The Open Enrollment Clock is Ticking: Get Coverage by Jan. 31

The Open Enrollment Clock is Ticking: Get Coverage by Jan. 31

January 26, 2016
ACE TA Center
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This is a cross-post from The Black AIDS Institute Weekly Update.

Uninsured Americans only have until January 31 to enroll in a 2016 qualified health plan. Many staff at Ryan White HIV/AIDS Program sites and elsewhere are working to assist people living with HIV in getting covered.

How many people have enrolled so far? More than 8.7 million people signed up for health coverage through HealthCare.Gov or had their plan auto-renewed before the holidays. And this doesn't include enrollment in the 13 states that run their own state-based marketplaces.

How Do You Engage People Who Still Have Not enrolled?

Despite the promising HealthCare.Gov sign-ups, there are still many uninsured Americans who are eligible for coverage but have not yet enrolled. ACAsignups.net estimates there are 14 million people in this category. It helps to understand why people may be reluctant to enroll and what messages may motivate them to consider coverage.

Financial Help Is Available

A recent poll of uninsured Americans from the Kaiser Family Foundation found that almost half say they have tried to enroll but plans were too expensive. However, more than 8 in 10 people who signed up for coverage last year got financial help. Also, people's eligibility may have changed, and there are many new plan options, so it's a good idea to compare costs and coverage every year to make sure they are getting the best deal. In fact, many people can find low-premium plans for $75 or less per month.

  • Consumers can use the HealthCare.Gov Plan Estimator Tool to preview plans and price estimates before they apply. The first bill: This monthly bill (also called a "premium") needs to be paid before coverage can begin. Sometimes the consumer needs to pay that bill, and other times it is their employer, the Ryan White HIV/AIDS Program, or someone else. The insurance card: People should keep this card in their wallet so they have it at their doctor's appointments. If they do not receive their card, individuals can call their insurance company.
  • HRSA's ACE TA Center Health Care Plan Selection Worksheet is another tool that assisters can use to help people living with HIV list their care needs, including medications and providers, and compare plans. People living with HIV often have concerns about affordability, too, but the Ryan White HIV/AIDS Program, including its AIDS Drug Assistance Program (ADAP), can often help with insurance and medication costs. And health insurance companies are required to cover HIV medications. While people are choosing a plan to apply for, they can check to see if their specific HIV medications are covered by that plan. The HealthCare.Gov Plan Estimator Tool allows consumers to look up prescriptions. They should also find out if their ADAP provides financial support for that plan.

Avoid the Fee for Not Having Health Insurance in 2016

People who can afford health insurance but choose not to enroll may have to pay a fee - up to $695 [or up to 2.5% of household income, whichever is greater]. Some can get an exemption from the fee if an affordable plan is not available; if they are very low income and do not have to file a tax return; if they had a short gap in coverage; or if they are not lawfully present in the U.S.

Resources to Support Consumers and Enrollment Assisters or Navigators

HRSA's ACE TA Center has developed a consumer Q&A handout specifically for people living with HIV who get their care through the Ryan White Program to address some of these common questions and concerns people might have about coverage. A series of consumer posters was also designed to share some of the benefits of health insurance and spark conversations about enrollment.

In addition, the ACE TA Center offers tools and resources for case managers and other enrollment assisters, including those who may be new to supporting people living with HIV. Remember, if people don't enroll by January 31, they can't get Marketplace coverage for 2016 unless they qualify for a Special Enrollment Period. Get covered today!

By Mira Levinson, MPH, Project Director, ACE TA Center. The HRSA-supported ACE TA Center works with Ryan White HIV/AIDS Program grant recipients and sub-recipients to help diverse clients get enrolled in health coverage. Learn more at the TARGET Center