Ready for New, Affordable Health Insurance Coverage Options coming this October?

By Roberta Riley

Ever since an HMO canceled my coverage in the middle of my long battle with cancer 20 years ago, I've been keeping a close eye on health reform efforts. Like me, you might be wondering how to cut through all the spin about the Affordable Care Act (“Obamacare”), to find out: How is the new law going to affect me, and my friends and neighbors?

I'd like you to meet Heather and Carrie.  Though they lead very different lives, both women’s lives will change when open enrollment for Affordable Care Act coverage begins this October 1st.  Join us today, and in coming posts, as we explore what the new health insurance options will mean for Heather, Carrie and maybe even you. 

Heather

Young and brimming with energy, Heather is an artist extraordinaire. From her perch at Canary Salon on Broadway in the heart of Seattle's Capitol Hill neighborhood, she greets clients of all ages and sensibilities.  Whenever I am tormented by a bad hair day, I step into her cheerful salon, and emerge uplifted, transformed by yet another of Heather's personalized creations. 

Heather takes the time to make her clients feel their best, but she must skimp on her own needs.  Fortunately, at 28, she enjoys good health and gets her birth control and Pap smears at Planned Parenthood. 

She’s looked into health insurance in the past, but realized the monthly premiums cost more than a doctor visit—yet she still would have faced high deductibles and fine print. That doesn’t work for Heather, since she’s still paying off her student loans, and now that she's opened her own salon, she's paying business startup costs. 

Why should a young, healthy woman like Heather look into the new health coverage options? 

Heather’s curious about the new options because she’s ready for peace of mind. She knows the scary story of my cancer diagnosis when I was her age. “I don’t need much health care right now, but I realize I'm just one accident or illness away from financial disaster,” she laments.  

The new coverage options will give Heather the security of knowing she can see a doctor in case she does get sick. Under the new law, she will be able to find a plan that fits her budget, and all plans will cover the basic, preventive care she needs, such as annual women’s exams, contraception and Pap smears, with no co-pay.  That means that if Heather gets sick, she won’t have to put off seeing a doctor until it is too late. 

Carrie

If you bite into a plump, delicious heirloom tomato from a local farmers market, you might taste one of Carrie’s creations.  At midlife, Carrie’s dream came true when she founded Little Earth Farm, a sustainable, organic farm that stretches across the Puyallup River Valley near Orting, in the shadow of Mount Rainier. 

Carrie loves cultivating the strawberries, kale, butternut squash and Walla Walla sweet onions that nourish our community.  But Carrie has had to face a trade-off: her farm income is low, so she and her husband stretch to meet their budget.

She is 52 and her husband is 62, so they are too young for Medicare. Right now, they pay over $900 a month for a “catastrophic” health plan that just covers the bare bones. 

"Thank goodness we had that plan when my husband fell off the roof he was repairing at the farm," she says. Not only did he break his leg in three places, the doctors discovered an aneurysm. His medical bills would have wiped them out—had it not been for the insurance coverage, they would have lost the farm.  Still, it's a struggle to make ends meet and under their current plan Carrie must pay out-of-pocket for her mammograms and doctor visits. 

How will Carrie and her husband fare as the Affordable Health Care enrollment begins October 1?

Because their farm business is just breaking even, their income is low and Carrie and her husband will likely qualify for free or low-cost coverage. Plus, their new plan will cover her mammograms, immunizations, cancer screening and yearly doctor visits without any co-pays or deductibles. And her husband will be able to get the care he needs, when he needs it, even though he, like me, and millions of other Americans, has a pre-existing condition.

In the next few weeks before the new market opens up, we will find out what monthly premiums will be available to Heather and Carrie, so stay tuned for my next post. In the meantime, ask yourself: 

Who do you know who needs health insurance?

Over one million Washington residents lack health insurance—that’s 1 in 7 Washingtonians.

This fall is the time to reach out and encourage your friends, neighbors, and family members to explore their new options.  Here are the key things every Washingtonian needs to know:

• You will be able to find the plan that fits your budget. Premium rates in Washington are expected to decrease with the new coverage options. Plus, you might be able to get financial help to pay for insurance, depending on how much money you make. Even a family of four making as much as $94,200 could qualify for help with costs. 

• The insurance plan you choose will be there to cover the care you need.  All insurance plans will have to cover the basic care you need, including doctor visits, hospital stays, emergency room visits, mental health care, and prescription drugs. Plans will have to cover many preventive services, like mammograms and annual women’s exams, with no co-pay from you. 

• You will be able to get help choosing a plan. You can get help online, over the phone, and in person to find the plan that is best for you and find out whether you can get financial help to pay for it.

• Don’t delay!  Open enrollment starts October 1st. For some options, open enrollment ends March 31st. 

How You Can Apply:

• Starting in October, you can apply for the new coverage options through the Healthplanfinder, a state-approved website and call center that will help you understand and compare your new options. 
• You can get in-person help from an organization in your community who is trained to help you.  
• You can get help in your language or disability accommodations for free. 

When You Can Apply:

• September 3, 2013 – Call Center Opened
• Call 1-855-WAFINDER (855-923-4633) if you have questions about your new coverage options (but you can’t start applying until October). 

• October 1, 2013 – First Day to Apply
• You can also use the website and call center to find an in-person help from your community, who can walk you through your new options.

• March 31, 2013 – Last Day to Apply for some options (until next year). 
• Other options will still accept enrollment after this date. 

Roberta Riley currently works for Northwest Health Law Advocates, a non-profit dedicated to health care for all. In her former role as Legal Counsel for Planned Parenthood, Ms. Riley won a groundbreaking federal court decision requiring health plan coverage of prescription contraception. She has also served as a consumer advocate at the National Association of Insurance Commissioners, and was appointed to the Washington State Health Reform Realization Panel by the Hon. Mike Kreidler. In recognition of her achievements on behalf of women, she was given a 2001 Ms. Magazine Women the Year Award.