The Epilepsy Foundation’s staff is partnering with organizations like Catalyst Miami and Sant La in Little Haiti that will help with education and enrollment efforts in Miami-Dade.
The foundation’s toll-free number is 877-553-7453.
The National Hispanic Council on Aging has not yet announced its partners but advises consumers to call 866-488-7379 or send an email to email@example.com for assistance.
Community health centers:
In July, HHS awarded $8 million to 46 Florida health clinics so they can help consumers learn about the new exchange. The clinics, which serve more than 1.1 million patients a year — half of whom are uninsured — will hire about 100 additional employees with the grant money.
Among the South Florida health centers that received the grants: Banyan Community Health Center in Miami; Broward Community and Family Health Centers in Hollywood; Camillus Health Concern in Miami; Citrus Health Network in Hialeah; Community AIDS Resource in Miami; Jessie Trice Community Health Center in Miami; North Broward Hospital District in Fort Lauderdale; and the Rural Health Network of Monroe County in Key West.
A full list of community health centers where consumers can meet with outreach and enrollment workers is online at:
Certified application counselor groups:
Certified application counselor groups help people understand, apply and enroll for health coverage through the exchange. Counselors are trained and must comply with privacy and security laws. A list of counselors can be found online at https://localhelp.healthcare.gov.
Agents and brokers:
The government expects agents and brokers to play a key role in the new exchanges. In Florida, many insurance agents and brokers have taken the required certification training so they can educate consumers about the exchange. They also will help consumers determine eligibility and subsidies, compare plans and enroll in coverage.
Do it yourself online:
Call for help:
Call 800-318-2596 for help 24 hours a day, seven days a week in 150 different languages.
Florida Champions for Coverage:
Dozens of Florida organizations and businesses have formed a volunteer network to help uninsured residents learn more. The network includes Community Service Center of Perrine; Community Service Center of Westchester; the Episcopal Diocese of Southeast Florida; Health Council of South Florida; Jackson Health System; Jessie Trice Community Health Center; and the League of Women Voters.
For a full list of groups nationwide, go online to marketplace.cms.gov/help-us/champions-for-coverage-list.pdf.
WHAT is the cost?
Consumers can compare policies, including premiums, deductibles and other out-of-pocket expenses, sold by different companies on the exchange.
Benefit information is standardized to make it easier to compare cost and quality.
Plans are divided into four different “metal” levels — bronze, silver, gold and platinum — based on the deductible size, copayments, provider networks and cost-sharing. A low-cost, high-deductible catastrophic plan will also be available for those 30 and younger. The plans are divided into the “metal” tiers based on cost-sharing. In a bronze plan, there’s a 60/40 split, with the insurance company paying 60 percent and the insured paying 40 percent of covered costs after the deductible is met. For silver, the split is 70/30, and for gold, it’s 80/20. A limited number of platinum plans with higher premiums will also be available.
To determine eligibility for government subsidies, the exchange will be linked to tax information as well as state wage databases to which employers report every quarter. The application also asks consumers to project their income for 2014.
A worker who gets job-based insurance is eligible for a subsidy only if the employer’s coverage is either not affordable or doesn’t provide “minimum value” — which means that the employee’s share of the premium for self-only coverage (not a family policy) cannot exceed 9.5 percent of household income, and the plan covers at least 60 percent of expected medical costs.
Any individual and family members eligible for an affordable, minimum-value, employer-sponsored health plan cannot get federal subsidies.The health law provides subsidies to help only people earning between 100 and 400 percent of the federal poverty level, a range that translates into $11,500 to $46,000 for an individual and between $23,550 and $94,000 for a family of four.
The subsidy is calculated using household income and the cost of a benchmark plan — the second-lowest priced silver plan on the exchange.
If you qualify for a subsidy, you can use it to buy any of the plans you like. Healthcare.gov, the marketplace website, has a subsidy calculator.
The exchange will tell applicants the maximum credit they are eligible for, and consumers can decide whether they want to take the maximum or some lesser amount. Those who think their income might increase beyond what they projected might consider taking less so they won’t have to repay the government at year’s end The subsidy is paid directly to the insurance company.
More financial help:
There’s one other type of financial help: a cost-sharing reduction for individuals and families with incomes of up to 250 percent of the poverty level ($28,725 for an individual or $58,875 for a family of four).
Under the health law, health insurance companies offering coverage through the exchange must lower the amount these consumers pay out of pocket for deductibles, coinsurance and copayments.
The out-of-pocket savings apply only to silver-level plans, and consumers will find out if they’re eligible for these cost sharing reductions when they apply through the exchange.
The law does require consumers to contribute a specific percentage of income to the premium, based on a sliding scale.
For example, if your household income is 100 to 133 percent of the poverty level, your subsidy will ensure you never pay more than 2 percent of your income for silver-level coverage, no matter how much it costs.
If your income is at 300 percent of poverty, then you’re required to contribute 9.5 percent. The subsidy then makes up the difference between that amount and the cost of the benchmark plan.
For everyone, regardless of income, annual cost-sharing — what consumers pay out-of-pocket for medical services and deductibles but not premiums — will be capped at $6,350 for individual policies and $12,700 for family plans in 2014.
You can choose not to buy health insurance, but you’ll pay a penalty unless you fall under a narrow list of exemptions. The penalty for all others in 2014 is 1 percent of annual income or $95 per person a year, whichever is higher. The penalty increases every year. In 2016, it is 2.5 percent of income or $695 per person. For uninsured children in 2014, the fee is $47.50 per child, with a family maximum of $285.
After open enrollment ends on March 31, those who have chosen not to enroll won’t be able to get health coverage through the exchange until the next annual enrollment period, unless they have a qualifying life event, such as moving to a new state, certain changes in income and changes in family size.
Information from Kaiser Health News, Healthcare.gov, the U.S. Department of Health and Human Services, and the Center for Medicare and Medicaid Services was used for this report.