Navigator: Insurance mandate comes with subsidies, protections

Sign-up required for most by March 31

jgaines@macon.comJanuary 15, 2014 

  • Affordable Care Act enrollment

    To search for and compare health insurance plans, go to www.HealthCare.gov.
    Consumers can enroll by phone at 800-318-2596. The hearing-impaired can get teletypewriter assistance at 855-889-4325.
    To find a local navigator for assistance, call 855-899-6092.

Buying health insurance as required by the Affordable Care Act, often called Obamacare, is like using vacation-booking services such as Travelocity, a navigator helping people sign up for coverage told a Macon audience Wednesday.

People can enter their needs and wants online and get a list of available options and costs, said Yoshi Barber, lead Georgia navigator for the national nonprofit agency Seedco. She spoke to the League of Women Voters during the group’s monthly meeting at the Brickyard at Riverside Golf Club.

“ACA is just putting consumers back in charge of their health insurance,” Barber said.

Georgians can use the federal “marketplace” to buy coverage or do so on their own. But subsidies are available for most buyers through the marketplace, she said. Seedco is the leading agency in a 15-member consortium that received a $2.1 million federal grant to help Georgians sign up for insurance coverage.

Five private insurance firms have agreed to sell insurance in Georgia through the federal marketplace, but not all are doing so statewide, Barber said. In the Macon area, perhaps only Blue Cross/Blue Shield and United Healthcare are offering coverage, she said.

“Some companies don’t want to come to certain areas because there are a lot of sick people there,” Barber said.

The law requires all U.S. citizens older than 18 to have insurance by March 31 or pay a penalty, unless they’re living in a foreign country or are already on Medicare and Medicaid. People making less than $11,490 a year aren’t required to sign up, Barber said. Those people -- including the homeless -- won’t qualify for any insurance and will have to keep seeking care from low-cost or free, usually charitable, providers, she said.

“This program is not all-inclusive,” Barber said. “That’s why we’re really pushing for (Medicaid) expansion in Georgia, because it’s really going to help those people who can’t qualify otherwise.”

Georgia is one of 21 states to refuse expansion of Medicaid, which would cover more than 600,000 additional people in the state. States would get federal subsidies to cover the expansion cost for three years, with those subsidies gradually decreasing afterward.

The Affordable Care Act forbids insurers from denying coverage to people with pre-existing conditions, Barber said. It also allows young people to stay on their parents’ insurance plans up to age 26, an increase of three years, she said.

Companies can no longer cancel coverage without reason, and consumers have a right to appeal denied claims, Barber said.

For people with pre-existing conditions, paying a higher premium for a plan with a low deductible probably is a good idea, she said. Generally healthy people, however, would be better off opting for low premiums and higher deductibles, Barber said.

“You either pay up front or you pay on the back end,” she said.

The law ends the limit on lifetime claim coverage, which was typically $1 million, Barber said. And when insurers seek a premium increase, it must be announced in advance and a good reason given, she said.

Preventive care such as mammograms is covered at no cost to the consumer, while insurers can no longer charge extra for unplanned out-of-network care such as an emergency room trip while traveling, Barber said.

One woman, who later refused to give her name but said she spent 35 years in the insurance business, asked Barber what profit margins insurance companies made before the law passed.

“It was very high,” Barber replied. “Upward of 75 percent.”

The woman disputed that, saying insurance companies made profits of just 2 to 4 percent.

“When the big stir came up about the enormous profits, they showed the numbers,” she said.

In 2010, British newsweekly The Economist quoted various sources putting the average insurance profit margin at 3.3 percent. But it said raw profit isn’t a good measure of financial return on the work put into providing insurance. A better gauge would the return on invested capital, measuring how much it takes to set up and run an insurance firm, according to The Economist. That return rate worked out to 16.1 percent, higher than most other sectors of the economy, the magazine said.

To contact writer Jim Gaines, call 744-4489.

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