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Lunch and Learn session at Aspirus Grand View centers on Affordable Care Act


Cortney Ofstad/Daily Globe

ALICIA COOK, a patient services specialist, speaks on the Affordable Care Act during a Lunch and Learn session at Aspirus Grand View in Ironwood Wednesday.

IRONWOOD - More than a dozen residents from Michigan and Wisconsin attended a Lunch and Learn session at Aspirus Grand View Hospital Wednesday on the federal Affordable Care Act, known as Obamacare.

Attendees learned about different kinds of insurance policies, including private, government and employer-provided policies.

Alicia Cook, patient services specialist for Aspirus Grand View, spoke on how using navigators can help people through the process of the online insurance marketplace.

As of Jan. 1, people cannot be refused coverage based on pre-existing conditions or gender, annual limits on insurance coverage are eliminated and premium tax credits are also available.

Other changes include subsidies to reduce out-of-pocket costs are available and the small business tax credit will increase.

Just recently, the website was upgraded to allow potential shoppers to view different policies and see what their estimated tax credits would be if they qualified.

"We weren't able to do this a couple of months ago," Ray Sharp, of the Western Upper Peninsula. Health Department, said. "You can look at different options and see what would work best for you."

The tax credit, for those who qualify based on their incomes, allows for insurance holders to use the credit toward paying monthly premiums, receiving it as a tax return, or both.

The website also includes a section where potential buyers can search for the nearest navigator in their area to answer questions about the insurance process.

According to Cook, there are three ways to sign up for insurance - online, over the phone or with a navigator in person.

"It's much faster to do it online or over the phone, if you can," said Sue Stephens, an Affordable Care Act navigator in Ashland, Wis.

For insurance companies to be available on the marketplace, they must include at least 10 categories of coverage - ambulatory patient services, emergency services, hospitalization, maternity and newborn care, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, pediatric services, including oral and vision care, and mental health and substance use disorder services, including behavioral health treatments.

Beginning this year, most people must have health insurance coverage or they will have to pay a penalty.

For 2014, the penalty is $95 per adult in the household, or 1 percent of the income. In 2015, the penalty increases to $325 per adult, or 2 percent of the income, and in 2016, the penalty increases to $695 per adult, or 2.5 percent of the income.

According to Stephens, there is a cap on the penalty, and for 2014, the max is $285 for a household.

Some people may also qualify for an exemption from the penalties, which include having income below the tax filing threshold, membership in a health care sharing ministry (faith-based), membership in a federally-recognized tribe, membership in a religious sect that objects to health coverage and being incarcerated in jail or prison.

Other exemptions include unlawful presence in the United States, lack of insurance coverage for less than three consecutive months between coverage, lack of affordable coverage based on actual income (8 percent of the household income) and hardship.

To be eligible to purchase insurance in the online marketplace, the buyer must live in its service area, be a U.S. citizen or national, or be a non-citizen who is lawfully present in the U.S. or cannot have affordable insurance through an employer.

The open enrollment to purchase insurance ends March 31 and the next open enrollment is not until Nov. 15.

According to Stephens, enrollment periods can also take place if special circumstances were to happen.

"For example, let's say you lose your job in May and you don't have insurance anymore," Stephens said. "That would qualify for a special enrollment."

People in certain income levels can be a part of state-run insurance expansions, as well. In Michigan, starting April 1, the state will have a program called Healthy Michigan, which acts as a Medicaid expansion to help more people.

According to Sharp, the plan is to have the expansion in place April 1, but things are not "set in stone."

"I would like to give a definite answer, but with how things have been, I can't," Sharp said.

In Wisconsin, BadgerCare Plus services will change on April 1, but the changes will not affect Medicaid. Changes include new income limits, new rules for counting household income, one benefit plan for all members and coordination with new Qualified Health Plan coverages.

The changes in Wisconsin were set to happen Jan. 1, but the current plan was extended.

On April 1, BadgerCare Plus members will lose coverage, but can choose to fill out a form to see if the new rules allow them to stay enrolled after that date.

Attendees asked questions pertaining to their situations, clearing up misconceptions about their health insurance coverages.

Despite problems early on with the ACA, Cook believes things are slowly working themselves out.

"There are some glitches, I'm not going to lie, but we're working through it," Cook said.

For more information on the ACA, visit To work with Cook at Aspirus Grand View, call 906-932-7627. In Wisconsin, Iron County residents can call Stephens at 715-682-9141, or call the Northern IM Consortium at 888-794-5722. In Michigan, residents can call Sharp at the Hancock office of the Western U.P. Health Department at 906-482-7382.


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