(Editor’s note: This version of the story includes an update regarding the extension of enrollment to Tuesday).
By LEAH WANKUM
(JOHNSON COUNTY, Mo., digitalBURG) – Care Connection for Aging Services is offering navigator services provided through a federal grant to help Missourians enroll in the health insurance marketplace.
Marilyn Gunter, director of care management at Care Connection for Aging Services in Warrensburg, said Care Connection has used the funding to employ three staff members and train two already on staff for navigator services. These five licensed navigators have assisted about 178 clients.
She said Care Connection in Warrensburg offers navigator services for 13 counties: Carroll, Chariton, Lafayette, Saline, Johnson, Pettis, Henry, Bates, Benton, Vernon, St. Clair, Hickory and Cedar.
The Missouri Association of Area Agencies on Aging, also known as MA4, has employed 80 certified navigators for the state of Missouri.
“We completed a series of online training: 14 modules and 14 tests,” Gunter said. “They covered cultural sensitivity, employment coverage, eligibility determination and other subjects.”
Stacey Gilkeson is one of the licensed navigators employed at Care Connection.
“I’ve enrolled numerous clients,” Gilkeson said.
She explained the step-by-step process navigators take with clients when enrolling.
First, the navigator helps the client set up a profile. The client then proceeds through the application process, answering questions regarding income and providing other data.
“If the data is not verified, clients send further information such as a birth certificate or driver’s license to the agencies involved in eligibility and enrollment, including the Department of Health and Human Services, the Internal Revenue Service, Social Security Administration and the Department of Homeland Security,” Gilkeson said. “Once identification is verified, you determine what your projected income will be in 2014. Then you click ‘View eligibility’ and you will see your list of options based on income and family size.”
According to a brochure on frequently asked questions published by Cover Missouri, a project of the St. Louis-based nonprofit Missouri Foundation for Health, Americans qualify for premium tax credits if they have a household income between 100 percent and 400 percent of the federal poverty level. Further, Americans qualify for lower out-of-pocket costs if they have income at or below 250 percent of the federal poverty level.
Only individuals who meet certain requirements are eligible to enroll in health insurance through the marketplace.
“Anybody 64 and under that does not have employer coverage are eligible to shop on the marketplace,” Gunter said. “If you have employer coverage, then they would encourage you to take insurance through your employer. If that employer coverage is not affordable for your income that you’re making, then you’re eligible to shop on the marketplace.”
The deadline for applying for health insurance to be covered by Jan. 1, 2014, is Tuesday.
The deadline to enroll in health insurance without being penalized is March 31, 2014.
Americans who don’t enroll in health insurance by that time will be penalized when they file their federal income taxes in 2015.
According to a brochure on new health insurance rules published by Cover Missouri, the penalty will be a flat rate or a percentage of income. For example, in 2014, the penalty is the larger amount of 1 percent of income or a flat cost: $95 per adult, $47.50 per child and up to $285 for a family.
In 2015, the amount will increase to 2 percent of income or a flat cost: $325 per adult, $162.50 per child and up to $975 for a family. In 2016 and beyond, the amount is 2.5 percent of income or a flat cost of $695 per adult, $347.50 per child and up to $2,085 for a family.
Gunter said it’s easy to help clients get set up, for the most part, especially when helping them from start to finish.
“They have to create a profile first and be verified who they are before actually starting the application,” Gunter said. “If they have contacted the marketplace via phone and have begun the application process, then come to us to complete the enrollment, and their profile hasn’t been set up, that causes confusion and creates a longer time.”
Eligibility determination isn’t the only problem navigators at Care Connection have been experiencing with clients. The marketplace website has gone down, but Gunter said it works much better than before. However, there are some malfunctions with the website application process.
Responses to certain questions on the application can also cause difficulties in the process, such as if clients have never filed a federal income tax return due to their income being below the filing amount, and then answering on the application that they don’t plan to file one in 2014. This can create an issue with the application, and clients may not receive the tax credits due to them. This means they must start the process all over again.
“The most distressing situation for us is the individuals who truly need the health insurance,” Gunter said. “Their income is too low for them to qualify for the tax credits to make it affordable for them. We feel like we have let them down by not being able to get them enrolled. We have begun asking those individuals to contact their state representative and senators and share their stories.”
Clients come from all kinds of situations and demographics.
“Most of the situations we have been seeing are people with a low income that aren’t able to access the tax credits on the marketplace but also don’t qualify for Medicaid,” Gunter said. “Most of these have been people 50 or younger with major health issues.
“We have also had situations where it’s plainly visible that the client should qualify for tax credits but for some reason through the application process, if a question hasn’t been answered correctly it causes them to not qualify. The application has to be deleted and restarted.”
For more information, contact Care Connection for Aging Services at 660-747-3107 or visit warrensburg.goaging.org.