If you have not yet enrolled in health insurance under the federal Affordable Care Act (ACA), there is still time - but not much. In less than two weeks, on March 31, the enrollment period will close for 2014. Those who are not signed up by that date could face financial penalties when they submit their tax returns for 2014.
It also means they will not have another opportunity to enroll in a plan until November, and that coverage will not become effective until January 2015. A few exceptions to the March 31 deadline are possible for people who have proof of a major, life-changing circumstance such as losing a job, having a baby or a change in marital status.
Not everyone is required to sign up through the Health Insurance Marketplace, however. This includes people on Medicare, Medicaid, private insurance and those who are covered through their employer.
Illinois residents can determine if they need to purchase insurance and then begin the sign up process at www.GetCoveredIllinois.gov (which includes a Spanish-language version). The website offers a simple screening process that leads users either to the federal Marketplace website or the state’s new Medicaid eligibility site, ABE.illinois.gov (Application for Benefits Eligibility).
Information is available by phone at the Get Covered Illinois Help Desk, phone (866) 311-1119. Operators are available each day from 8 a.m. to 8 p.m.
Help is also available nearby at the Community Health Partnership/Youth Service Bureau, 1007 Main St., Mendota. Their staff members have been specially trained to help people with the sign up process. Walk-in hours are offered on Wednesdays from 10 a.m. to 4 p.m. and Sundays from 10 a.m. to 2 p.m. throughout the month of March. People may also call (815) 539-6124 or (815) 538-4684 for an appointment other days of the week.
Kim Abel, a registered nurse and co-founder of Trinity Healthcare Free Clinic in Mendota, said they have been encouraging their clients to sign up ever since enrollment began last October. Abel said one of their most utilized services has been providing high-cost prescription medications to their clients. The clinic had been receiving the medications free from the drug companies but that program is about to stop. “They aren’t going to be giving us free drugs any more, the expensive ones you could sign up to get, because people can get insurance now,” Abel explained. “We have people whose drugs cost $1,000 a month.”
So far, Abel said she has heard only positive reports from clients who have signed up for health insurance through the Marketplace. “Our people are low income, the working poor, so we’re not hearing horror stories about signing up. They’re thrilled,” she said. “For $100 a month, they can get their doctor, hospital and and meds covered.”
As of March 11, numbers from the U.S. Department of Health and Human Services (HHS) showed that for the first five months of enrollment, 113,733 people had enrolled in the Illinois Health Insurance Marketplace. In addition, approximately 200,000 people enrolled in Medicaid under the ACA totaling more than 313,000 Illinois residents who have gained access to health care as a result of the state’s enrollment efforts.
The HHS report also found that more than 246,000 people have started the enrollment process on the federal website and been found eligible to purchase a plan. Of the 113,733 who purchased a plan, 77 percent have been eligible for a subsidy to help pay for the insurance. The report shows that in Illinois, about 54 percent of those enrolling are women, and that the percentage of young people aged 18 to 34 signing up is 25 percent, the same as the national average.
Individuals and families with an income between 138 percent and 400 percent of the federal poverty level, (a maximum of $45,960 for individuals and $94,200 for a family of four) may be eligible for financial assistance if they obtain coverage through the Marketplace. Those with income below 138 percent of the federal poverty level ($16,104 for individuals and $21,708 for couples) may be eligible for Medicaid.
Even though the Trinity Healthcare Free Clinic provided a valuable service to people with no other access to healthcare, its scope was limited. “We had doctors that could provide basic care but we couldn’t find specialists to do anything for free,” Abel said. “Our doctors did an excellent job but we couldn’t do everything for people.”
Although the clinic is still running, Abel said there is not as much demand as there had been. “I don’t know if it was the bad weather this winter that kept people away but we are only holding a clinic once a month right now and we had been having it every week,” she said.
Abel said a big frustration for her has been the amount of misinformation surrounding the ACA. “I think the health care law is good - if I were writing the bill, I would have written it differently - but at least we’re going to get moving and try something different,” she said. “I went to school 35 years ago and they were talking about a healthcare law then. I thought this would never happen.”
One of the big positives Abel sees with the law is disease prevention, which will save everyone money in the long run. “It’s so important,” she emphasized. “If we can prevent strokes and other diseases it will save us all money . . . that’s my dear hope.
In America it seems to me that basic healthcare should be something we all agree is good and we want to share just like food and clean water,” she added. “It’s what America is all about.”
What is the penalty?
Most Americans are required to have health insurance in 2014. Those who do not will pay a penalty collected by the Internal Revenue Service (IRS).
The penalty in 2014 is calculated one of two ways. You will pay whichever of these amounts is higher:
1 percent of your yearly household income. (Only the amount of income above the tax filing threshold, $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average yearly premium for a bronze plan.
$95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.
The way the penalty is calculated, a single adult with household income below $19,650 would pay the $95 flat rate. A single adult with household income above $19,650 would pay an amount based on the 1 percent rate. (If income is below $10,150, no penalty is owed.)
The penalty increases every year. In 2015, it is 2 percent of income or $325 per person. In 2016 and later years, it is 2.5 percent of income or $695 per person. After that it will be adjusted for inflation.