Open enrollment for health care marketplace closes Saturday

ALBANY — As the open enrollment deadline approaches for individuals or families planning to take advantage of a marketplace health plan through the Affordable Care Act, officials in the Albany area working directly with people in the region are encouraging those who need health care coverage to apply.

Tony McCullough, outreach and enrollment manager with Albany Area Primary Health Care, said the deadline is Saturday, and that anybody who is “lawfully present” in the United States can apply, choose to purchase a plan or ask about assistance through subsidies to meet their needs in prevention care, basic health services and prescriptions.

“Anybody can apply,” she said.

Jane Gray, revenue cycle vice president at Phoebe Putney Memorial Hospital, said that the plans — which also cover shots and screenings — have changes in them from last year. She said the subsidies can be good for someone who believes they need it.

“It is really important to have health care coverage to protect you,” she said.

McCollough said that there are some cases in which the subsidies will result in individuals having to pay little if anything for their coverage.

“There are cost-sharing subsidies available to those who don’t even realize (they might qualify),” Gray said.

Gray said persons intending to apply for a plan ought to do so by Saturday, but there will be exemptions for those who have major life changes such as the birth of a child or a marriage.

“You have to re-enroll if you did it last year,” she said. “If you get married or have a child, you can enroll (outside open enrollment), but this is the only time everyone can enroll.”

Depending on which county in Georgia a person lives, insurance providers Ambetter, Peach State Health Plan, Alliant, Anthem Blue Cross Blue Shield and Kaiser will be the carriers an individual gets coverage from. Gray said many insurance brokers sell on the exchange, but that the process on the marketplace website has been simplified from prior years.

“In prior years, it would take hours (to enroll on the website),” she said.

Benefits will take effect on Jan. 1. Standalone plans, medical plans and dental plans — but no vision plans — are available. Plans are available on “Gold,” “Silver” and “Bronze” levels. The “Gold” plans generally have the highest monthly premiums, while “Bronze” have the lowest.

Gray said the subsidies start on the “Silver” level. She also said that, since Georgia is not a Medicaid expansion state, there is an income requirement.

McCollough said questions regarding costs and who can apply are the ones applicants in the Albany area are asking about the most.

“I always tell people it doesn’t hurt to apply,” she said.

A single-person household income cutoff is $12, 500, while it is $160,000 for a family of eight.

“People may not think they qualify when they do,” Gray said.

Gray advised those getting coverage through the marketplace to remember to hold on to their 1095-C forms when they file their taxes to make sure their refund does not get kicked back. She added that it is important to maintain the monthly premium payments and report any changes to the insurance company.

Gray added that, even with the controversy attached to the health care law, it is a good thing for many families with limited options — or even the single person working part-time who does not have benefits.

“Access to care is very important,” she said. “It provides people access to care they may not otherwise have. I think it will improve care of the community.”

Health coverage can be particularly critical when someone requires specialty care. Individuals who do not get the health care they need can easily develop complicated health problems.

“I have seen some individuals who have major health problems and concerns,” McCollough said.

For plan years through this year, those who can afford health insurance but choose not to buy it may pay a fee called the individual Shared Responsibility Payment. Starting with the 2019 plan year, for which people will file taxes in April 2020, the Shared Responsibility Payment no longer applies.

The fee no longer applies to those who do not have coverage during 2019. Individuals do not need an exemption in order to avoid the penalty, the Centers for Medicare and Medicaid Services says.

The benefits individuals apply for will be in effect for the whole year. They do cover pre-existing conditions.

Anyone in the Albany area needing more information can visit healthcare.gov, call 1-800-318-2596 or call Albany Area Primary Health Care at (229) 888-6559.

Jennifer Parks