What You Need To Know About The ACA

What is the Affordable Care Act?

The Affordable Care Act (ACA), also known as Obamacare, is a bill that was passed by Congress and signed into law in March of 2010.  Before, Americans did not need to have health insurance.  With the passing of this law, almost every person living in the United States will have to have health insurance.  This began on January 1st, 2014.

How does the ACA make healthcare better?

Coverage for those with pre-existing conditions
Individuals can no longer be denied from health insurance coverage for having pre-existing conditions!  Examples of pre-existing conditions include HIV/AIDS, diabetes, cancer, or a history of heart problems.  Additionally, insurance companies can only look at your age, where you live, and whether or not you smoke to determine how much your health plan will cost.

No lifetime limits
Your health insurance company will keep paying your healthcare needs no matter how much you need.  There is no lifetime limit and your coverage won’t run out.  Additionally, there are yearly out-of-pocket maximums for the consumer for each plan.

Increased coverage for children
Kids can stay on a parent’s healthcare plan until they are 26 years old.

Covered preventative care for women
Including breastfeeding support, birth control, and well-woman visits.

Better benefits and more preventative care
Yearly checkups are covered.  Many preventative services are also covered such as blood pressure tests, shots, and some cancer screenings.

Expanded Medicaid (Washington Apple Health)
Effective January 1, 2014, Medicaid in Washington State was expanded to include individuals between the ages of 19 up to 65 (parents, and adults without dependent children) with incomes up to 138% of the Federal Poverty Level (FPL) based on modified adjusted gross income.  When you enter your income information into the Washington State Health Benefit Exchange Website, you will know right away if you are eligible for the state's Expanded Medicaid program, called Washington Apple Health.

More opportunities for subsidies
One of the ACA’s main goals is to make sure everyone can afford health insurance.  If you are between 138% and 400% of FPL, you are eligible for “tax credits.”  These tax credits can be applied towards your monthly premium to significantly lower your monthly premium costs.

How do I enroll?

October 1st, 2013 was the opening day of Washington State’s Health Insurance Marketplace also known as a Health Benefit Exchange.  The Exchange is an online marketplace that lets you compare and buy health insurance plans.  The name of our Exchange is “HealthPlanFinder.”

The next Open Enrollment period will be from November 15, 2014 through February 15, 2015.  To apply and enroll, you must log on to www.wahealthplanfinder.org and follow the instructions.  You will then be able to shop for health insurance plans by comparing them side by side, find out how much of a subsidy you can get, and if eligible, you will be enrolled in Expanded Medicaid, also known as Washington Apple Health.

If you qualify for WA Apple Health (Expanded Medicaid), you may enroll at any time.  Also, American Indians and Alaska Natives who are enrolled members of a federally-recognized Tribe or Alaska Native Corporation may also enroll at any time.

If open enrollment is closed, you can still enroll into a Qualified Health Plan if you meet one of the following “Qualifying Events”:

  • You no longer are eligible for WA Apple Health
  • You have given birth to a child, adopted a child, or placed a child for adoption
  • You lose your health coverage for reason other than lack of payment
  • You permanently move to new area where your current plan doesn’t provide coverage
  • Your COBRA coverage ends
  • Your dependent loses their coverage on your employer plan due to age
  • You get married or enter a domestic partnership
  • You get divorced or end a domestic partnership

Can Evergreen pay for my Qualified Health Plan?

Evergreen can pay for your insurance in the Health Benefit Exchange as long as it is not a Bronze-level plan or a Health Savings Account plan (HSA). You must also be enrolled in the Early Intervention Program (EIP). There are three steps involved in selecting a plan in the Exchange and applying for Evergreen to pay the premium.

Step One:
Create an account in the Health Benefit Exchange (www.wahealthplanfinder.org) and select a plan. You want to be sure that your doctor is in-network with the plan that you choose. If you qualify for tax credits, when the HealthPlanFinder asks how you want these tax credits applied, you must choose the default "Apply the full amount monthly" — You do not need to move the 'slider' bar in response to this question. Click on “buy” to select the plan, but do not enter payment as Evergreen will do this on your behalf. Remember that Evergreen does not pay for Bronze-level plans or Health Savings Account plans.

Step Two:
You must link to the appropriate Evergreen Insurance Advocate as your navigator in the Exchange. To determine which Insurance Advocate to select as your navigator, cross-reference your last name with the Insurance Advocates as follows:

  • James Ludwig = A-E
  • Jenea Bradford = F-Maq
  • Beth Navarro = Mar-St
  • Laura Stone = Su-Z and all Spanish monolingual clients

To link to your Insurance Advocate as your navigator in the Exchange, you will click on “Find a Navigator” on your dashboard once your account is created. Next, enter the last name of your Insurance Advocate to search for that person. Your Insurance Advocate’s name will appear and you will see EIP/EHIP beside his/her name. Click on “request help.” Then, you will need to answer the several questions that appear on the next screen, and indicate that you would like an “ongoing relationship.” After that, click on “partner.” Your Insurance Advocate will receive your help request and confirm the partnership. This will enable your Insurance Advocate to receive your invoices and enter payment for your plan.

Step Three:
If you are not yet enrolled in the Early Intervention Program, you will need to complete the dual EIP/Evergreen application and submit it only to EIP. If you are currently an active client with EIP, you can submit the New Enrollment/New Payable application directly to Evergreen.

Glossary of Terms:

Penalty Tax

If you don’t enroll in health insurance in 2014, you will pay additional taxes on your tax return.  These taxes will increase over time.

Open Enrollment

A period of time during the year when people can buy or make changes to a health insurance plan.

Premium

The amount of money you pay each month in order to have health insurance.

Subsidy

The amount of money the government payts to your insurer to help pay your premium.

Co-pay

The set amount of money you pay at the time of certain medical services.

Coinsurance

The portion of your medical bill you pay, for certain services, after you meet your deductible.

Deductible

How much you pay for certain services, in total, before your insurance starts to pay.  How much you pay depends on the plan you purchase.

Out-of-Pocket Maximum

The total amount you’ll spend for healthcare during the year, after which the insurance company pays for all your medical care until the year ends.