Need Health Insurance? Here’s How You Can Get Affordable Coverage Starting Oct. 1
African Americans make up nearly 20 percent of 48.61 million people in this country who are living without health insurance coverage, according to the Census Bureau’s Current Population Survey. But on October 1st, the public will finally be able to begin “shopping” for affordable health insurance due to the launching of President Barack Obama‘s Affordable Care Act, which is projected to have a historic impact on our community.
Just days before the launch of the unprecedented health care act, NewsOne spoke with the White House’s Director of External Affairs at the U.S. Department of Health and Human Services Anton J. Gunn (pictured below) to get informed about how the African-American community can benefit from the President’s new law in addition to learning important details about what the Affordable Care Act (akaObamacare) will mean to us. Get educated about how you secure affordable health care for you and your loved ones here.
1. NewsOne: Who will benefit from the Affordable Care Act starting October 1st?
Anton Gunn: Millions of Americans, many of them people of color, have been disenfranchised when it comes to being able to buy health insurance, meaning you were priced out of the market, which means the price is too high for you to even buy; you were forced out of the market, where they [insurance companies] say, “You’ve reached a million-dollar cap on your policy so we are not going to cover anything else”; or you were just locked out, which is, you were born with a pre-existing condition, we are not going to cover that.
Or maybe you’ve developed the condition over time — we [insurance companies] are not going to cover that. Or maybe your child developed a condition — we are not going to cover that. So forced out, pushed out, or locked out of the Insurance market, priced out of the insurance market, that’s how it used to be.
But beginning January 1, 2014, nobody in America can be forced out, they can’t be locked out, they can’t be discriminated against because they have a preexisting condition. You’ll be able to buy health insurance coverage, and the health insurance coverage will be more affordable now than it has ever been before.
And what do I mean by more affordable?
What the Health Insurance Marketplace is, is just think about it just like a marketplace, if you went to Chelsea market [in New York], and you say, “I want some bread or I want a soda. Well, there’s not going to be just one kind of soda or one kind of bread that’s sold in the store. You’ve got choices.
So what the Health Insurance Market does is give you choices of health insurance plans that you can pick from.
And Insurance companies have to sell you a plan if you want to buy one.
So you’ll be able to go to Healthcare.gov, put in your e-mail address, and set up an account to see what you qualify for, and the reason I say, Qualify, is because some people…if you’re 25 years old and you just finished college or grad school and you’ve been looking for a job and you’ve been unemployed for the entire year and you have no income, well in some states, you will be able to get health insurance through the Medicaid program of that state.
So if you lived here in New York and you make below $15,000 a year, you can sign up right now and get health insurance through Medicaid. You don’t have to have kids; you don’t have to have a disability. You can get health insurance through that regard.
Now let’s say you make between $15,000 and $46,000 a year, so you are in the income range of a young professional. You got your first job out of college, out of grad school. You’re making $30,000 a year.
You can shop for health insurance, but you’ll also qualify based upon your income and the number of people in your household for a tax credit to help you to buy insurance.
For example, if you’ve ever bought a book on Amazon or you’ve ever used Expedia or Kayak to purchase a plane ticket, you know you go in search for the package you want. So you say, “I want these services covered, I want to pay this kind of deductible, I want this copay — it’s all self-explanatory — and you press enter, and you are going to get choices of health plans, and you’re going to see three plans — just like Expedia, you are going to see four or five choices of flights by price.
You’ll say, “OK, I see this plan here. Aetna will cover me for $334 a month and it meets all of my needs,”but because your income is at a certain level, it’s going to show you the subsidy amount you qualify for.
Let’s just say it’s $234 of subsidy, so you can pick that plan and it says, “You picked the Aetna plan, and it’s $334 a month, minus your subsidy. If you apply all of your subsidy, your health plan will be $100 a month. And so you say, “Yes,” and you pull out your debit card and you pay the first payment to Aetna and the IRS will send the other $234 right to Aetna to pay your insurance plans.
Every time you make a payment, the IRS makes a payment.
So effectively, you just got quality health insurance coverage for $100 a month, which is cheaper than your cell phone bill if you have a smart phone.
2. NewsOne: I’m glad you explained it that way, because initially what I thought was, I only have $100, does that mean that the insurance that I’m buying is an inferior form because I only have $100 and somebody else has $1,000 so they get much more and I get less coverage?
AG: No, so the way that it works is that the only insurance plans that can be offered on the marketplace have to be comprehensive, quality health plans. So, even after the Affordable Care Act is fully implemented, you can still go and call an insurance company on your own and say, “I want to buy a policy, and they can sell you a policy.
It can be inferior; it can be great. You don’t know what it is, but if you go to healthcare.gov, you will know that every plan on that marketplace will cover prescription drugs. It will cover birth control.
Let’s say some of your readers pay $50 a month, $70 a month on birth control — well that will be free under the Affordable Care Act. You have smoking cessation programs, all of these programs, so it’s going to be a quality product, because what the marketplace ensures is that all of the plans on there have to meet an actuary of value, which means it has to be quality health insurance.
It can’t be what I used to have: I used to walk around with an insurance card because I was self-employed and my wife was self-employed and I spent a bunch of money on a policy. It didn’t cover my prescriptions, it didn’t cover my daughter’s shots, it didn’t cover any of the stuff that I needed covered, but yet I’m paying them $700 a month for a policy.
So you can still buy that [type of policy] after the Affordable Care Act goes in to effect, but you won’t have those types of [inferior] products at Healthcare.Gov.
So if you are low-income, again you go in to see what you qualify for, put in your e-mail address. It’s going to ask you what is your household size. It’s going to ask you how much money you made. You answer those questions and press enter, and it’s going to say that based upon your income and your household size, you qualify for a subsidy, or it may say, “Your income is so low you qualify for Medicaid. We are going to redirect you to the state Medicaid agency for coverage.”
Well, let’s say you are balling. You are 30 years old; you are making $90,000 a year and you are a self-employed web developer and you got some big name clients, but you don’t have health insurance because you have a pre-existing condition. Maybe you don’t have anything wrong with you at all, but you just didn’t buy coverage because you thought it wasn’t important.
You can go to healthcare.gov and find a plan that is more affordable than it has ever been before. and you can buy health insurance.
For example, in New York City right now anyone who went out to buy a health insurance plan, the average health insurance plan costs $1,001 a month right now.
Under the Affordable Care Act, though, shopping at Health.NewYork.Gov, which is the New York health exchange — and you can go to Health.gov and it will take you there too — you can find the same plan that will cost you $1001 a month today, and the same plan will cost you $334, so that’s a 70 percent reduction in the health insurance prices.
So right there, if you are balling, making $90,000 a year, and don’t have any health insurance, $300 a month will be affordable to you so you can get health insurance coverage. Clearly, $1,000 is affordable to you too because of your income, but you may not want to pay that when you can get it for $300 a month.
That’s why the insurance marketplace is for everybody.
So you know young readers can go online and figure this out and use a computer. If you’ve ever filled out a financial aid form or if you’ve ever done your turbo taxes online, you can do the same thing with this website. It’s pretty self-explanatory and it guides you through the process.
3. NewsOne: What about the older consumers out there who may not be as savvy as their younger counterparts?
AG: That’s why we have two other ways to sign up for health coverage. 1. We have a 24-hour, 7-day a week call center that will be translated in to 150 different languages. So if you speak some rare brand of Creole, because you live in lower Louisiana between New Orleans and Lafayette, there will be someone who can answer the phone and explain for true how you sign up for health insurance coverage.
Call our 1-800 number. It’s 1-800-318-2596.
You can call at 3 o’clock in the morning because it’s 24/7 and say, “Hey, I’m looking for health insurance, can you explain to me what options I have under the Affordable Care Act,” and they’ll tell you everything I just told you about how the marketplace is going to work.
Or let’s say it’s after October 1st, and you say, “I’m looking to buy some health insurance coverage, can you tell me about what’s available to me?” They are going to ask you what state you are in, what’s your income, and how many people live in your household, etc. And they’ll tell you, “Well, based upon the information you gave us, here are the four insurance companies that are offering plans in your state.”
Each one of them has five plans at each metal level, which is, you get a bronze plan, silver plan, a gold, or a platinum plan, so there are a lot of plans out there, but you tell them, “I need a dental plan, because I need to get braces. I’ve needed braces since I was 16, my but parents couldn’t afford it. Now I’m 31 and I want to get braces, so can you find me a plan that will give me dental coverage so I can get braces?”
And they’ll search and they’ll find it and say, “Well, here’s one insurance plan that includes a dental plan but here we have another standalone dental plan that actually provides dental. Which dental plan would you like to buy?”
So you can do all of that through the same call center or we have what’s called “local navigators” or local organizations in each state who will basically do the same thing that I just said over the phone or over the Internet but they’ll do it face to face. They’ll sit down with you. They’ll hand you a paper application that is going to be just three pages.
4. NewsOne: Will it really on be only three pages?
AG: OK, so in the private market, before the Affordable Care Act, if you wanted to apply for insurance, you would fill out the 14- to- 17-paged form and you don’t even know what you are signing up for. Well, if you are a single person and you are applying for affordable healthcare, we’ve shortened the application down to three pages.
We don’t ask you about your pre-existing conditions; we don’t ask you about your health history, because guess what, it doesn’t matter anymore. Insurance companies can’t use that as a condition to deny you.
So you fill out some information about who you are — birthday, social security number — and you fill out a couple more pages. And if you got other members of your family, like children, you just fill out an additional page for each one of them.
So you won’t get the 15 pages unless you’re married with 11 kids!
