Three years after Congress approved the Affordable Heath Care Act, millions of people will be able to shop for health insurance coverage beginning Tuesday through what are known as exchanges or marketplaces.
The new law, also known as Obamacare, is intended to provide health insurance options for individuals and families who dont have access to affordable health plans. In Georgia alone, more than 1.85 million people are uninsured, according to the U.S. Census.
Consumers will be able to find out if they qualify for a financial subsidy to help them pay for their premiums as well as compare plans based on pricing, quality and benefits. Plans cover a comprehensive set of benefits including doctor visits, hospital stays, preventive care and prescriptions.
No one can be denied coverage because of a pre-existing condition.
Tuesday begins the six-month-long open enrollment period that runs until March 31. Coverage begins as early as Jan. 1. Everyone who can afford health insurance is required to have minimum coverage in 2014 or pay a fee.
To learn more about the new health plan, go to www.HealthCare.gov for English and www.CuidadoDeSalud.gov for Spanish.
However, those wanting to learn more about their options and what they need to do to sign up will have access to trained professionals called navigators.
Two groups in Georgia received federal grant money in August to hire and train navigators who will be available to provide face-to-face help to consumers. Navigators will be able to guide people through various options, help determine if they qualify for subsidies and assist them in enrolling in the exchanges.
The University of Georgias College of Family and Consumer Sciences and its Cooperative Extension Service received a nearly $1.7 million grant to help people navigate the health care maze.
The grant was used in part to hire 12 navigators, 11 of whom have been sent across the state to set up in county extension service offices. Each of those navigators is responsible for helping people in several counties, and the 12th navigator has statewide responsibilities.
Two navigators who will serve several midstate counties each are in Johnson and Upson county extension offices.
We are doing educational outreach to make sure people have the information they need in order to go to the marketplace and compare insurance policies that are available to them and make choices about their health insurance policies, said UGAs Deborah Murray, associate dean for extension and outreach.
(Navigators) will be available to work with church groups and libraries, a lot of different organizations in the communities of the counties that they serve, she said. Were already gotten many invitations to work with different organizations to do outreach.
As of Friday, no workshops had been set up in Middle Georgia, but as meeting places are set up, the media will be notified, Murray said. If an organization wants to set up a workshop, they should call 877-762-8442.
Tuesday, people can go to any county extension office to get handouts about the new insurance plan, but navigators may not be able to provide one-on-one help then, she said.
If they need individual assistance right now, we cannot do that until we get the license from the state insurance commissioner, Murray said. We expect (the licenses) to arrive very soon, and (navigators) will be able to give the personal assistance to sit down with someone and work with them.
Navigators in Georgia are not allowed to recommend one health plan over another or give advice about the benefits, terms and conditions of marketplace health plans.
The navigators will be in place to help people until August 2014, which is when the grants run out. Even after the March enrollment period ends, some life-changing events -- such as marriage, divorce, births or deaths -- could require people to make changes to their insurance plan.
Various plans offer consumers choices
Georgia consumers will have an average of 50 qualified health plan choices from at least two health insurance companies. While people in some areas of the state have more than two companies to chose from, residents in Middle Georgia have two choices: Blue Cross Blue Shield and Humana.
Plans in the marketplace are categorized as platinim, gold, silver and bronze, depending on the share of costs covered. Adults under 30 also will have the option of buying a catastrophic plan.
Premiums are usually higher for plans that pay more out-of-pocket medical costs. For example, under the gold plan, people will pay a higher premium but may have lower costs when they go to a doctor or hospital. A bronze plan will likely have a lower premium, but a person would have to pay a higher share of the costs when getting care.
Since Georgia policymakers did not set up health insurance exchanges in the state, consumers must access an exchange managed by the U.S. Department of Health and Human Services.
Gov. Nathan Deal and Insurance Commissioner Ralph Hudgens have opposed the insurance exchange program and continue to speak out against it.
Most people buying insurance in the exchanges will be eligible for federal subsidies in the form of tax credits, which will cut their costs considerably. The tax credits will be available for eligible residents who earn between 100 percent and 400 percent of the federal poverty level.
Estimated premiums through the marketplace for someone living in Macon, based on a calculator created by The Henry J. Kaiser Family Foundation, are:
A single adult with no children and making $25,000 a year would have an unsubsidized monthly premium of $234, a government tax credit subsidy of $144 a month for a total monthly premium of $90.
A household with two-adults with income of $40,000 a year and two children 20 years old or younger would have an unsubsidized monthly premium of $829, a government tax credit subsidy of $665 a month, with a total monthly premium of $164.
People shopping for health insurance should not only consider the premium price but also which medications are covered and which doctors and hospitals are available with a plan.
Some people might come to the marketplace and learn they are eligible for Medicaid, UGAs Murray said. If thats the case, the online system would make the consumer aware of that.
Medicaid is a medical assistance program that helps people who cant afford medical care pay for some or all of their medical bills. It currently covers 1.5 million low-income and disabled Georgians.
Georgia opted out of the Affordable Care Act provision that would have expanded Medicaid in the state, which would have covered about 650,000 more people.
Anyone who does not get health coverage will have to pay a fee in 2014, with some exceptions. The fee is 1 percent of the yearly income or $95 per person for the year, whichever is higher.
The fee increases every year. Someone who pays the fee will not get any health insurance coverage, and they will be responsible for 100 percent of their medical care costs.
After open enrollment ends March 31, no one can sign up for health insurance through the marketplace until the next annual enrollment period.
To contact writer Linda S. Morris, call 744-4223.