ACA help offered
ZELIENOPLE — Without help, understanding the Affordable Care Act and the federal government’s Health Insurance Marketplace can be a daunting task.
“The federal government realized that the Marketplace might be kind of overwhelming and difficult to maneuver,” said Jennifer Grybosky, a Marketplace navigator whose job it is to help people understand the program.
Grybosky, an employee of Mental Health America of Westmoreland County who is paid by a federal grant, is one of several Navigators assigned to 23 counties in Western Pennsylvania.
Along with fellow navigator Sue Gaffron, she spoke at an informational seminar Monday for about 20 people at the Zelienople Public Library.
The program focused on the upcoming open enrollment period for the Health Insurance Marketplace that will run from Nov. 15 to Feb. 15. Uninsured people who don’t qualify for Medicaid can enroll by creating an account on the healthcare.gov website.
Healthcare.gov, which crashed and caused problems during last year’s inaugural open enrollment period, has been retooled and redesigned to work more effectively, Grybosky said.
“It should go much smoother this time,” she said.
Changes to the site include the ability to view the available plans without having to enter in any personal information and to make an account.
People who don’t receive insurance through an employer also can enroll and receive tax credits based on annual income and other factors.
To have the insurance coverage go into effect by the first of a month, the insured needs to sign up between the first and 15th day of the previous month.
Starting with tax returns for 2014, everyone must show proof of health insurance or they will be assessed a fee. The fee for 2014 is $95 or 1 percent of the yearly household income. In 2015 the fee will increase to $325 or 2 percent of the yearly household income, whichever is larger.
For uninsured people who are skeptical about the program, Grybosky offered advice: “Don’t just ignore, don’t just assume it’s too expensive to get insurance.”
People also can enroll through the Marketplace at any time if they qualify for special enrollment. Qualifying events for that include losing a job, getting married or having a child.
The plans and rates offered in the area through the Marketplace will be announced shortly before the open enrollment period begins. There will be four providers: Highmark, UPMC, Healthcare America and a fourth company, which has not yet been announced, she said.
One factor Butler County residents need to consider is that patients with Highmark/Blue Cross Blue Shield insurance will either be barred from treatment at UPMC facilities or be treated as an out-of-network patient, due to an ongoing dispute between the two providers.
Though Highmark will have the least expensive plan offered in the Marketplace, some people may want to opt for a UPMC or another plan if they know they will want to use UPMC doctors and facilities, she said.
Grybosky said she has scheduled about 40 informational seminars in the region. She also is available for individual consultations, which typically take about an hour and a half, or she can talk with people over the phone.
To reach the navigators for the region, call 855-274-5626 or e-mail westernpanav@mhawc.org.
