Mercy Health Love County - News

Obamacare Explained, Deadlines Looming

Posted on Friday, December 13th, 2013


Want Obamacare Plan for All of 2014? Enroll by December 23
By Barbara W. Sessions
Chair, Love County Community Coalition
The enrollment deadline for eligible people who want health care coverage under the Affordable Care Act (Obamacare or “ACA”) for all of 2014 is fast approaching.
December 23 is the last day to enroll in an Affordable Care Act marketplace plan and have help paying medical bills at the earliest possible date, which is January 1, 2014.
In-person assistance in selecting an ACA plan and enrolling is available at Big Five Community Services in Marietta. Call 276-3154 for an appointment. Federally-trained plan navigators under the Affordable Care Act are on duty to assist.
Other sources of information or assistance are the hospital business office in Marietta and the independent insurance agent Melodie Schaffer of Pearman Insurance in Thackerville. Schaffer is a certified agent under the Affordable Care Act.
There is no charge for in-person assistance from any of the offices named above.
Alternatively, consumers can go to or call the enrollment help line at 1-800-318-2596.
People who already have health care coverage, such as Medicare, Medicaid, Veterans, Tribal, or employer plan do not enroll in the Affordable Care Act. The facts in this story do not apply to them. They should take no action except to share the following information with their uninsured loved ones and friends.
The ACA applies to citizens under age 65 who have no health insurance or, if they have a personal health insurance plan, purchased on their own, choose to find better coverage or lower rates under the ACA.
Census records indicate 2,500 uninsured people in Love County.
After December, for each month an uninsured person subject to ACA waits to enroll, coverage for 2014 is delayed by one month. The last date to enroll for coverage in 2014 is March 31.
After March, enrollment for 2014 ceases and the person still uninsured would be liable for a penalty when they file their tax return for 2014. The uninsured person’s next opportunity to enroll would be in the fall of 2014 for coverage that would begin in 2015.
The penalty does not apply if the person had income for 2014 that was too low to qualify for a subsidy under an Affordable Care Act plan. (Under $11,490 for one person; or under $23,550 for a family of four, for examples).
Under ACA, those individuals should be declared eligible for Medicaid. But Oklahoma’s Governor and Legislative leaders have not yet consented to expand Medicaid to bring them in, even though the federal government pays 100% of the costs of expansion for the next three years before gradually leveling out at paying 90% of the costs against the state’s 10% in 2023 and beyond.
The Oklahoma Hospital Association has advocated for expanded Medicaid to reduce hospitals’ level of uncompensated care.
Twenty-five other states already have expanded Medicaid. For now, low-income adults in Oklahoma are left with no new options – neither being placed in Medicaid nor able to afford the full cost of coverage under an ACA plan.
At the subsidy level is where the Affordable Care Act earns its name. Most uninsured working people in Love County do have incomes that will qualify them for a subsidy that will reduce their monthly plan premiums. (Examples of incomes that qualify for a subsidy are: Between $11,490 and $45,960 for an individual, or between $23,550 and $94,200 for a family of four).
Plans with subsidies are being offered by Oklahoma insurance companies that are competing for business in the ACA marketplace of plans at They include Blue Cross/Blue Shield of Oklahoma, Coventry Health and Life, and GlobalHealth.
These companies are competing on premium price in four tiers of plans -- bronze, silver, gold, and platinum. Altogether, their average premiums, taking into account all 37 plans they are offering across all age groups and regions of Oklahoma, are fourth lowest in the U.S. 
Most single adults will find bronze plan coverage for under $100 a month, after subsidy, with lower-income adults paying substantially less than $100 a month, some near $0.
Participants in an ACA marketplace plan will have health insurance that shares payments with them on their medical expenses, and most services are covered: doctor’s visits, hospital stays, surgery, therapies, maternity care, and prescriptions.
Mental health care is covered and will be treated as any other medical event. Substance abuse treatment also is covered. All plans provide a number of free well-care visits and free screenings, such as mammograms.
Essentially, in the worst case, an insured person is protected against catastrophic medical expenses that are the source of 80% of bankruptcies in the U.S.
At the same time, the insured person’s hospital, doctor, or other provider will be receiving from the plan at least 60% to 90% of what they are owed, rather than having to provide totally free care or pass along losses to other consumers who do have insurance.
A broad purpose of ACA is to get everyone into the “pool” of insured people from any source so that shared risk can function to maintain or reduce the cost of coverage for consumers across the board.
The Affordable Care Act website at is the site to visit to apply for insurance and select an ACA marketplace plan. There, an applicant will learn the exact amount of their subsidy.
By seeking in-person assistance at Big Five, an independent insurance agent, or the hospital, an applicant will be guided through the website or fill out a paper application.
But before making an appointment or going to the ACA enrollment page, there are web tools a person can review to receive a preview of what their subsidies and plan costs might be.
It is recommended to look at the following sites; they are readily accessible without delay:
A. Preview Your Likely Subsidy
Your subsidy reduces your premium.
Enter your age, income, and family size. (Enter the actual number of dependents in your household, even if you plan to insure only yourself). Your approximate annual subsidy will be shown. Divide by 12 to get a monthly amount.
 B. Preview Your Plan Premiums
See prices for the 37 Oklahoma plans in the ACA marketplace.
Note: Plan prices shown are pre-subsidy. Subtract your estimated monthly subsidy in A. from the monthly premium in B. to determine a more accurate net monthly cost for each plan.

(This article will be saved on the hospital website, More articles with details about the Affordable Care Act will follow from January-March 2014).