BY KENNETH WELLS
If you have not acquired health insurance previously, you have until midnight Mar. 31 to do so. Since we live in Oklahoma, and our state government rejected the Patient Protection and Affordable Care Act, aka, ObamaCare, one may still be required to purchase health insurance if he/she falls within the act’s financial guidelines.
Due to Oklahoma State Insurance Commissioner John Doak’s rabid dislike for the ACA, there has been little information provided locally regarding available assistance to sign up on the Federal Insurance Marketplace.
It seems the commissioner is more interested in pandering to his political base than assisting Oklahomans to meet even the minimum insurance requirements of the Affordable Care Act.
For example, he has failed to apprise you that there are 73 different agencies in Stephens, Grady, Comanche and Carter counties available to assist in signing up for insurance at the Federal Insurance Marketplace.
For individuals, locations and telephone numbers of such agencies can be found at https://LocalHelp.healthcare.gov.
The Federal Insurance Market Place offers 24-hour, seven-days-per-week customer service at https://www.healthcare.gov/contact-us/ to assist individuals in starting or finishing their applications. The individual is also able to compare plans, enroll or request other information about insurance.
The small business owner with 50 or fewer employees, applying through the SHOP Marketplace, should use https://www.healthcare.gov/contact-us/. Agents and Brokers can also use this website.
Health insurance is like vehicle insurance or job-related accident insurance. It helps you pay the doctor and hospital if you are sick [without having to have an accident]. Benefits of health insurance plans may be reviewed through the Marketplace at https://www.healthcare.gov/get-covered-1-page-guide-to-the-health-insurance-marketplace/. To determine what free preventive care each plan covers search https://www/healthcare.gov/what-are-my-preventive-care-benefits/.
Who can afford a three-day stay in the hospital because of illness when the national average cost is $10,000 per day? The cost of a broken leg can cost as much as $7,500. Health insurance will pay some of incurred costs.
The total amounts one will have to pay hospital/doctor bills involve deductibles, co-insurance or co-payments. The amount of the deductible stipulated in your insurance plan will determine the costs you will have to pay for your accident or illness. Once that deductible is paid, the insurance company starts paying on balances due.
If your plan calls for a co-payment, that will be a fixed amount one will pay for each medical incident. For example, the individual might have to pay $25 for a doctor’s office visit that costs $150. The plan may be one that has a co-insurance clause. In that case, the insured must pay a fixed percentage of the total amount charged for a medical procedure.
The above-mentioned plans will pay for covered care above specified amounts for the rest of the year. This is called “out-of-pocket maximums.”
Health plans can no longer establish dollar amounts on the limits they will pay out each year or for your lifetime. After reaching your “out-of-pocket maximum” the insurance company must pay all covered medical care with no additional limits.
Only people under 30 years of age – and some low-income individuals who are exempt from paying a fee – can get a “catastrophic plan” through the marketplace. These plans cover essential health benefits but require much higher deductibles.
Most catastrophic plans do not cover prescription drugs or preventative inoculations. Premiums are lower, deductibles are higher; thus, the individual will pay thousand of dollars before full coverage is attained.
If you mail in a paper application and don’t receive a call from the marketplace within seven days, call 800.318.2596 to finish your enrollment by phone.
Do not be ashamed to ask questions with whomever you speak, whether it is someone at the federal marketplace or a local navigator. That is why they are there – to help you!
– Kenneth Wells lives in Ratliff City, OK, and is an occasional contributor to The Oklahoma Observer. His essays appear in newspapers across southwestern Oklahoma.