Affordable Care Act, a work in progress (includes timeline and resources)

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Editor’s note: This is Part 2 of a two-part story continued from the Oct. 1 edition of El Defensor Chieftain.

Oct. 1 kicked off the health insurance enrollment mandate required by the 2010 federal Patient Protection and Affordable Care Act, also known as Obamacare.

All U.S. citizens with few exceptions must have health insurance coverage by Jan. 1, 2014. Low-income New Mexicans — even single adults — can now obtain subsidized insurance through Medicaid, but they need to sign up by the end of December to have coverage in place by the Jan. 1 deadline.

The New Mexico Health Insurance Exchange website is out of service until Oct. 21, but the online Medicaid application process is working “like a dream,” said New Mexico Human Services Department director of external affairs Matt Kennicott. New Mexicans can enroll for Medicaid online, in person or by phone.

Gov. Susanna Martinez supported expanding Medicaid in New Mexico to provide free or low-cost health benefits for all adults and families earning 138 percent or below of the federal poverty income level, Kennicott said. Now single adults earning less than $15,288 per year qualify for Medicaid in New Mexico. A family of four qualifies at $31,000 per year.

Over 170,000 New Mexicans are expected to sign up for Medicaid in New Mexico, also known as Centennial Care. As of Oct. 14, the NMHSD has received about 9,000 new applicants for Medicaid, he said.

“Medicaid in New Mexico covers a very rich benefits program,” Kennicott said. “It’s a no-cost program, with only a few co-pays. It’s like most traditional health plans. It covers doctor’s appointments, urgent care, dental visits, necessary surgeries and eyeglasses.”

But Medicaid recipients at the higher income levels will pay for part of their emergency room visits, he said.

Kennicott said New Mexicans applying for Medicaid can choose from four insurance companies: Blue Cross, United Health Group, Presbyterian and Molina Health Care. First-time Medicaid enrollees choose their plans starting Jan. 1. Current Centennial Care patients started choosing plans Oct. 14.

For those who aren’t sure they can qualify for Medicaid and don’t want to enroll online, Kennicott recommends stopping by or calling the local New Mexico Human Services office on California Street next door to Socorro Springs Brewing Company.

“Even if people have health care through their workplace, if they would like, they can visit one of our income support offices,” he said.

Those who don’t have any health insurance coverage in place by the Jan. 1 deadline will probably end up paying a federal penalty, according to the Kaiser Family Foundation website. Single adults under 65 earning more than $9,350 in taxable income per year, or $18,700 for a couple, will pay a $95 fine or 1 percent of their annual taxable income per year, whichever is greater. The penalty amount goes up yearly until 2016, when the fine will be $695 per year or 2.5 percent of the yearly taxable income.

Single adults making less than $15,288 qualify for state Medicaid health insurance coverage at no cost.

“How and when that penalty will be assessed is anybody’s guess,” said insurance agent Michael Olguin.

The U.S. Internal Revenue Service will collect the penalties.

Besides those whose income levels are too low to pay federal income tax, certain other uninsured Americans won’t be assessed the tax penalty for not signing up, including American Indians, those with religious objections, people in jail and illegal aliens. Those who have been without insurance for three months or less also won’t pay the penalty, or if the cost of the lowest priced insurance available on the exchange exceeds 8 percent of the household income.

“If I have to go to the hospital, they have to pay for it,” many people say.

True, hospitals have to care for patients whether they can pay or not, but they will do their best to make patients pay something, said Olguin.

But in 2014, patients will also have to pay a $95 federal fine if they don’t have health insurance coverage.

Currently, part of everyone’s health care bills covers uncompensated health care costs incurred by uninsured people who can’t pay for their medical care. The ACA hopes to reduce this burden by enrolling more people in health insurance plans.

Patient Protection and Affordable Care Act timeline

2010
• All adult children may remain on their parents’ health plan until age 26 regardless of marital or student status.

• Insurance companies required to cover preventative services for men, women and children

Oct. 1, 2013
• State and Federal health insurance exchanges opened

Dec., 2013
• Sign up for New Mexico’s health insurance exchange plan or Medicaid to get coverage started by Jan. 1

Jan. 1, 2014
• Most American citizens required to have health insurance. Uninsureds liable for a federal fine.

• All certified insurance plans must offer essential benefits (co-pays and co-insurance may apply) including ambulatory care, hospitalization, mental health and substance abuse treatment, rehabilitative and habilitative services, laboratory services, emergency care services, maternal and newborn care, prescriptions, preventative and wellness services, chronic disease management (cancer, diabetes), and pediatric services including oral and vision coverage.

• Insurance companies must cover everyone; no denials or penalties for pre-existing conditions.

• No annual or lifetime maximums on what insurance companies must pay for covered medical expenses.

Health Insurance Information Sources

Kaiser Family Foundation: www.kff.org

New Mexico Health Insurance Exchange – NMHIX: www.bewellnm.com (website unavailable until Oct. 21); 1-855-99NMHIX (bilingual); 575-517-5073 (local NMHIX health care guide); 575-835-1331 (Socorro County’s registered NMHIX insurance agent)

Federal health insurance information website: www.healthcare.gov

New Mexico Medicaid websites: www.yes.state.nm.us; www.CentennialCare.net

Medicaid expansion hotline: 1-855-637-6574 for New Mexico

New Mexico Income Support Division Socorro Office (for Medicaid): 1014 North California Street, 575-835-0342

 

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