Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement began in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare’s Effect on West Virginia Health Insurance
In West Virginia, the Congressional delegation supported healthcare reform and opted to expand Medicaid. The state also implemented auto-enrollment processes to flag individuals that were receiving government assistance in another area, so they could be automatically enrolled in Medicaid. In addition, the state invested in utilizing navigators to help first-time enrollees find the best options available. As a result, West Virginia Obamacare has resulted in a decrease of uninsured residents from 17% to 7.7%, which is lower than the national average (9.1%), according to the National Health Interview Survey.
What West Virginia Residents Should Know About West Virginia Obamacare
Pros and Cons of West Virginia Obamacare
West Virginia Obamacare has made health insurance coverage available to many that could not previously afford care through a highly successful Medicaid expansion. The public exchange has also contributed to the success in reducing the uninsured as 37,000 residents enrolled through the exchange and 87% received subsidies to help offset the cost of coverage.
It has also been successful in stressing the importance of individuals owning their own care by taking advantage of wellness programs and early screenings. Finally, Obamacare in West Virginia has successfully eliminated denial of care based on pre-existing conditions and has disabled West Virginia companies from charging a higher premium based on race or gender.
There are criticisms of Obamacare in West Virginia based on the limited number of carriers available on the exchange. In addition, there has been a notable struggle in getting re-enrollments, especially for the healthy young adult population who would rather pay the fine for not having coverage than be responsible for monthly health insurance premiums they cannot afford.
Apply for Obamacare: Health Plans And How Much You Will Pay
When shopping in the West Virginia Obamacare Marketplace, you will find four primary health plans to can choose from: Bronze, Silver, Gold, and Platinum. These plans each have a different percentage of healthcare costs they will pay for over the course of a coverage year; the remaining percentage (out of 100%) is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. Think about it this way: If the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay the remaining 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze Plan – 60%
- Silver Plan – 70%
- Gold Plan – 80%
- Platinum Plan – 90%
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How Do I Sign Up For Obamacare In West Virginia?
You can get West Virginia Obamacare quotes and sign up for Obamacare plans through the West Virginia Obamacare Marketplace. This Marketplace can be accessed through the federal website, healthcare.gov, or by calling (800) 318-2596.
What Are The Obamacare Marketplace And Exchange?
The Marketplace is a central location to look for insurance options and enroll for selected coverage. In the case of Obamacare, West Virginia utilizes a Federally-Facilitated Marketplace (FFM) that operates as a partnership. This means that the U.S. Department of Health and Human Services operates and manages the Marketplace where public health insurance plans are offered, but the state of West Virginia still has a certain level of involvement.
Do I Need To Use An Exchange?
To access public health insurance, you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in West Virginia is if you are able to seek help from a West Virginia certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How Do I Use The Obamacare Exchange In West Virginia?
You can use the exchange in one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling (800) 318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What Does It Mean To Be On-Exchange Or Off-Exchange?
On-exchange generally refers to purchasing public health insurance from the Obamacare West Virginia Marketplace while off-exchange refers to purchasing private health insurance coverage from a private company or marketplace.
When Is The Obamacare Enrollment Deadline And What Do I Do If I Missed It?
The Obamacare open enrollment period for 2017 in West Virginia is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short term individual private insurance to avoid a health insurance penalty.
What Is The Obamacare Penalty If I Don’t Buy Health Insurance?
If you do not enroll in Obamacare or another qualifying health plan (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 years of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What If I Cannot Afford Obamacare?
If you cannot afford to pay for an Obamacare plan, you may be able to qualify for a government subsidy. For more information on government subsidies, visit the HealthCare.gov website.
What Are The Alternatives To Obamacare In West Virginia?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.