Only five health care companies offer essential benefits in Fort Bend Affordable Care Act kicks in and Access Health says it can help By Elsa Maxey
T
he Affordable Care Act is taking root this year after its passage three years ago. It is intended to make insurance affordable for all Americans, especially those with low and moderate incomes. Effective in 2014, federal law requires all Americans to have health insurance or face financial penalties. What Fort Bend residents are immediately concerned about is how they will be individually affected by the health law and what plan they need to get. If already enrolled in an employer health plan, Medicare and/or a supplement or another private insurance company approved for access in Fort Bend County meeting essential benefits of the federal law, then this detail is out of the way. But for others, the need to get insurance this year still remains a bit confusing. Knowledgeable about the new health care plan undertaking locally is Carol Edwards, who runs Access Health in Richmond as its CEO. Edwards, who has been with the 38-year organization for more than 10 years, confirms that making sense of the changes in health care plans and the new law’s health insurance market place can be difficult. Access Health was formerly known as Fort Bend Office of Early Childhood Development, in the 1980’s the name changed to Fort Bend Family Health Center, and in November 2012…Access Health. It is a federal qualified health center, not a health care exchange. The health care exchange marketplace in
10
Texas is operated out of Washington, D. C. since Texas opted out of setting up health care exchanges, said Edwards. She also reports that there are only five health care companies with approved plans for Fort Bend County residents - Humana, Aetna, Signa, Blue Cross Blue Shield and Community Health Choice. These companies have health insurance plans that meet all the ten essential benefits set forth by the Affordable Health Care law. Plans that do not have them cannot participate in the health marketplace. Here’s a side note, Blue Cross Blue Shield has plans in every state, according to Edwards, and there are also national and regional plans. She said people can continue to keep employer plans but the plans have to meet the essential benefits. Those reportedly loosing their plans did so due to health plans not having the benefits required by the federal health law. Access Health’s three certified application counselors funded with federal monies are available to help residents. “Their job is to go out in the community and do outreach,” said Jana Endicott, registered nurse and director of outreach and enrollment with Access Health. Endicott has been at health fairs, day cares and community groups “where people want us to come and tell them what they’re eligible for,” she said. If they’re eligible for something else, “our job is to assist them for enrollment for that,” she said. Access Health operates with a $15 million budget from which a little over a million comes from the federal government for serving persons in Fort Bend and Waller Counties, 25 percent comes from the state health department, and it also receives United Way funding. The balance of their operations is funded by what it makes from patient services, the sliding fee scale charges and what is billed to insurance companies including commercial plans, Medicare, February 2014 H Fort Bend / Katy Business Journal
Medicaid and the Children’s Health Insurance Program. Here’s what Ford Benders need to know. Aside from work related health insurance plans and other health insurance coverage arrangements, open enrollment for health insurance on the federal website started October 1, 2013 and it runs through March 31, 2014. In order for an insurance policy to be in effect on January 1st, a person must already be enrolled and the first premium must have been paid by December 31st. Access Health says it can help someone through the electronic or other walk-through process. For those looking for health care coverage offered through the exchanges, you can sign up anytime during year up until March 31 and after that, even if a person is between the 100 to 400 poverty level and qualifies for subsidies, a penalty will have to be paid for each year that individual chooses not to enroll. That penalty for a federal income poverty individual would be between $115 to $400 on a federal income tax filing in 2015. There’s more information that Access Health says it can provide to help. For more information, Access Health has a hotline – 281-633-3175 – with a live person unless staff is assisting others.