Local agents field Obamacare questions
With the controversial “Obamacare” rolling out - or trying to - this month, Bethel-area health insurance agents have been getting plenty of questions.
Policies obtained under the Affordable Care Act go into effect Jan. 1. People can sign up online at healthcare.gov, but continuing problems with the website have left many frustrated.
Last Thursday about 30 people turned out to hear a real person - W.J. Wheeler Co.’s Mike Newsom - do a presentation at Telstar on health insurance options.
Newsom held a similar event in the South Paris area, with about 50 people attending.
“The turnout has been great,” he said.
Newsom provides information and then encourages people to get their policies through him, which he said comes at no additional cost to the consumer.
The Telstar group, according to a show of hands, was comprised mostly of people who currently have individual plans, with representation as well from uninsured people and those who have (or had) employers offering insurance. Many were middle-aged, with some younger people mixed in.
During the 90-minute meeting, Newsom led them through the basic structure of ACA - the individual mandate to buy insurance, tied with guaranteed issue and no denial of coverage for a period of time for pre-existing conditions; the timetable for enrollment; penalties for not enrolling; eligibility for federal subsidies for individual/family plans (determined by income); maximum premium payments; and out-of-pocket expenses.
He also described the ACA’s requirements and incentives for businesses to offer insurance to employees.
Drawing many questions was the ACA’s cap on how much individuals or families would be required to pay toward annual premium costs, and toward annual out-of-pocket expenses.
He said some people currently on an individual plan could see their premium costs go down, while others would go up. Because of new requirements to provide expanded coverage, people who currently have high-deductible plans will be “forced into better coverage.”
Maximum out-of-pocket amounts can vary, but would never be more than $6,350 per individual, Newsom said.
He noted some features of the ACA that he said would leave his listeners “shaking their heads.”
One was the case of a family that makes barely over the limit for a subsidy and is not eligible. The abrupt cut-off of subsidies creates an incentive not to earn just over the limit, he said.
Another was the effect of Maine’s refusal to expand Medicaid as part of the ACA. For states that expand it, people making under $11,490 would be eligible for Medicaid and would not need to seek private insurance. Those making more, and meeting other income and household guidelines, would be eligible for a subsidy.
But because Maine chose not to expand, the lowest income people are not eligible for any subsidy and would therefore have to pay the full premium price, while those making more get help paying the premium.
The people below $11,490 would not be required to buy insurance, however, and could still get charity care at hospitals, Newsom said.
“Every hospital administrator I talk to wishes they would expand [Medicaid],” he said, on the theory that “something is better than nothing.”
Some people at the meeting with variable income wondered about the requirement to estimate their income, in order to determine if they are eligible for a subsidy.
Newsom said the estimate must be done for each year. People in the lowest income group who overestimate, or others who underestimate, could end up having to pay back the subsidy amount at tax time.
Newsom also fielded questions about people who get coverage for themselves through their employer but must pay the entire premiums for family members, if they add them to the employer's group plan.
He said family members who are eligible for such coverage, but for whom the premium is too high to pay, would be ineligible for federal subsidies under the individual plan. So if the family would otherwise be eligible for a subsidy, they would be better off if the employer didn't offer coverage to the employee's dependents, he said. (However, if the family is not subsidy-eligible, then the dependents are better off getting coverage through the employer, if affordable, because those premiums are tax deductible, whereas individual premiums are not.)
Newsom said that currently, medical costs are the leading reason for bankruptcy filings in the U.S. He was asked if he believed that would change with the new $6,350 out-of-pocket annual maximum.
“My guess is it will have an impact but will not eradicate it,” he said, noting for some people that maximum figure would still help drive them to declare bankruptcy.
As for the difficulty enrolling on the federal website, Newsom said he has been encouraging people to fill out a paper application.
He said after the meeting that he has helped about 30 people enroll for insurance so far.
Another local insurance agent, John Rothwell of the Varney Agency, has also been busy.
“I’ve been getting a lot of inquiries for individual quotes,” he said.