Finding Affordable Health Insurance

By Dennis Wilson

Debbie Little Eagle, 57, is the full-time caretaker for her disabled 61-year-old husband, but she has diabetes and pulmonary problems of her own. She worked full time as a waitress in Independence until her health forced her to cut back to part time in 2000. By going part time, however, she lost her employer-provided health insurance.

She quit her job altogether in 2007 to take care of her husband, David Scurlock, who is disabled after a series of strokes. Scurlock receives health coverage from the Department of Veterans Affairs, and his wife receives a small stipend from the VA as the sole caretaker for her husband.

Little Eagle is looking forward to January when she will be covered by health insurance made available by the Affordable Care Act (ACA). She said it was “awesome” that she now can afford coverage.

Beginning this month, Missouri residents and small businesses can shop for and compare plans offered through the health insurance marketplace, also called an exchange. People who enroll by Dec. 15 will have coverage on Jan. 1.

Explaining the health law

Brian Colby, policy director for the Missouri Health Advocacy Alliance, said the marketplace is a mix of “TurboTax and Travelocity” in that applicants can go on the website HealthCare.gov,  input their personal data, and review the range of plans—and their costs—that are available to them.

To help people like Little Eagle figure out the process, AARP Missouri staff and volunteer Ron Sergent have been going into the community to explain various aspects of the health law. For example, it opens coverage to people with preexisting conditions; closes the Medicare “doughnut hole” in coverage for medications; and makes coverage more affordable for small businesses and their employees.

“There is so much misinformation out there about what the Affordable Care Act does, we need to educate the public about what the law actually does,” said Norma Collins, AARP Missouri advocacy director.

“Anywhere we get an invitation to speak, we’ll go there,” Collins said. To request an AARP speaker, call 866-389-5627 toll-free.

State officials estimate that 850,000 residents who now lack coverage will be eligible to enroll in a health insurance plan.

About 160,000 Missouri residents ages 50 to 64 lacked health insurance in 2011, according to an AARP Public Policy Institute report. Of those, about 64,000 could have qualified for Medicaid, if the state had agreed to increase the program’s income eligibility threshold.

Basic coverage

The insurance plans offered through the marketplace must cover basic health care such as doctor visits, hospital stays and prescription drugs. They cannot charge a co-payment 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.

Consumers can also call a 24-hour telephone hotline—800-318-2596—to learn more about the enrollment process and the insurance plans. Trained “navigators” and certified counselors are available to provide one-on-one assistance.

Individuals with income less than about $46,000 or a family of four with an income less than 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 return.

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

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

Dennis Wilson is a writer living in St. Louis, Mo.