Navigating America’s health care system can feel like being out to sea. Every year the rules change but it’s still the same cat and mouse game of how to get adequate coverage without spending a fortune.
Keys’ Insurance agent Stacy Dumas explains, “There is a lot of confusion right now about subsidies, people need to know they have not been cut.” A subsidy is the financial aid the government provides monthly in order to help afford a health insurance policy. “What has been eliminated is the subsidizing of co-pays and payments towards the deductible of policy. This will now be the burden of the insurance companies.” What’s relevant is the timing of the elimination. According to Dumas, insurance companies already filed their rates for 2018 before the change “Since the insurance companies will have to absorb the cost share reduction, the real challenges and cost increases lay ahead.” This means an even more dramatic increase in insurance costs for 2019 but … not yet. If already insured, re-enrollment in the existing plan will be automatic but will reflect an increase in premiums for 2018.
For now, the Affordable Health Care Act still exists — providing subsidized policies for those who qualify. Qualifying depends on how many live in the household and the household’s income and whether it is above or below the Federal Poverty Level. To qualify, a household must be between 100 – 400 percent of the federal poverty level. This math is tricky because other factors such as age and tobacco use also come into play and the government changes the income margins yearly.
Open enrollment for Obamacare (ACA) has been drastically reduced from 3 months in the beginning to now six weeks from November 1 to December 15, 2017 and options are limited. Unlike years past, there is only one available insurance company for Monroe County residents, Florida Blue Cross/Blue Shield. Other insurance companies are available but at full price without subsidies.
“These are off exchange and they are the major companies like Cigna, United, Humana, Aetna and Florida Blue,” said Agent Greg Baumann “ My suggestion is to call doctors and find out which they prefer when choosing the right plan down here.”
If a resident chooses to go without insurance there is a tax penalty. For 2017 tax filing it will be 2.5 percent of the household income or the penalty is $695 per adult plus $347.50 per child (up to a maximum of $2,085 per family), whichever is greater. The 2018 penalties have not been announced. But the penalty isn’t necessarily an incentive to obtain insurance due to the overall rising costs.
What to do? The first step is to figure household income and go from there. Either begin by navigating www.healthcare.gov and filling out the forms to see which plans or subsidies may work. Also the site offers www.localhelp.healthcare.gov listing local agents such as Dumas and Baumann and organizations that provide help. Whether using an agent or a navigator at a health facility, it is free and at the cost of the insurance companies.
Community Health of South Florida will be taking appointments at its offices in Marathon (2855 Overseas Highway) and AT Womankind in Key West. The help to navigate and explore health care options is free. To schedule an appointment call 786-272-2100.
Understanding Healthcare Plans Coverage
Platinum — covers approximately 90% of health care costs
Gold — covers approximately 80% of health care costs
Silver — covers approximately 70% of health care costs
Bronze — covers approximately 60% of health care costs