Affordable Care Act

Topic:   Affordable Care Act

Guest:  Colleen Wentz  – Admitting/Financial Team Supervisor for Patient Access Services

Date:  Oct. 8, 2013

The health care law is intended to increase accessibility to health care benefits. Specifically, it’s designed to provide coverage to more people and to people with pre-existing medical conditions by expanding Medicaid and by creating new health insurance exchanges. That’s big news in Yakima County.

The statistics:

  • There are an estimated 76,800 uninsured people in Yakima County. That’s about one-third of the entire county population.
  • Under the expansion, more than 1/3 of those people would qualify for Medicaid, which will now be known as Washington Apple Health.
    • If you earn less than 138 percent of the poverty level, you’ll be eligible to enroll in Medicaid. For a single person, that’s $15,856 per year. For a family of four, it’s $32,499 annually.
    • Eligibility is determined solely on income now. It was previously based on income and assets. So given that change – and the expansion – you should reapply even if you’ve applied before.
  • Another 1/3 of those uninsured people likely qualify for subsidies to help pay for health coverage. Tax credits will be available to people with incomes between 100 and 400 percent of the poverty guidelines who can’t afford coverage elsewhere.
    • At 400 percent, an individual’s income is about $46,000. It’s about $94,000 for a family of four.  
    • And you can get the tax credit before tax time, which should make it easier to pay insurance premiums.

There are five insurance plans available under the insurance exchange to Yakima County residents:

  • Group Health Cooperative
  • Coordinated Care
  • LifeWise Health Plan of Washington,
  • Premera Blue Cross
  • Community Health Plan of Washington.

All offer four levels of coverage and premiums to meet different needs. For instance, bronze plans feature the lowest premiums but only cover 60 percent of average medical costs, while a platinum plan would cover 90 percent of those costs but has higher premiums.

Some key points to remember:

  • There is no annual or lifetime cap to how much insurance will pay.
  • You cannot be denied coverage if you have a pre-existing condition.
  • You cannot be dropped from your insurance if you get sick.
  • Insurers must cover preventive care to promote wellness.
  • You cannot be denied coverage if you choose to take part in a clinical trial. This applies to all trials that involve cancer or other life-threatening diseases.
  • Parents can keep children on their insurance until age 26.

Enrollment opened Oct. 1. Enrollment continues through March 31, 2014.

Many key provisions of the law take effect on Jan. 1.

The state’s new web portal allows you to compare health plans side by side, find out if you are eligible for tax credits, get answers to questions and enroll in the plans. It’s at www.wahealthplanfinder.org. Or you can call 1-855-WA-FINDER or 1-855-923-4633.

Locally, there are people ready to assist with the process at Yakima Neighborhood Health, which is located at the old Greyhound Bus Station on Yakima Avenue downtown, or other physician clinics, such as the Yakima Valley Farmworkers Clinic. Memorial also has brought in additional people to help process applications for our patients.

Again: That website is www.wahealthplanfinder.org. Or you can call 1-855-WA-FINDER or 1-855-923-4633.

Or go to Memorial’s website at yakimamemorial.org

 

 

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