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Navigating The Health Insurance Marketplace

Bryan Thompson
Heartland Health Monitor

The federal health insurance marketplace opened Nov. 1 for 2016 coverage. An effort called Cover Kansas has been branching out all across the state to help Kansans find a plan that best suits their needs. Heartland Health Monitor’s Bryan Thompson paid a visit to one of their outreach events in Dodge City.

Most of the chairs in the public meeting room at the Dodge City Public Library are full, as clients wait for the consultations to begin. Don and Louise Tawzer, of Dodge City, signed up for Obamacare last year, after Don retired from the job that had furnished their health coverage. But he turned 65 this spring, so he’s now on Medicare. Louise isn’t there yet, so she needs coverage through the Affordable Care Act.

“We’re looking at roughly $1,200 more a year next year for the same plan, according to the letter we got from Blue Cross Blue Shield," Don says. "There may not be anything available, but we just want to look and see if there’s something that’ll help.” So the Tawzers have come to sit down with health insurance navigator Lyn Weatherhead to see what plans are offered based on their income.

After looking at their options, the Tawzers conclude that Louise’s current policy is probably their best option—even though the premiums are nearly $100 a month higher this year.

“Because of our income, we do have some help with the credit on your taxes, or whatever they call it. So, if we didn’t have that, it would be considerably higher," Don says.

Eighty percent of the people who buy insurance through the federal marketplace get some level of premium subsidy. But premiums aren’t the only costs that need to be taken into account.

“The biggest cost for us has been the prescription part," Don says. "Louise, she has several different prescriptions she takes for different things, and the cost of that went up dramatically once we got off of Cargill’s insurance.”

Another important consideration is the cost of co-payments, co-insurance, and deductibles. Don Tawzer says there’s a limit to the out-of-pocket costs Louise is required to pay per year—but it’s around $5,000. Those expenses are a big concern for Joe and Sylvia Ascencio, too.

“Deductibles are pretty high," Joe says. "Like, for instance, for us the deductible it’s $2,500 for each one of us. And so, in a way, it’s like not having insurance. So, the insurance is good if you go to the hospital, you break a leg, or something. Other than that, it really doesn’t help.”

Until last April, the Dodge City couple had health insurance that was furnished at no cost to them by Ascencio’s employer.

“I was insured, but I lost my job. So, I was forced to retire two years earlier," Joe says. "So I end up with no health insurance, no coverage, and here we are, so we had to find a solution.”

Ascencio is diabetic. He would be uninsurable without the Affordable Care Act, and he’s grateful for the coverage the federal marketplace offers. Like the Tawzers, he’s also appreciative of the federal subsidy, which knocks their premiums down to a manageable level.

“If I didn’t have any help from the federal government, I won’t be able to pay this much money, so I’d have to do without insurance," Joe says. "And I’m sure there’s a lot of people out there doing exactly that, because the insurance premiums are so, so expensive.”

Both families say they’re thankful to have a well-trained insurance navigator to guide them through the enrollment process, and to help them understand the choices and trade-offs among the 26 coverage plans available in Kansas. Anyone who wants coverage for all of calendar year 2016 has to sign up by Dec. 15.

Cover Kansas has already held coverage events featuring multiple navigators at locations all across the state. Many more are scheduled. Navigators are also available by appointment statewide.