by calling Neil Scharpe at Minot State University at 800-233-1737 or Tinka Duran, who helps the American Indian population enroll in plans, at 877-209-1215. For more contacts, visit localhelp.healthcare.gov.
Q. How long do I have to enroll?
A. This year, the enrollment period lasts from Oct. 1 to March 31. The earliest effective date for the plans starts Jan. 1, but customers have to enroll by Dec. 15 for that to happen, Stueland said. In the following years, the enrollment period shortens to Oct. 15 to Dec. 7. For those who enroll outside that period, a life-changing event such as a new child or a job loss is required to be considered for enrollment.
Websites that include basic information on the insurance marketplace and eligibility:
North Dakota Insurance Dept.: www.nd.gov/ndins/healthcarereform/Consumers/#top
Blue Cross Blue Shield ND: