With federal, state and private exchanges up and running, now's the time to enroll

By Greg Grisolano, staff writer

The clock is ticking toward the end of the open enrollment for health insurance under the Affordable Care Act. If you are not already enrolled in a public or private health care plan or do not have health insurance through an employer-provided plan, the deadline is approaching to purchase coverage or risk paying a tax penalty.

Rick Welsh, president of Welsh and Associates, a Kansas City-based health care and insurance consulting business that works with OOIDA’s Medical Benefits department, has one piece of advice for those looking for coverage: Don’t put it off.

“The prudent thing to do would be to take action well before the end of this open enrollment time, because we don’t anticipate another postponement. The prudent thing to do is to get signed up, at the latest by the first of March.”

The deadline for enrolling in health insurance is March 31. The penalty for not having insurance in 2014 is $95 per person ($47.50 per child under 18), or 1 percent of your yearly household income, whichever is greater. Unless your yearly household income is less than $9,500, you can expect to pay much more than $95 in tax penalties.

“There’s plenty of time; the systems are working, even the federal exchange works,” Welsh said. “We don’t anticipate another postponement because everything is working now. But if you wait until the very end, you’re going to have a problem. I would not do that. I’d do it in the first half of March (at the latest). Before March 15, just so you don’t put yourself in any jeopardy of not getting it booked.”

Both Welsh and members of the OOIDA Medical Benefits Department said they have seen a high volume of call inquiries. They said they expect the numbers to increase as the deadline draws closer, creating the potential for a huge backlog that could jeopardize an individual’s enrollment.

“There’s more calls coming in than they can handle every day,” Welsh said. “We’re having to call people back, but a lot of folks are still not pulling the trigger buying because they’re going to put it off to the point that they absolutely have to do it. They don’t want to spend the money.”

Welsh said the risk in waiting until the deadline to enroll is, “once March 31 passes, you’re done.”

“You’re going to have to wait until next year, unless you have a qualifying event,” he said.

Qualifying events include marriage, divorce, loss of insurance through job loss. Another qualifying event unique to the Affordable Care Act will be moving from one state to another.

“The one caveat that the ACA has added is if you do move, from one state to another geographically, because there’s certain areas of the country that have plans available and if you happen to move, that obviously changes. The plan you have may not be in place, or there may be more choices that you didn’t have before,” Welsh said.

OOIDA’s private insurance exchange is up and running in six states with multiple carriers, including Assurant, Humana, and most of the local Blue Cross and Blue Shield affiliates.

The six states in the Association’s pilot program are Illinois, Indiana, Kansas, Missouri, Ohio and Texas.

Brenda Smith, OOIDA Medical Benefits manager, said agents in her office are “quoting and taking enrollments hand over fist, basically.”

“If you’re having trouble getting hold of us, please leave a message, send an email, and let us know,” she said. “We will get back with you. We’re having people come in on Saturdays (to deal with backlog).”

Smith said the Association is working to set up an online enrollment portal similar to the federal and state exchanges, where members can enter their information and get quotes directly from OOIDA’s insurance partners.

“We are going to set up a link on the OOIDA website, where they can go in and set up quotes on their own,” she said. “And we’ll always be here to help and to service them.”

While the exchange is set up for six states, Smith said members from most other states can still call and get quotes for private insurance policies through OOIDA partners. Assurant, for example, underwrites policies in 41 states.

Smith said New York and New Jersey are two states where residents have no choice but to go through the state or federal exchange. Private exchanges are not authorized under those states’ laws.

Customers who purchase health insurance through a private exchange such as OOIDA’s are not eligible for federal tax subsidies. In order to qualify for the subsidies, insurance must be purchased through state or federal exchanges. Furthermore, those applying for subsidies must fall between 133 percent and 400 percent of the federal poverty level in order to qualify.

The Kaiser Family Foundation offers an interactive subsidy calculator on its website, kff.org/health-reform/, to help determine whether an individual or family may qualify for the tax break.

Consumers with questions are encouraged to call the HHS call center at 800-318-2596 or visit HealthCare.gov where they can find local help. Agents in OOIDA’s Medical Benefits Department are also available from 7:30 a.m. to 5:30 p.m. CST, Monday through Friday at 800-715-9369 or via email, at medben@ooida.com. LL