8 tips to know for Affordable Care Act Open Enrollment


The enrollment period for health insurance coverage under the Affordable Care Act is shorter than in years past, beginning Wednesday and ending Dec. 15. With that in mind, understanding the coverage and getting help in the enrollment process is more critical than ever. Insure Georgia is a nonprofit, federally funded organization aimed at helping individuals gain access to affordable health care. It is currently offering several free events in the Middle Georgia area to assist in understanding and obtaining health insurance. You can find a list of the scheduled events below but here are several frequently asked questions and things to keep in mind before sitting down with a health insurance navigator.

Q: What is a health insurance navigator?

A: A health insurance navigator as defined by healthcare.gov is a licensed individual or organization trained to help individuals, families or business owners understand and secure the best health care coverage plan for them. They can assist in eligibility, enrollment forms and general questions and concerns. They are different from insurance brokers or agents because their services are completely free and they do not receive a commission.

Q: What is the Health Insurance Marketplace?

A: The health insurance world is full of acronyms and lingo that can be overwhelming if you’re not an insurance expert. To avoid any confusion, make sure to ask your navigator what exactly this program is and what it can do for you. Briefly, the Health Insurance Marketplace is for people who do not otherwise have health insurance coverage, either independently, through their employers or through a federally subsidized program such as Medicare, Medicaid or Children’s health Insurance Program. It can also provide eligible households with a lower monthly insurance rate or a lower deductible and co-payments in order to make health insurance accessible for everyone.

Q: What does my income have to do with it?

A: Eligibility for a lower insurance rate depends on your expected income during the coverage year. Annual incomes must fall between 100 percent and 400 percent of the Federal Poverty Guidelines in order for people to receive discounted coverages. For the state of Georgia, 100 percent of poverty is considered to be an annual income of $11,880 for a single individual and increases by $4,140 for each person in the household. The maximum income for a poverty rate of 400 percent is considered $47,520 per year for a single individual and increases by $16,560 for each additional person in the household. During the last enrollment period, eight out of 10 people who applied qualified for some type of discount or assistance in paying for their health insurance plan. Be sure to ask your navigator how to estimate your income and who qualifies as a part of your household. These factors can determine your eligibility and cost of coverage.

Q: What if I don’t qualify for any help or discounts?

A: If your income falls outside of these ranges, you can still purchase health care insurance in the Health Insurance Market Place at full price. Your income does not affect your ability to apply for a health insurance plan.

Q: What types of coverage can I get?

A: There are a number of health insurance plans to choose from in the Health Insurance Marketplace depending on the type of coverage you are looking for and the health insurance needs of your household. Currently, the Health Insurance Marketplace offers three levels of plans based on the percentage of coverage: bronze, silver and gold. Bronze covers roughly 60 percent of health care costs, while silver and gold cover 70 and 80 percent respectively. Talking through these levels of plans with your navigator will allow you to choose the right plan for your needs.

Q: What is Cost Sharing Reduction?

A: Cost sharing reduction is a supplemental discount that can be applied to plans in the silver level in the Health Insurance Marketplace. It covers additional health care costs and reduces deductibles and co-payments. Eligible households have an annual income between 100 percent and 250 percent of the Federal Poverty Guidelines. Ask your navigator if you qualify for this extra discount.

Q: How do I apply?

A: You can apply for a health insurance plan through the Health Insurance Marketplace in several ways. To apply online, you will need to make an account and fill out the application at healthcare.gov. To apply by phone, call the Health Insurance Marketplace at 800-318-2596, 24 hours a day, 7 days a week. To apply by mail, you must download, print and fill out the paper application from the healthcare.gov website. To apply in person, you can contact one of the many assisting organizations in your area and schedule an appointment or attend one of the Insure Georgia. To find organizations near you, visit healthcare.gov and enter your zip code.

Q: What happens when if I decide not to enroll?

A: If you decide to forgo purchasing a health insurance plan through the Health Insurance Marketplace and do not have coverage independently, through your employer or from one of the federally subsidized programs, you face the penalty of a fine. The Shared Responsibility Payment, as it is called, is $750 for adults, $250 for children or 2.5 percent of your household income above your tax return bracket.

Health Coverage Assistance events

Baldwin County

Ms. Stella’s Restaurant, 10 a.m.-6 p.m. Monday

Collins P. Lee Harrisburg Community Center, 9 a.m.-1 p.m. Nov. 11

Central Georgia Technical College, 9 a.m.-5 p.m. Dec. 4

Macon-Bibb County

Shurling Library, 10 a.m.-6 p.m. Friday

Macon Memorial Gym, 10 a.m.-2 p.m. Nov. 18

Shurling Library, noon-7 p.m. Dec. 7

Macon-Bibb County Health Department, 9 a.m.-5 p.m. Dec. 15

Houston County

Centerville Public Library, 10 a.m.-6 p.m. Nov. 10

Nola Brantley Memorial Library, 11:30 a.m.-7:30 p.m. Nov. 20

Perry Public Library, 11:30 a.m.-7:30 p.m. Dec. 5

Houston County Health Department, 8:30 a.m.-4 p.m. Dec. 8

Jones County

Jones County Health Center, 9 a.m.-5 p.m. Nov. 7

Jones County Health Center, 9 a.m.-5 p.m. Nov. 11

Laurens County

Laurens County Library, 2 p.m.-6 p.m. Thursday

Laurens County Library, 2 p.m.-6 p.m. Nov. 13

Monroe County

Monroe County Library, 10 a.m.-3 p.m. Dec. 9

Peach County

Thomas Public Library, 9:30 a.m.-5:30 p.m. Nov. 27

Twiggs County

Twiggs County Board of Education, 10 a.m.-2 p.m. Wednesday

Twiggs County Board of Education, 1 p.m.-6 p.m. Nov. 30