'Straight Talk’ on Health Care Exchange

Peter Hoffman

By Jacqueline Thomas

Julie Mortier, 66, a retired Valparaiso teacher and school administrator, is one of a half-dozen AARP volunteers working to educate Hoosiers about the federal Affordable Care Act (ACA).

She talks to groups around the state—mainly made up of seniors—about the changes they can expect in January. Often, she is able to calm their fears that the system “is going to collapse.”

Among the most frequent questions: “How much more will it cost?” “Will I be able to go to any doctor I want?”

She explains that choice in doctors will be maintained. She also emphasizes that Americans are already paying for care for the uninsured—not just in dollars but in lost productivity.

For people ages 50 to 64, the ACA offers affordable insurance coverage, particularly for the uninsured. For those covered by Medicare, the ACA will expand their benefits by gradually closing the Part D prescription drug “doughnut hole” on out-of-pocket expenditures.

Compare coverage, cost

Beginning this month, Indiana residents and small businesses can choose from among several plans offered through the health insurance marketplace, also called an exchange, where consumers can compare coverage and premiums and sign up for a policy.

For more information about the plans, consumers can visit the HealthCare.gov website or call a 24-hour hotline at 800-318-2596.

There is much confusion about the ACA in Indiana, notes Sarah Waddle, AARP Indiana associate state director for advocacy.

Thus the need for the “straight talk” Waddle says the volunteers and staff are providing to groups around the state. To request a speaker, call toll-free 866-448-3618 or email IN@aarp.org. AARP Indiana also produces a biweekly newsletter that can be obtained by an email request.

In 2011, roughly 13 percent of Indiana residents ages 50 to 64, or more than 172,000 people, were uninsured, according to an AARP Public Policy Institute report.

The ACA will help close the gap. Among the law’s goals are to make coverage more affordable, expand Medicaid, improve health care quality, reduce costs and promote preventive care.

Gov. Mike Pence (R) opposed expanding Medicaid, saying he favors a plan that would give the state more control. If the state had expanded Medicaid, 69,000 low-income residents ages 50 to 64 without insurance could have been covered, said Katie Moreau, AARP Indiana communications director.

Indiana has also chosen not to set up its own health insurance exchange, a key mechanism of the ACA, where people can shop for insurance plans and compare costs and benefits. Hoosiers, instead, will participate in an exchange operated by the federal government.

 Four levels of coverage

Plans on the exchange must cover basic health care such as doctor visits, hospital stays and prescription drugs. Insurers can’t charge a copayment for preventive care such as mammograms, Pap smears and blood pressure or cancer screenings.

The plans come in four levels—bronze, silver, gold and platinum—with bronze considered basic coverage, silver standard and gold and platinum higher coverage with higher premiums.

The ACA prohibits insurers from denying coverage or charging higher premiums based on preexisting medical conditions, a person’s gender or occupation. Adult children are able to stay on their parents’ insurance until age 26.

Older people who buy private insurance before they are eligible for Medicare at 65 can’t be charged more than three times the rate of younger customers’ premiums. People who enroll by Dec. 15 will have coverage on Jan. 1. People who enroll later will receive coverage about a month after they sign up.

Individuals with income up to about $46,000 or a family of four with income up to about $94,000 may qualify for a subsidy that can be used to lower monthly premiums or taken as a credit on their federal income tax returns.

Hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance. This toll-free service will help answer questions, and starting this month it will provide personalized assistance for callers who are filling out their application or selecting a plan.

The ACA requires most Americans to have health insurance next year or pay a penalty of at least $95 on their federal tax return.

Go to healthlawanswers.org for more information about how the ACA can affect you.

Jacqueline Thomas is a freelance writer based in Indianapolis.