Deadline Looms For Health Insurance

This Friday, December 15 is the last day of the healthcare open season that began November 1. The Affordable Care Act, “Obamacare,” is still the law of the land. Everyone, regardless of job status, must renew or sign up for minimum essential healthcare for 2018 or be subject to a penalty, unless eligible for an exemption. 
‘Minimum essential’ means that plans must meet 10 conditions, including outpatient and hospital care, preventive care, maternity and newborn care, prescription drugs, lab, rehab, mental health and substance abuse programs, etc., and pay 60 percent of covered charges.
Benton County residents with incomes between $16,240 and $64,960 who have not yet done so may get help to enroll, or they may wish to complete the process themselves by going to, referred to as the “Marketplace,” i.e., a health exchange in each state that has one. Missouri has no state exchange; therefore, the federal exchange serves as its marketplace. 
Note that Medicare Part A, or Medicare Parts A and B coverage meet the minimum essential mandate, but coverage under Medicare Part B alone does not. Recipients of qualifying Medicare cannot use the exchange.
Professional help is available from “assisters” and agents/brokers listed on the website whose offices are within a 45-mile radius of Warsaw. They have all been trained and certified or registered by the Marketplace. A difference between them is that while assisters must remain impartial while explaining plan options, insurance agents can give advice on which plan is in an applicant’s best interest.  
Assisters at Katy Trail Community Health of Harbor Village, 17571 North Dam Access Road, Warsaw are available to Benton County residents.  
Although Suzie Brodersen of State Farm in Warsaw is a Marketplace-registered agent-broker, she belongs to an insurance alliance that does not offer products in Benton County; only in Hickory and two other counties.
There is another option for anyone who would like the advice of an insurance agent, but who does not have time or opportunity to call around or visit offices out of town to find one offering policies for Benton County. The “Get Contacted” link on the home page takes the user to a Help on Demand request form to be filled out and submitted. For assistance from an insurance agent or broker, usually within 30 minutes, submit the form on weekdays between 9 AM and 5 PM. At this point, of course, it should be done right away.
“It is confusing and frustrating for most people,” said Rachelle Fiene, “to understand healthcare requirements.”  Fiene is an assister, and outreach and enrollment manager at Katy Trail Community in Sedalia who helps people understand their options for insurance on and off the exchange. For plans on the exchange, besides income level, family size affects the amount of assistance available as subsidy credits that offset monthly premiums.  
Last year there were four, but this year insurance carriers have pulled out of the exchange, citing losses of millions in revenue and uncertainty about the future. Therefore, Benton County is left with fewer options for 2018. 
Blue Cross-Blue Shield of Kansas City dropped coverage in 32 counties. While keeping group plans, it no longer offers direct pay plans.  BCBS enrollees covered prior to October 2013, however, will remain so.  But for new enrollments, BCBS will offer short-term plans only.  
Only one insurer, Ambetter from Home State Health, will cover Benton County, offering five (5) choices among Bronze, Silver and Gold health plans, all EPOs that must be bought on the exchange.  Only services from “exclusive provider organizations” are covered; consumers must pay 100 percent of charges by healthcare providers outside the limited network.  A provider search on the website will produce names of doctors and facilities within 200 miles of the zip code or location entered. Likewise, a prescription drug search for specific medications produces names of those covered under the five plans. 
“Ambetter is adding providers daily,” Fiene said, “so it is a good idea to call the providers directly to ask if they are on the covered list.”  For example, Katy Trail and Bothwell Family Medical clinics in Warsaw are in the Ambetter network. To date, however, Golden Valley Medical in Warsaw is not.
The exchange is not available for people whose incomes are lower than the exchange minimum or higher than the maximum. Fiene said earners of less than $16,240 fall within the “Medicaid gap” and eligible for assistance from county and community health organizations. They can receive services on a sliding fee scale, with no monthly premiums but copays between $25 - $55. They can apply for financial plans for hospital expenses, and a program to help pay for medications for chronic illnesses, and $4 prescriptions at Walmart. They are exempt from the penalty fees.
Fiene refers people who earn more than $64,960 to private insurance companies. One of her contacts in Sedalia, Kim Horstman of Prueitt Insurance Services, said many higher income earners enroll in short-term (usually three-month) coverage plans and pay the penalties.  Short-term plans do not meet the 10 minimum essential conditions or cover pre-existing conditions.
Another alternative to the marketplace exchange for people on lower incomes, the uninsured or underinsured, is the Public Health division of the Benton County Health Department. 
Tammy Lawler said, “Where should I go?” is the question most people ask. She works with anyone who comes in or calls for assistance, whether to help them on site or to steer them to the right resources. 
“Our primary concern is how to keep people in their homes and as healthy as possible,” she said. 
They provide services under Medicare, Medicaid, the VA, private insurance, donations and memorials. They offer reduced rates, such as tuberculosis shots for $5.00 and children’s immunizations at no cost. People come to the office for their pill and medication boxes to be set up every week. They help with the Women, Infants, and Children (WIC) nutritional supplement program for pregnant women, new mothers, infants and children up to 5 years old.
Latest census data shows approximately 15 percent of Benton County residents do not have health insurance. Some may be eligible for a penalty exemption based on one or more of the following: religious objection to receiving health insurance benefits; illegal immigrant; incarcerated; member of an Indian tribe; individual income in 2017 less than $10,400; family income in 2017 less than $20,800; paid more than 8.16 percent of income for health insurance after deductions, and employer contributions; or eligible for a hardship exemption.
Many are hopeful about the possibility that the healthcare law will change soon, or will go away entirely someday. But for now, for the county’s 85 percent majority who need or want healthcare, the December 15 deadline is real, and nearer than ever.