Health insurance marketplaces open Oct. 1

By Amy Geier Edgar

As an AARP Wisconsin volunteer, Jim Senderhauf has faced numerous questions from older people concerned about how they will be affected by the Affordable Care Act (ACA).

The answer is that there is a range of benefits. For example, older people who buy private insurance before they are eligible for Medicare can’t be charged more than three times the rate of younger customers’ premiums.

For those covered by Medicare, the ACA gradually closes the “doughnut hole” in Medicare Part D prescription drug coverage. Medicare beneficiaries do not have to apply for new insurance.

For everyone, the ACA prohibits insurers from denying coverage or charging higher premiums based on a person’s preexisting medical conditions, gender or occupation.

It also eliminates most annual and lifetime coverage caps. Adult children are able to stay on their parents’ insurance until age 26.

The law requires insurance companies to cover preventive health services such as colonoscopies, mammograms and flu shots, without charging for copayments and deductibles.

Two dozen volunteers
“AARP is making the ACA a priority in getting this information to people … and will strive to be a leader as a resource for ACA information,” said Senderhauf, 70, of Oshkosh.

He is one of roughly two dozen volunteers who have been trained to give presentations about how the ACA works and its benefits, said Lisa Lamkins, federal advocacy director for AARP Wisconsin.

Beginning Oct. 1, people will be able to enroll in a private health insurance plan through a federally run marketplace by going online at HealthCare.gov, by calling 800-318-2596. Customer assistance will be available 24 hours every day. Information can also be obtained from the state Office of the Commissioner of Insurance (OCI) website, oci.wi.gov.

Volunteers from some nonprofit groups and other organizations are being trained as “navigators” to provide guidance on using the insurance marketplace, but will not advise people which plan they should select.

AARP will not have navigators, but AARP Wisconsin volunteers will distribute information about the ACA at senior fairs, exhibits and senior centers and through television, radio and social media.

The health insurance plans are scheduled to be available for the public to study this month. Because some health insurers in Wisconsin provide coverage on a regional basis, the federal marketplace will likely follow a similar pattern, said J.P. Wieske, legislative liaison and spokesman for the Office of the Commissioner of Insurance.

Half-million uninsured
About 500,000 people are uninsured in Wisconsin, including roughly 100,000 ages 50 to 64, according to an AARP Public Policy Institute report. Of those 100,000, about 37,000 could have been covered by Medicaid if Wisconsin lawmakers had not voted against expanding Medicaid eligibility.

Coverage for those enrolled by Dec. 15 will begin Jan. 1. People who enroll later will receive coverage about a month after they sign up.

Low- and middle-income people may qualify for a subsidy. For example, subsidies will be available for single people with no dependents who earn up to about $46,000 and for families of four with an income of up to about $94,000.

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

Groups can request a trained AARP volunteer speaker by calling toll-free 866-448-3611, ext. 56309, or going to aarp.org/wi for a speaker request form.

“By cutting through the myths and delivering the facts, we can help ensure that the benefits of the ACA are understood and fully utilized,” said Sam Wilson, AARP Wisconsin state director.

For more information about the ACA, go to healthlawanswers.org.

Amy Geier Edgar is a freelance writer living in Racine, Wis.