How’s your health insurance looking? Are you confused about what to sign up for? Do words like “premium” and “deductible” get you stuck? It’s okay. There is help for you. Although the individual shared responsibility penalty of the Affordable Care Act (ACA) has been repealed by Congress, the District still requires that residents have health insurance or they could face a tax penalty.
DC Health Link has been in the business of getting people enrolled in health insurance plans that fit their households and budgets for years now. It has developed an effective strategy for reaching people across age groups and cultural backgrounds. These creative tactics ensure that no person is left behind in the quest for coverage.
Let’s Talk about Metals
If you are looking for free coverage or reduced premiums, the process begins with very basic questions about age, income and number of individuals in the household. From there you can see if you qualify for Medicaid (which can be obtained year-round) or advanced premium tax credits (which reduce your monthly premiums). If you are not interested in free or reduced-price coverage, you can use the short application (age and address) and shop for a plan that suits your needs and budget. There are four levels of coverage, called “metals,” ranging from Bronze, which has the lowest premiums and highest deductibles, to Platinum, which has the highest premiums and the lowest or no deductibles.
DC Health Link has 25 plans to choose from including HMOs and PPOs from Kaiser Permanente and CareFirst Blue Cross Blue Shield. Premiums are based on age and the level of coverage selected.
Feeling nervous about the cost already? Relax. Mila Kofman, executive director of the DC Health Benefit Exchange Authority, says there’s something for everyone in the exchange. “People think that health insurance is going to be too expensive for them. And my answer is that there is something in everyone’s budget. The other misconception is that people look at some of the deductibles like Bronze level. The Bronze level has low premiums but the deductibles are higher. And so, people think that they are not going to be able to access medical care. That’s not true. We have standard plans and that means people get access to specialists, mental health providers, primary care and urgent care without any deductibles.”
Help!
If all of this sounds like a foreign language, you are not alone. DC Health Link has employed assisters to work with you through the process. They provide free, one-on-one assistance for anyone who is stumped.
You can meet assisters at various events around the city. DC Health Link has been creative in reaching out, deploying tables at sporting events, clubs, health fairs, even restaurants. “I have a great team,” explains Kofman. “But we also like to partner with community groups, navigators and assisters. Every so often we bring them together to ask for ideas and input. And the creative ideas come from people in the community and people on my team. They are topnotch.”
Young Invincibles
Adults ages 18-34 may have their whole lives ahead of them, but life has unexpected ways of happening. Many young people perceive themselves as immune to illness and injury. Health insurance companies sometimes refer to them as young invincibles. They may decide to forego health insurance because it’s just too expensive.
Kofman says one of the best strategies for reaching young adults is at faith-based institutions. “We had a lot of young people enroll through our faith-based partnerships with churches. We find that the 20-year-olds are making health decisions for the first time and they actually want to talk to someone about it. At some of the events we do on Sundays at churches and temples we get younger people to sign up that way.”
Young adults need to get coverage not only because they may need medical care and financial security that insurance provides, but also because it lowers the costs for everyone. When more healthy individuals and families purchase coverage, that makes premiums more affordable, especially for people with medical needs.
DC Healthcare Alliance: The Rundown
DC Healthcare Alliance is insurance that covers low-income residents in the District who are not eligible for Medicaid or other public programs. The plan provides coverage for most basic healthcare needs such as doctor’s visits, prenatal care, prescription drugs and dental coverage up to $1,000. Besides being a DC resident 21 years or older, a qualifying individual must earn an income at or below 200% of the federal poverty level, and have resources (for example, a bank account) at or below $4,000 for one person and $6,000 for a couple or families. They have to be ineligible for Medicaid or Medicare in order to receive DC Healthcare Alliance benefits. Enrollment begins with a face-to-face interview at any of the Economic Security Administration (ESA) service centers around the City. Also, DC Health Link assisters can help with the application.
Open enrollment for health insurance begins on Nov. 1 and goes on until January 31, 2020. If you need coverage sooner and you have a life event like getting married or divorced, you can enroll now through a special enrollment. To see if you qualify for coverage now, go to www.DCHealthLink.com. Take a moment this summer to become familiar with the plans and costs so you can make the best choice for yourself and your family.
Candace Y.A. Montague is the health reporter for Capital Community News.
