MANATEE -- There's a buzz out there that penalties have increased for those who fail to enroll in a health care plan in 2016 under the Affordable Care Act.
The buzz is, in fact, true.
Individuals and families who do not have health coverage during 2016 and do not have an exemption could be assessed an annual monetary penalty of 2.5 percent of household income, or $695 per adult and $347.50 per child under 18 without coverage, whichever is greater, said Bevin Holzschuh of Bayfront Health Port Charlotte and Punta Gorda.
The penalty will be assessed when filing taxes for 2016, Holzchuh added.
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Although the penalties are high, there is plenty of help this year for people who want to avoid the penalty but find enrollment too intimidating to take on.
The deadline to enroll is Jan. 31, 2016.
Help starts right in Manatee
MCR Health Services, formerly Manatee County Rural Health, is the leader of the local Affordable Care Act counseling scene with nine certified application counselors spread out in Sarasota, Manatee and DeSoto counties.
MCR Health Services is taking appointments now, said Linda Snyder, director of specialized programs and contracts at MCR Health Services.
"These are free services," Snyder said. "The best way to access them is by making an appointment."
Residents need not feel shy about calling MCR Health Services for enrollment help. The organization receives roughly $300,000 annually from the U.S. Bureau of Primary Health Care to pay certified application counselors who work at five locations in Manatee and one location in DeSoto County,
"We are going into our third enrollment cycle. Last year we actually helped 7,100 people fill out applications and we had 4,600 folks actually enroll in an insurance plan," Snyder said.
Health Planning Council of SW Florida
Lynne Thorp, regional director for the Health Planning Council of Southwest Florida, which provides Affordable Care Act services in 10 counties including Manatee, is considered the foremost local expert on enrollment in the health insurance marketplace.
Thorp's non-profit organization has 25 licensed marketplace navigators.
"Some are full-time while others are part-time at partner organizations who help the community with other public assistance like United Way, Goodwill, Manatee Memorial and Comprehensive Care Clinic," Thorp said. "Last year we met with about 3,600 consumers in person and at appointments. We interacted with over 6,000 at educational and community events."
Thorp started her career at MD Anderson Cancer Center as a managed care analyst, but her passion led her to her current role.
"I was asked to manage this project before the first open enrollment," Thorp said. "My job is to coordinate the enrollment and education and help people acquire health insurances. I am passionate about helping people. I think it is important that everyone have access to education and to visit a doctor."
Thorp is a proponent of Affordable Care.
"Many individuals with pre-existing conditions like cancer could not access health insurance before the ACA or were charged more because they were sick," Thorp said. "Their lives were changed."
Health Planning Council's toll-free line covers all 10 counties at 1-866-547-2793.
"By visiting our website, the community can make counseling appointments on-line," Thorp said. "The online scheduling is new this year. It will send you a text with reminders and directions to your appointment. Go to EnrollSWFL.com."
As for the ease or difficulty of enrolling for Affordable Care at healthcare.gov, said Thorp: "It depends upon prior experience with health insurance enrollment and terminology such as network provider list, deductible, coinsurance, etc. It depends on access to a computer. If you don't read English or Spanish, it could be challenging. It depends on your ability to read or see.
"Some people may find the process or their circumstances challenging; that is what we are here for," she added. "We have each been through hours of federal training in addition to weekly on going education. We have been finger-printed and background-checked and are certified by the state as Navigators. We must provide free and unbiased assistance and have access to a language line. Each navigator does this work because they like helping people and think that getting to see a doctor is important."
The Manatee Memorial Healthcare System is also in on the counselor action.
"We have a trained health-care marketplace navigator on-site at Manatee Memorial Hospital," said Tammy Grant, Manatee Healthcare System's director of admissions and patient access. "This navigator will respond to requests for Manatee Memorial Hospital and Lakewood Ranch Medical Center. The public can call 941-745-6809 to make an appointment with a navigator and come right to Manatee Memorial Hospital."
If a person somehow gets a busy signal at all the above help locations, Bayfront Health Port Charlotte has invited Manatee and Sarasota residents to call them if needed.
"We can help people sign up for health coverage between Nov. 1 and Jan. 31, 2016," Holzschuh said.
Manatee and Sarasota residents or visitors are asked to call Bayfront Health Port Charlotte at 941-766-4013 or Bayfront Health Punta Gorda at 941-637-2503 to make a free appointment with an application coordinator, Holzschuh said.
ACA at a glance
The Affordable Care Act is a law passed by the government in an effort to help more Americans obtain health coverage and receive medical treatment they need to make them healthy or ensure they stay healthy, Holzschuh said.
"It was put in place with comprehensive health insurance reforms that have improved access, affordability, and quality in health care for Americans," Thorp said. "The Health Insurance Marketplace is for people who don't have health coverage. If you don't have health insurance through a job, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or another source that provides qualifying coverage, the Marketplace can help you get covered. If you have job-based insurance you can buy a plan through the Marketplace, but you'll pay full price unless your employer's insurance doesn't meet certain standards. Most job-based plans do. If you have Medicare, you can't switch to Marketplace insurance, supplement your coverage with a Marketplace plan, or buy a Marketplace dental plan. The law allows for the expansion of Medicaid programs in some states as well as the creation of the Health Insurance Marketplace. The Marketplace is a virtual shopping center where applicants submit their information to determine eligibility for financial assistance based on household size and income and shop multiple insurance plans to find the best coverage that suits their individual or family needs."
All the local counseling organizations urge clients to bring pay stubs, proof of residence, picture IDs and Social Security numbers for all household members.
"Applicants should be aware of who is included on their taxes when filing as well as their Social Security number and date of birth," Holzschuh said. "They should have any income information such as pay stubs or the previous year's tax return in order to project their income for 2016. Completing the application online may be easier with the assistance of someone who is more familiar with the process. Our facility has certified application counselors who can walk applicants through the process and help explain areas that may be confusing. The Marketplace has specific requirements in place for insurance plans offered to ensure specific services are covered.
"Millions of Americans are now eligible to receive free or low-cost health coverage who previously had no way of paying for medical expenses or health insurance," Holzschuh added.
Richard Dymond, Herald health/social services reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.
MCR Health Services 'Affordable' counselors
It is recommended that clients call first and make an appointment. The enrollment deadline is Jan. 31.
North County Family Health Care Center, 1949 Northgate Blvd., Sarasota, 941-343-5025
East Manatee Family Health Care Center, 1312 Manatee Ave. E., Bradenton, 941-708-8569
Lawton Chiles Children and Family Health Care Center, 1515 26th Ave. E., Bradenton, 941-708-8600, ext. 336
North Manatee Family Health Care Center, 5600 Bayshore Road, Palmetto. 941-721-2020
Southwest Health Care Center, 5325 26th St. W., Bradenton, 941-752-7173
Arcadia Children's Health Care Center, 250 N. Brevard Ave., Arcadia, 863-494-4433