Health insurance site to open without fanfare
The federal Health Insurance Marketplace will go live Tuesday, bringing the country one step closer to full implementation of President Barack Obama's Affordable Care Act.
And then. . .what?
The marketplace is one of the most anticipated sections of the health care overhaul bill (or dreaded, depending on your political bent), but as best we can tell there will be no ribbon-cutting or confetti cannons to commemorate its opening.
It's much less dramatic.
Sometime after midnight, a new section of www.healthcare.gov will become available to the general public. Anyone can log on, fill out some financial information and quickly find out their health insurance options.
If you don't make much - about $32,000 for a West Virginia family of four - the website will help you sign up for Medicaid.
Everyone else will be directed to another section of the website, where they can compare a variety of health insurance plans and then sign up.
"Practically, that's about the gist of it. It's supposed to be a very streamlined process," said Jeremiah Samples, assistant to state Department of Health and Human Resources Secretary Karen Bowling. "It's not an enormously time-consuming process."
If you already have health insurance and are satisfied with your coverage, there's no reason to log onto the marketplace. However, even people with insurance can use the website to see if lower-cost options are available.
Those purchasing health insurance through the marketplace will have eight to 10 different plans to choose from, Samples said, all provided by Highmark West Virginia Blue Cross Blue Shield.
Some plans will cost more than others, providing varying levels of health coverage. Highmark will follow up with each customer after they've selected and signed up for a plan.
Before any tax credits are applied, the average monthly premium for a midrange plan will cost $331 per person, compared with $328 nationally. In West Virginia, Highmark also will offer a lower-cost plan for an average of $280 per person.
Averages can be misleading, though: People can have dramatically different costs based on their circumstances.
Tax credits are based on income, age, location, benefit plan and family size. Tobacco use affects the bottom line, too, and West Virginia has the nation's highest smoking rate: Nearly 29 percent of adults smoke, according to the U.S. Centers for Disease Control and Prevention.
People can choose from four levels of coverage - bronze, silver, gold and platinum.
All provide the same benefits, and all cap annual out-of-pocket expenses at $6,350 for an individual, or $12,700 for families. The big difference is cost sharing. Bronze covers 60 percent of expected costs; silver, 70 percent; on up to platinum at 90 percent.
Bronze plans have the lowest premiums; platinum have the highest.
Anyone making less than 400 percent of the federal poverty level (somewhere around $46,000 for a childless, unmarried West Virginia resident) will be eligible for a special government subsidy to help pay for that health insurance.
For Medicaid-eligible users, the website will send a notice to the state Department of Health and Human Resources, which will then enroll that person in the government health insurance program.
Coverage through plans purchased in the marketplace will begin as early as Jan. 1.
While there's no deadline to sign up for Medicaid, open enrollment for other health plans ends on March 30.
Several groups have received grants from the U.S. Centers for Medicare and Medicaid Services to hire "navigators," which will help citizens sign up for health insurance through the marketplace.
You do not need a navigator to sign up, however. Most people will be able to complete the process by themselves.
If you have difficulty signing up for health insurance or are confused about the process, you can call the Centers for Medicare and Medicaid Services at 1-800-318-2596, or chat online at www.healthcare.gov.
Samples said staff members at each of the DHHR's county offices also have been trained to answer questions about the health insurance marketplace and help people sign up.
DHHR has not hired extra workers for the marketplace rollout.
"We've been working very hard," Samples said. "We're going to be trying to use technology and maximizing our existing resources to get through this."
DHHR is expecting three major rushes on the marketplace website: Tuesday, Jan. 1 and around the end of March.
Samples said people probably would flock to the marketplace as soon as it opens this week. Then, once health insurance begins after New Year's, interest will be renewed.
He said the final rush would come around March 31, as people realize they are running out of time to sign up.
To lighten the load on the marketplace website and make it easier on consumers, DHHR has in recent weeks sent out 118,000 auto-enrollment letters to families that are eligible for Medicaid insurance.
"All they have to do is send in that letter, check a box and we will enroll them in Medicaid," Samples said.
About 40,000 people have already signed up for Medicaid through the auto-enrollment letters.
Anyone not signed up for some kind of health insurance after March 30 will be subject to a penalty through the Internal Revenue Service.
That penalty will start small - $95 per person, or 1 percent of household income, whichever is greater - but will increase significantly in 2016, to $695 per person or 2.5 percent of household income.
That penalty will continue to increase in subsequent years according to a formula determined by the IRS.
There are exemptions. Those who cannot afford coverage and those who are experiencing hardships won't have to purchase coverage. Anyone who qualifies for Medicaid under the new law but lives in a state that refused to expand its Medicaid program also is exempt.
Among the other exempt groups are Native Americans who are eligible for care under a separate program, illegal immigrants, prisoners and members of a health care sharing ministry. There is also a religious exemption.
Some portions of the health care marketplace will not be available Tuesday.
A section of the marketplace where small business owners were supposed to be able to shop for health insurance won't go live until Nov. 1, at the earliest.
Republicans in the U.S. House of Representatives have attempted to stall the marketplace's opening by threatening a government shutdown if funding for the Affordable Care Act remains in place.
President Obama said in a speech last Friday the marketplaces would continue to operate even if the federal government shuts down while Congress works out a budget deal.
The Associated Press contributed to this report.