SEARHC Offers Help in Health Care Signup

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Category: News

Created on Thursday, 07 November 2024 14:48

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By SHANNON HAUGLAND
Sentinel Staff Writer
    Enrollment is now open for federal help for health insurance coverage under the Affordable Care Act, and you have until December 15 to enroll if you want your plan to start January 1.
    “The pricing and subsidies look the same as last year,” reports Susan Briles, one of six SEARHC patient health benefits specialists ready to help with signing up in Southeast Alaska. They are certified by the Centers for Medicare and Medicaid and Services to provide this free assistance on health care plans.
    Since open enrolllment for 2025 opened on November 1, Briles has helped about a dozen Sitkans select a health care policy from among 15 options, figure out their subsidy and sign up.
    Those already signed up for 2025 won’t see a huge difference from last year in plans and premiums, Briles said.
    “It’s been very, very similar to last year,” she said.
    With the Affordable Care Act, the federal government helps pay for your health insurance, with a subsidy based on your age, your household makeup and your tax return. Only those without access to insurance through their employer or other programs (Medicaid, Medicare) are eligible to participate.
    The cost of programs goes up or down depending on income, household composition and age.
    “The lower your income the higher your subsidy will be, therefore the cost of your insurance goes down,” Briles said. “You could have someone get a bronze plan for as low as $2 or a gold plan for $140. Depending on what your health care needs are we can help you pick the best plan for you.”
    Currently, 15 plans are available through the two companies participating in the Alaska health insurance marketplace: Premera Blue Cross Blue Shield of Alaska and Moda Health. The SEARHC team is likely to steer you toward one of the plans offered by Premera, she said.
    Briles said most two-income families in Sitka have at least one family member with insurance, but she ran through a few scenarios for insurance plans and subsidies for a single person and a double-income family with two children.
    A 31-year-old woman making $60,000 a year would get $617 a month in subsidy to purchase a plan of her choice. The lowest  priced plan you could get with Premera is a “bronze” plan for $23.14 a month. The deductible would be $7,500 and out of pocket maximum is $9,200, after which you are covered 100 percent.
    Briles and others on the SEARHC health benefits team, depending on the client’s health care needs, may recommend Premera’s Preferred Gold 1500 plan. The same person under this plan would pay $240.38 a month, and would have a $1,500 deductible and $6,300 out of pocket maximum.
Running through another scenario, a family of four, parents ages 52 and 48, with two teenage children and a household income of $140,000: their family’s subsidy is $3,357 per month using the criteria of age, household income and family makeup.
This family could get “an OK bronze plan” for as low as $28.35 per month. That plan has an $6,350 per person deductible and maximum out-of-pocket maximum of $8,700 per person. The same family under a Premera Preferred Gold 1500 plan will pay $497.86 a month, with a $1,500 per person deductible and a $6,300 per person out of pocket maximum. Deductibles are waived for doctor visits.
    Briles said the specialists in SEARHC patient health benefits offices can help in-person and over the phone, and are happy to spend time to walk clients through the pros and cons and costs of all the plans, generally divided into Gold, Silver and Bronze categories. The Silver plans were once the most attractive and affordable plans in the early years of Obamacare but that is no longer the case and often the price is similar to the Gold plans.
    Briles said over the years, she’s learned which plans and companies work well for the clients her office serves, and she will share what she’s learned through her more than decade of experience in this work.
    With a new administration headed to the White House in January, Briles was asked what she sees for the future of the Affordable Care Act, informally known as Obamacare.
    “If we lose the Affordable Care Act, I’m extremely concerned for the state of health care in the United States, not to mention Medicare and Social Security,” she said.
    Briles said Sitkans can sign up on their own for health insurance through the marketplace at healthcare.gov, but assistance by the SEARHC health benefits office is free. For an appointment call 907-966-8684.
    The deadline for a January 1 start date for 2025 coverage is December 15, but the marketplace remains open through January 15 for insurance coverage starting February 1.
    The Affordable Care Act was passed into law in March 2010 with the goals of making affordable health insurance available to more people, expand Medicaid to cover adults with income below 138 percent of the federal poverty level; and “support innovative medical care delivery methods designed to lower the costs of health care generally.”