The only insurance company which the federal Affordable Care Act will allow to sell health insurance in the 11 counties in the Southwest Arkansas Rating Area is attempting to take the confusion out of the new law.
The only insurance company which the federal Affordable Care Act will allow to sell health insurance in the 11 counties in the Southwest Arkansas Rating Area is attempting to take the confusion out of the new law. Blue Cross Blue Shield Southwest Region Executive Leann Rogers presented an overview of the impact of the law recently at Wadley Regional Medical Center at Hope, admitting that neither she nor her company know everything about the impact of the new law. “This is an incredibly complicated law that is 2,700 pages in length,” Rogers said. “This is very complicated and not everybody knows everything about it.” But, Rogers said, the basic impact of the law is that it will require every human being in the United States to purchase some form of health insurance. She said that aspect of the law was settled by the U. S. Supreme Court, which ruled that the originally conceived “penalty” of the law for those who failed to participate was actually a “tax” under the law. She said that tax, which will be automatically withheld from any income tax refund, will amount to one percent of an individual's adjusted gross income or $95, whichever is greater. U.S. citizens already covered by Medicaid or Medicare, or U. S. military veterans covered by Tricare, are automatically exempt from the tax provision of the law. The law is basically built around two factors, Rogers said, including residence and income. Eligibility for Medicaid under the expanded Medicaid law in Arkansas is also a factor, she said. But, for most people who have private coverage or employer-based coverage, whether they will be required to buy new insurance through the state Medicaid or federal enrollment system is based upon the extent of their current coverage and whether that coverage was purchased prior to March, 2010. Rodgers said that, in most cases, health insurance coverage purchased before March, 2010, which does not change either in coverage quality or premium payments, will be “grandfathered” under the new law. However, any changes whatever in the coverage or premium cost of insurance, whether purchased before March, 2010, or not, will automatically render the policy void under the new law. “The all-metallic plan benefits have been determined and set by the federal government, and there is no deviation from that,” Rogers said. Consequently, she said Blue Cross Blue Shield recommends that individuals with “grandfathered” policies keep them intact. But, should anything change, Rogers said policyholders should contact an insurance professional with Blue Cross Blue Shield, since it is the only insurer allowed to sell new policies in Sevier, Howard, Little River, Miller, Hempstead, Lafayette, Nevada, Columbia, Ouachita, Union and Calhoun counties. “Once you give up a grandfathered policy, you cannot get it back,” Rogers said. Another change Rogers explained is based upon what is known as a “tax household,” or the number of people who are declared as dependent on an individual IRS Form 1040, based upon the adjusted gross income of that individual. “That's where you go to determine if you're eligible for a federal subsidy,” Rogers said. Once an individual accesses the enrollment website or speaks to a representative by telephone, that eligibility will be one of the first things determined, she said. Rogers recommended having an insurance professional assist in the process. “Most people, unless they are really computer savvy, don't want to navigate it by themselves; it's not a bad idea to get help,” she said. Under the Arkansas Health Improvement Plan, individuals can determine whether they are Medicaid eligible, first by whether they are a non-pregnant adult with a “tax household” income below 138 percent of the Federal Poverty Level. Rogers said that provision and the exclusive nature of Blue Cross Blue Shield's coverage helps simplify the process. “In South Arkansas, we are the private pay option,” she said. “Really, this is what is getting people enrolled. People who haven't had insurance before may not understand that they can get coverage.” Rogers said Blue Cross Blue Shield will walk individuals through the process. “If you're eligible for the private option through Medicaid, you don't have to enroll through the federal website,” she said. Rogers said once an individual enrolls through Medicaid, they should wait for a confirmation letter from the Arkansas Department of Human Services before completing the remainder of the enrollment/purchase process. Medicare recipients should also know that the so-called “donut hole” age barrier will be closed by 2020, under the law, she said, and that supplemental policy coverage is not eligible for tax credits under the law. She said most people who are employed by companies with 50 or more employees will likely see no change to their insurance plans, depending upon whether the company has qualified to “grandfather” its employee coverage. “If you are on a grandfathered policy through a large employer, you're probably not going to see a lot of change,” Rogers said. She said smaller employers may face changes because of new benefits under the ACA. “When you have new benefits, you have new costs; that probably means your share of that premium will go up,” Rogers said. Currently, Rogers said, there are about 500,000 Arkansans without health insurance, of which some 250,000 will likely be eligible for Medicaid, and another 200,000 will be eligible for some form of federal insurance premium subsidy, and the remaining 50,000 will be required to purchase insurance without subsidies. Rogers referred questions to Blue Cross Blue Shield customer services at 870-773-2584, 800-470-9621, or at healthadvantage-hmo.com or blueadvantagearkansas.com online.