The Jan. 31 deadline to enroll in the Affordable Health Care Plan, better known as Obamacare, is fast approaching and consumers need to better understand the programs available.
With so many plan options offered it can be confusing or possibly intimidating. That’s where Shawn Holcombe, a health plan expert with Humana, does her best work. She helps people understand their health plan choices and simplifies the process.
When it comes to making sense out of the health exchange and all the health plans available, including Medicare Parts A-D, Holcombe suggests finding an agent.
“They provide a free service and agents work with many health plans, so they’re not specific to one company,” she says. “They can help evaluate people’s needs. A professional agent can help people through the entire enrollment process and prepare them. That’s one of the biggest hurtles. People want to get health coverage, but they don’t know how – an agent can guide them down the path.”
In Holcombe’s experience, the three most commonly asked questions are 1) Can I really afford it? 2) Can I qualify? 3) Will my information be secure and private?
Those are valid questions, but she always starts by making sure people understand their financial position and healthcare needs.
“It’s important for people to understand there’s more to think about than just the monthly premium. Some health and prescription drug plans will have deductibles, or costs that must be paid by the individual before the plan’s coverage begins,” Holcombe says. “People need to consider both the premium and deductible costs as they make their choices.”
One of the ways Humana differentiates itself is through the Silver Plan, which 94 percent of Humana members in Metro Detroit choose, Holcombe says. People also appreciate that the plan has no deductible for prescription drugs.
“It’s really unusual to have a plan where you can have access to your prescription drugs without having to satisfy a deductible that can be $600 or more,” Holcombe says. “The main thing is understanding what’s important to you, and how you want to spend your money. There’s no one plan that’s best for everyone. That’s why it’s important for people to shop the plans and understand the differences.”
All in all, the Affordable Care Act (ACA) serves as a “blanket” beneath consumers to protect them from unexpected health care costs that could be impact people’s financial health. To help out those with low incomes, there is help through tax credits that can lower monthly premiums. Holcombe suggests checking into this when talking to health plans or agents.
It appears to be helping. According to a 2015 survey by the Commonwealth Fund, the number of Americans struggling to pay medical bills fell for the first time in nearly a decade since the ACA went into effect.
From a national perspective, 18 to 25 percent of personal bankruptcies filed in the U.S. were prompted by medical debt in 2014, as reported by the Wall Street Journal. In contrast, in Massachusetts, where universal healthcare has been in effect since 2005, only 3 to 9 percent of bankruptcies in the U.S. were caused by medical debt.
Holcombe notes every plan has something called an out-of-pocket maximum, or the most a covered person would have to pay for health care even in an extreme situation. For ACA plans, including Humana’s, that amount is $6,600 in one year.
“As soon as you hit $6,600, the insurance plan covers 100 percent of the costs,” Holcombe says. “Even if your medical care costs $150,000 or more, the most you’re going to pay is $6,600 in your plan year. And that’s a significant protection.”
The best way to keep health care costs low, however, is through preventative care. Health screenings and regular doctor visits can identify health problems before they become serious.
“The benefits of preventive care are early diagnosis and early treatment,” Holcombe says. “You know when you go into the doctor, you’re getting piece of mind. It’s like regular oil changes and tune-ups for your car. A small investment of time and money can save you a serious car repair down the road.”
Humana has several outreach programs that work with community service programs and social services within Detroit and other areas in Michigan. It also provides educational materials to faith-based organizations as well as culturally based organizations. “We’re trying to simplify the process and partnering with community organizations helps us reach out to people where they are,” Holcombe says.
Simplified or not, if you don’t have insurance you need to enroll now. If you don’t meet the Jan. 31 deadline you face penalties … and they are stiffer this year. This year it’s $695 per adult and $347 per child up to a family cap of $2,500 or 2.5% of household income, whichever is greater.
Bottom line? Meet the enrollment deadline on Jan. 31 to protect your money and your health.
While it is still possible to get health coverage after the deadline, you still have to pay the penalty, and you must qualify for the special enrollment. Qualifications include a change in your family status, loss of your plan, or if you have one of many hardships. You can find out more at Obamacare Facts, Humana Helps or by calling 800-713-5503.
Editor’s Note: Humana experts will be available in Detroit and Grand Rapids on Jan. 29 and Jan. 30. In Detroit, interested individuals can receive one-on-one advice from a local expert from noon until 7 p.m. at the Fairlane Town Center located at 18900 Michigan Ave., Dearborn, MI 48126. In the Grand Rapids area, individual help is available from noon at the Woodland Mall located at 3195 28th Street SE, Grand Rapids, MI 49312.