It would be fair to say that the Affordable Care Act has taken a beating since the new health-insurance exchanges were launched Oct. 1.
But Obamacare keeps moving down the track, with another milestone just a week away.
If you don’t have health insurance or the plan you have is being canceled (and you don’t want the one suggested by your insurance company), you need to act now. That’s because Dec. 23 is the last day to enroll in a plan if you want coverage that starts on Jan. 1.
Knowing that a lot of anxiety and frustration have surrounded the implementation of Obamacare, we offer five things you should know that can help you enroll in a health-care plan.
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1. Make sure you’ve calculated whether you qualify for a subsidy to help pay for the insurance or for Medicaid.
To figure this out, you first should gather all your income and deduction information to help determine the magic number — the Modified Adjusted Gross Income, or MAGI.
That includes everything you would report on your income-tax return, plus some others. To make sure you haven’t missed anything, a list at the University of California, Berkeley Labor Center website may help.
You can also find a paper Application for Health Care Coverage online at the Washington State Health Care Authority site. Be sure your total income includes any interest income, which the state paper form inexplicably does not include.
Get a sense of whether you do, might or absolutely do not qualify for a tax credit/subsidy. In general, subsidies are available to individuals earning less than $45,960. The cutoff for a family of four is $94,200.
The Washington Health Benefit Exchange suggests using the anonymous browsing feature on the Healthplanfinder site rather than the calculator; it says the browser function is a more accurate and state-specific tool based on actual silver-plan rates for different regions and ages.
If you clearly don’t qualify for a subsidy, you might want to skip the Healthplanfinder website, which lists only the plans whose premiums can be reduced with tax credits. You can see those plans and non-exchange plans on the state Office of the Insurance Commissioner (OIC)’s site.
Finally, go to the insurer’s site listed at the OIC site and look at some of the details for the plan you like, such as deductibles, restrictions and the plan’s prescription-drug formulary.
2. The Healthplanfinder website and customer support center have seen their share of problems, but they have managed to deal with hundreds of thousands of users, applicants and enrollees.
We’ve been checking the availability and responsiveness of the Healthplanfinder site, where you can enroll in an exchange health plan. Since it recovered from a tough week of outages and other problems — and resumed service last Tuesday — the site has been regularly available and free of delays.
The Washington Health Benefit Exchange says it is refraining from implementing major code changes before Dec. 23 to eliminate the chance of introducing new glitches.
The call center, however, has not been as smooth an experience. When we tried to reach it Monday morning, we weren’t even offered the option of being put on hold. Instead, we were advised to try later.
According to the exchange, the number of customer-service representatives helping applicants with problems or questions was increased to 286 on Monday.
In the meantime, the call center continues to “throttle” calls — advising callers to try at a different time, and then hanging up — in order to allow more flow for those already in the queue. According to the Washington Health Benefit Exchange, the call center has been receiving up to 25,000 calls a day.
3. If you need help getting through the sign-up process, consult an insurance agent or broker, or an in-person assister.
Government and private websites have tools and tables to help you compare insurance plans, but it can still be tough to sift through your options and successfully enroll.
Luckily, there are in-person assisters and insurance agents or brokers who can lend a hand. They are free — but serve different roles.
An in-person assister, also called a navigator, is trained to help people maneuver within Healthplanfinder. They can’t recommend which plan will best meet your needs, nor can they tell you about specific insurance options outside of the exchange. They can help you answer questions about eligibility for subsidies, resolve website error codes and compare insurance plans.
The state awarded grants to community organizations who trained a fleet of assisters, and health-care providers such as hospitals often have assisters available to help. You can find a list of the grant-receiving organizations on the Washington Health Benefit Exchange site.
You also can find an in-person assister by entering your ZIP code on the Healthplanfinder website.
Brokers are licensed professionals who can help people shopping for insurance in the individual market inside or outside the exchange. They typically are paid a commission by insurance companies for selling their plans, and can legally advise you on which plan matches your budget and health-care needs.
You can search for a broker through the Healthplanfinder site or through the Office of the Insurance Commissioner. The brokers in the Healthplanfinder search have gone through training for the exchange. The OIC site also allows you see if a broker has been investigated or received any disciplinary orders, and to learn which insurance companies the brokers represent.
4. It could be that getting help directly from the insurer will work for you.
You can call an insurance carrier directly and get help if you’re enrolling in a plan outside the exchange.
And in at least one instance, those considering an exchange plan can find help at a carrier. Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington, have a call center staffed with agents who are trained and licensed to enroll consumers directly into the companies’ plans both inside and outside the exchange marketplace.
If you’re fed up trying to get through to Healthplanfinder’s overloaded call center, the Premera/LifeWise call center might be a welcome alternative.
People who call Premera and LifeWise can typically expect to wait between two and 10 minutes to get through to a live agent, according to spokesman Eric Earling. But wait times do vary, Earling said.
5. The exchange and insurance carriers are discussing contingency plans to help those who can’t meet the deadline.
If you find it impossible to enroll in coverage through Healthplanfinder by Dec. 23, there may be hope of alternative ways to go.
Officials at the Washington Health Benefit Exchange said over the weekend that they are in discussions with carriers and regulators about possible contingency plans in case thousands of would-be enrollees are stuck without coverage for Jan. 1.
Exchange Chief of Staff Pam McEwan told the exchange board Thursday the exchange is having discussions with insurance carriers and the insurance commissioner’s office about potential ways to help people.
One option under consideration would be to allow consumers to complete enrollment and make a first premium payment in January for coverage that would be retroactive to Jan. 1.
Board Chair Margaret Stanley said to McEwan, “In the world of health insurance, retroactive enrollments are not unheard of. Is that a possibility?”
“It’s one possibility that’s being discussed,” McEwan said.
Exchange CEO Richard Onizuka has since said the exchange staff is waiting to hear from insurance carriers whether such a delay would be feasible.
Contributions for this story came from Seattle Times health-care reporter Carol M. Ostrom and freelancers Lisa Stiffler, Patrick Marshall and Amy Snow Landa. The story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.