Hospital helps navigate new healthcare marketplace

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By Shaina Stockton, Staff

Despite the ongoing battle that has resulted in a deadlock between Congress and President Obama, the next phase of the Affordable Care Act — the new federal health insurance marketplace — entered its third day of open enrollment on Thursday.
Because of the ongoing controversy and media coverage, the health care law often referred to as  “Obamacare” is known by almost everyone. But even for those who have followed the new law’s progress over the past three years, the rules might still seem pretty confusing.

To help explain how the new system works, Twin County Regional Healthcare (TCRH) is offering several resources to the public, which highlight aspects of the Affordable Care Act that matter the most to members of the community.
TCRH Chief Executive Officer Jon Applebaum shared a preview of their healthcare presentation to members of the TCRH advisory group at a meeting on Oct. 3.
“The Affordable Care Act was signed three years ago; and since then, a lot has happened,” Applebaum began. “We see it as an important role in our mission to share our knowledge of this subject with the community.”

The New Face of Healthcare
Applebaum began with a short video put together by the Kaiser Family Foundation. The clip walked the audience through the basics of how health coverage is changing, and how the new plans work.
Some people are asking why health insurance is so important. In fact, many individuals or families who struggle with finances have chosen not to enroll in a healthcare plan at all.
This option provides temporary relief to their budget — until they get sick. “When people can’t afford to see a doctor, they try to put it off, sometimes until the situation becomes critical,” said Applebaum.
When the illness is bad enough, the patient winds up in the emergency room. Without insurance, the costs are even higher for the patient than if they’d seen a doctor or paid for insurance in the first place. And, for an ER that treats people regardless of their ability to pay, the unpaid medical bills from uninsured patients who can’t afford care can affect the hospital’s finances.
At this time, it is estimated that 50 million people in this country will have increased access to healthcare. Of that number, Applebaum estimated 850,000 of these individuals live in Virginia and around 10,000 are residents of the Twin County region.
“Nationwide, it is estimated that 23 million will benefit from these [healthcare] plans,” Applebaum said.
The new healthcare law requires everyone to opt in to some form of health insurance coverage. However, they do not have to choose their insurance from the marketplace — they can still be covered under their employer.
Those who can afford coverage but refuse to sign up for it will be charged an annual fee. If the person can’t find a plan that costs less than 8 percent of their income, the fee will be waived.
In the past, some individuals have waited until they felt sick to sign themselves up with a plan, But since open enrollment is only available for a certain period of time each year, this will no longer be an option.
Health insurance companies can no longer deny a person coverage because of a pre-existing condition. “This is something that used to make getting insurance impossible for some people,” Applebaum said.
To help lower-income households with the new changes, financial assistance will be available for those who qualify. “This will be available for families with three or more who make less than 400 percent of the federal poverty level. We are estimating that a lot of people in this area will meet these qualifications,” said Applebaum.
The reform had also opened a larger window for patients to qualify for Medicaid. However, each state can choose to opt out of the expansion. “As of right now, Virginia officials have not agreed to move forward with the Medicaid expansion.” said Applebaum.
State officials are seeking major reforms to this aspect before allowing it in Virginia, which could delay expanded medicaid availability for up to 18 months.

How the Marketplace Works
The new health coverage options are made available through what is called a “Health Insurance Marketplace,” which allows patients to comparison shop for the plans that are best suited for them. The marketplaces were made available online beginning Oct. 1 and will remain open until March 31, 2014.
“Open enrollments in the future won’t be this long,” Applebaum noted. Due to the marketplace being new, the extended enrollment period will give patients plenty of time to explore their options and make an informed decision.
“Right now, people can go online for homeowner’s insurance, for auto insurance and many other types of insurance. It will work similarly with health insurance. On this website, health insurance companies will be competing against each other for your business,” he said.
The marketplace uses a value system to compare plans side-by-side, he explained. “There are four different ratings: bronze, silver, gold and platinum. A ‘silver’ plan will basically mirror traditional health insurance coverage, while a bronze plan will give you fewer services and a higher deductible.”
To be listed as a possible marketplace plan, insurance companies had to be pre-approved. The state of Virginia has nine approved plans available.
In Southwest Virginia, there are only three plans to choose from: Anthem, Optima and Aetna.
Individuals can research and sign up for their plans on the website, creating a “one-stop shop” for health insurance coverage, said Applebaum.
Due to the high demands and curiosity of the public, many of the marketplace websites have experienced downtime because of high volume.
Applebaum attempted to open Virginia’s website as an example at the meeting, which led him to the error message that most people had continued to see over the three-day period.
Minutes later, after he’d paused the website for a Q&A, the website refreshed, and allowed him to access the page.
The coverage that is purchased will go into effect as early as January 1, 2014. As a result, TCRH is predicting a higher demand for patient care.
With its partnership with Duke LifePoint, Applebaum is confident that the hospital will be ready in time for next year.

Twin County Regional Hospital is preparing several resources for patients who are interested in learning more about the new healthcare plans, or signing up for health insurance inside the marketplace.
“This presentation will be made available to various groups in our community,” hospital CEO Jon Applebaum said. In addition, the hospital will be reaching out to individuals to offer their resources, as well.
“At this time, the staff includes six certified application counselors on-site,” he said. These staff members will be available to provide information about Obamacare, assist with filling out applications, and help them choose an affordable plan.
• Counselors at TCRH are available Monday through Friday during normal business hours, or by appointment after hours and on Saturdays.
• The TCRH website, www.tcrh.org, has been updated to include access to information regarding the healthcare plans, including a checklist of documents people need to enroll.
• For additional information, people are encouraged to email the hospital at TwinCounty.CAC@LPNT.net to ask questions or schedule an appointment, or call 1-888-982-9144 for 24/7 support.

To view the Kaiser Family Foundation video that is included in the TCRH healthcare presentation, click HERE.