2017-11-23 / Editorial

Act now to find best insurance plan that’s available

Legislative Lowdown
by Rep. Martin Grohman

Since the Affordable Care Act Insurance Marketplace opened in 2013, Maine has seen its uninsured rate drop from 11.2 percent to 8 percent, meaning an additional 40,000 Mainers now have health insurance coverage. But this year, Health Care Open Enrollment is shorter than ever (Nov. 1 to Dec. 15), so now is the time to act. Call the Consumers for Affordable Health Care helpline at 1-800- 965-7476 to get started.

Health care has become very controversial. However, the options are better this year than they have been in some time. The number of plans is down a little, but the amount of subsidies is up. If you’ve got coverage already, you aren’t required to shop around, but you should. Plans and prices change frequently. You might be able to find a cheaper plan that pays for more. And this is the only time of the year when you can change plans. A family of three could save as much as $10,000. Anyone with an income under $60,000 will qualify for some sort of support. Because of some changes this year, most people who qualify for tax credits can get bronze plans for zero dollar premiums, and other plans are more affordable than ever – so even if you’ve checked before, now is the time to look again. You can sign up after this limited open enrollment window, but you will not qualify for subsidies.

It is important to make sure your current plan is the one that best fits your health needs, budget and most importantly is based off of your expected 2018 income. That’s income minus deductions, so you have time to plan: there’s almost 16 months till the end of next year’s tax time. Plan options are getting better, too: some silver plans cover chiropractic services, acupuncture, vison and even a gym membership.

And you should carefully check the plan networks. Are the doctors you prefer in network? Specialists? Local hospital? Also check on whether (and how) the plan covers any medications you are taking. And if you live on the Maine border and your doctor is across state lines, does your insurance cover their services?

I find one of the most overlooked health plan options is the Small business Health Options Program plan. It is for small employers, with as few as one employee or as many as 50, who want to provide health and/or dental insurance for themselves and their employees. I have met many selfemployed people that couldn’t save under the individual Marketplace plans, but would under the SHOP plans. Providing benefits to your employees is wonderful to be able to do, and if an employee makes less than $50,000 and your business pays the health insurance premium, you can get a tax credit of 50 percent toward the cost of that insurance.

It’s also important to update your income information to make sure you are receiving all the financial assistance that you qualify for. Perhaps you got a raise, moved to a new location, or increased your retirement savings. If you have coverage now and don’t shop around, you will be auto-enrolled into the same plan for 2018. But with changes in your income, you might become eligible for a different and possibly better plan.

Although there was a recent successful referendum regarding Medicaid expansion, the new rules are not in effect yet. That means, unfortunately, that single adults at some income levels – generally right around full time at minimum wage – cannot obtain Medicaid yet. In the meantime, though, you may still qualify for other health insurance coverage based on projected 2018 income, and many financial planners can help you look at options that will help you become eligible. Possible measures include increasing your retirement savings, paying tuition, covering moving expenses, or other steps to help you qualify.

You can do all this on your own by visiting healthcare. gov to search through different plans available to you. But if the thought of picking insurance on your own is overwhelming, there are health insurance navigators all over the state waiting to provide free help to anyone who asks for it. Remember, this stuff is complicated, and nobody expects you to know all the ins and outs: that’s why folks get special training to become health insurance experts to help you navigate your options.

Free local help is available but booking fast. Don’t wait until the deadline to start the process. Maine has a great organization called Consumers for Affordable Health Care which specializes in sorting out health care challenges. As your first step, call their help line at 1-800-965-7476 for information, answers and to get connected to free local help.

To sum up, if you don’t sign up for a health plan by Dec. 15, you may not be able to get health insurance in 2018. If you don’t have insurance, you might have to pay a fine when you file your taxes. That fine is currently $695 or 2.5 percent of your total household income – whichever is higher. So if you are eligible for one of the no-cost bronze plans, it’s definitely a good financial choice – not to mention a better option for your health care protection and peaceof mind – to enroll for health care coverage this year. And even if you don’t qualify for help paying for coverage, you may qualify for exemptions from the penalty, or find other options for care and coverage.

If I can connect you with a health care navigator, I would be pleased to do so – please don’t go without coverage because the process is daunting or confusing.

Happy Thanksgiving to you and yours!

Rep. Martin Grohman of Biddeford is an Independent State Representative serving his second term in the Maine Legislature and is a member of the Criminal Justice and Public Safety Committee. Marty hosts a podcast for Maine entrepreneurs called The Grow Maine Show. Find it on Apple Podcasts and Google Play, and sign up for legislative updates at www.growmaine.com or facebook.com/repgrohman.

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