WARSAW — If you need help comparing plans or filling-out an application on the Health Insurance Marketplace, Lutheran Health Network KCH is once again offering free assistance during Open Enrollment, Nov. 1  through Jan. 31, 2017.

Appointments may be made with the hospital’s certified assisters by calling (574) 372-7818, or can be booked online.

The Affordable Care Act (ACA) was passed in 2010, and this year’s Open Enrollment marks the fourth annual campaign to extend healthcare coverage to citizens who would otherwise be uninsured. More than 13 million people enrolled in Marketplace plans for 2016.

News of several large insurers either reducing their participation in the upcoming Marketplace, or exiting it altogether, has spurred concern about rising premiums (monthly fees) and higher deductibles (predetermined amounts of healthcare expense an individual pays before health plan coverage “kicks in”.)

However, Kaiser Health News (KHN) reports the majority of enrollees will be insulated from premium increases, since eight in 10 receive subsidies based on income/household size. (As premiums rise, subsidies increase.) KHN also projects any changes to premiums or deductibles will vary widely state-to-state, and in some instances, even county-to-county, since the number of insurers in each location influences competitive pricing, and insurers continuously enter-and-exit different markets.

“There are always questions concerning changes to premiums, deductibles and out-of-pocket limits before Open Enrollment launches each year,” explains Kirk Ray, CEO, Lutheran Health Network KCH. “This will always be the case as insurers enter and exit different markets. But what is consistent, year-to-year, is the value of the Marketplace. Millions of people are able to sign up for insurance who otherwise wouldn’t have access to care, or who would face a financial crisis due to medical bills.”

Majority of enrollees will receive assistance

To help make health insurance affordable, the government uses household income to determine who is eligible for financial assistance. This aid might include advanced tax credits to help pay for premiums, or discounts on co-pays and deductibles. As in past years, a majority of enrollees are expected to qualify for some type of financial support in 2017. Individuals who are re-enrolling on the marketplace are encouraged to re-evaluate and compare plans, as the lowest-cost option can change from year to year.

“I think this is where our certified assisters add so much value,” says Ray. “They know how to explain the pros and cons of each option, and they carefully screen each person to make sure any subsidies toward premiums, or any discounts available for deductibles or co-pays, are accessed.”

All health plans on the Marketplace must offer a comprehensive set of benefits, and coverage cannot be denied for individuals with a pre-existing health condition. Some of the health benefits include free preventive care and wellness services; doctor visits, prescription drugs, hospital and emergency department care, lab services, pediatric services and mental and behavioral health treatment.

Penalties

Individuals who are eligible for health insurance who do not purchase coverage not only pay a penalty when filing their tax return, but they also forfeit financial help with healthcare expenses throughout the year. The penalty is either 2.5 percent of family income or a predetermined flat rate, whichever is higher. The 2016 penalty was $695 per adult, $347.50 per child, with a maximum fee of $2,085; these fees will be adjusted for inflation in 2017.

Medicaid

Medicaid is a joint federal-and-state program which covers healthcare expenses for individuals within specified income brackets. In an effort to offer healthcare coverage to more citizens, many states, including Indiana, have expanded Medicaid eligibility so more people can qualify. The certified assisters at Kosciusko Community Hospital can help you determine if you qualify for Medicaid.