5. NewsOne: What if you are working and you have health insurance, do you still need to call or go online.
AG: No, so they can ask questions and go online. If you have health insurance on your job — 85 percent of Americans have health insurance like that — if you work for a large employer, which is someone who has 100, 200, 300 employees, you got a good deal in health insurance. It may not seem like it when you have to pay your portion of health insurance, but most people have a really good deal, so the law is not focused on that group.
But you can still call the call center and say, “Hey, I have health insurance, but can I get a better deal.” And they are going to explain to you that you are better off staying with what you got, and the law actually precludes in the first couple of years that employees who are employed with large companies can’t leave their plan to go in to the small, individual market.
6. NewsOne: What about small employers? How does the Affordable Care Act impact them?
AG: Say you run a small mechanic shop. You’ve got seven employees. You don’t pay them a whole lot of money and you keep losing mechanics because you don’t have health insurance. Every small business that doesn’t provide health insurance, they’ve got an employee that’s looking for another job. They are losing people with turnover and time and hours to train new people once someone leaves. So that business can’t be as productive as it wants to be, because of the unaffordability of health insurance.
So the law says, “If you are a small business owner and you’ve got less than 50 employees, you are not mandated to have coverage for all of your employees, but we want you to shop anyway, because you can find an affordable deal for all of your employees, and on top of that, if you pay up to 50 percent of your employees’ healthcare costs, you get a tax credit of 50 percent off what you spent on your employee’s health care costs and you can write the other half off on your taxes at the end of the year.”
So for employers, this is a chance for you to help your employees get good quality health coverage, get a tax write-off for it, and keep healthy workers.
Small business owners can watch a video on how the Affordable Care Act works for them here:
7. NewsOne: Being that healthcare is going to be so affordable and accessible to the public, what impact do you think this will have on the larger society?
AG: Here’s the thing, there’s a lot of people who work at companies, let’s say you’ve been working at your job for five years, and deep down inside of you, you’ve had this idea of starting your own business and you really want to make it big. You know it’s going to be hot if you leave your current job, but you are married with a spouse who has a pre-existing condition or maybe your child has asthma and that’s the reason why you are staying in this job, because you have good health insurance and you want to make sure your kid keeps the good coverage that they got.
Well, guess what, because of the Affordable Care Act, that won’t be an issue anymore. You can leave your job, start your dream, start the company that you want to start, go toHealthCare.gov and find an affordable policy that will cover your child’s preexisting condition or your husband’s preexisting condition. And you could get coverage yourself — all your preventative health care, your wellness visits, your pap smears — whatever you need and want — all of that is covered under your insurance.
And if your income is low enough — you might have some savings but you don’t have a lot of earned income — depending on your income, you could qualify for enough of a tax credit, that you won’t even have to pay for the insurance every month because your income is at a low level.
You could be on Medicaid or maybe you make $18,000 a year because you did four or five shows or four or five events and made a little bit of money as an artist, for example, but you didn’t make enough to be able to pay for private insurance. That tax credit could cover the entire cost of your health care plan.
So effectively, you are getting healthcare for free. That’s what the law and the marketplace is about.
8. NewsOne: What is the final point that the public needs to know?
The two things that people need to remember is that open enrollment starts October 1st. What that really means is that you can start signing up and shopping for plans beginning October 1st. You have a six-month period to pick a plan if you are uninsured or self-employed or a small businessowner.
You have October 1st to March 31st, so you’ve got six months to make a decision for you, your employer, your family. And anybody who signs up in October, November, or December, their coverage goes in to effect January 1, so that’s when the full benefits of the law kick in.
So when you sign up, you are not likely to get your new insurance card in the mail until December. They’ll let you know, “Here’s your new card, here’s your plan, your coverage begins effectively January 1.”
So these first 10 weeks of open enrollment is like a pre-enrollment, but January 1 is when all those new benefits kick in. If you sign up on January 1, your coverage starts on February 1, a month later. So that’s the opportunity to get coverage.
9. NewsOne: What impact do you think the Affordable Care Act will have on the African-American community?
AG: I fundamentally believe that this will transform the lives of so many Black and Brown people in this country. It’s going to be dramatic. Just think about it in these terms: if you aren’t healthy in your mind and body, how much can you really contribute to your family and community and to the world at large?
How can you be the economic engine for your family and your country if you aren’t fully healthy and capable? Think about athletes — there are so many could-have-beens and never-was athletes because they got an injury and they got surgery on the injury but they couldn’t afford the rehab. So their knee never got right, and because that knee never got right, they never made it to the league.
Or how many people are there who have a condition but couldn’t get the treatment to get well and they couldn’t fulfill their goals, destinies, and dreams?
So now, the Affordable Care Act is going to mitigate all those challenges for people and it will give people a liberated ability to contribute everything that they possibly can.
I tell people all the time, We may have lost the cure for cancer last year when some 25-year-old kid got sick and died and couldn’t get the treatment they needed; we don’t know what that person was going to birth out in to the world. We just have no clue, and all of those things were taken away from us because they couldn’t access quality preventative coverage when they got sick. We will fundamentally change our community and our country by providing healthcare to the masses.