It was just a few years ago that people were still being blocked from getting health insurance because they couldn’t afford the premiums, or had a pre-existing condition used as a reason to deny coverage. Thanks to the Affordable Care Act (known as Obamacare) health insurance companies are now required to accept anyone who signs up between November and January no matter what your health status is. Beyond that, there are income-based caps limiting how much most people have to pay for coverage so that more people can afford it.
With these protections in place, for most people the biggest obstacle getting health insurance is simply not knowing what the benefits are or how to sign up. Cascade AIDS Project is working to increase access to health care for people living with HIV and also the broader LGBTQ community, and can help walk you through it.
First of all, what’s the benefit of health coverage?
As you probably already know, health care costs these days are getting extremely expensive. A doctor’s appointment for a sore throat can cost you $150 or more just to find out you don’t need antibiotics. Let’s say that sometime over the next year you—heaven forbid—break a bone and need surgery to repair it, or get in a minor car wreck and need to stay in a hospital overnight. For even a brief hospital stay you could end up with a bill in excess of $20,000. That can really disrupt your life if your costs aren’t paid for by health insurance.
If you don’t have insurance, on top of the risk of expensive health bills there’s a tax penalty starting in 2016 for not having coverage. The penalty is $695 for an adult plus $347.50 per child up to $2085, or 2.5 percent of your yearly taxable income, whichever is higher.
Access to health care is also important for your health. Routine access allows you to have specific conversations with your health care provider, access free preventative care such as vaccinations, depression screenings, HIV screenings and other important medical tests, and receive affordable treatments that can include PrEP, which should be paid for by your insurer.
But how much will insurance cost?
If you sign up through the marketplace, your health insurance premium is capped based on your income if you make less than roughly $45,000 a year. In the higher income ranges the cap could be close to 10 percent of your annual income, while in the lower ranges it could be as low as 3.75 percent of your income, and if you make $16,000 a year or less you will qualify for Oregon Health Plan (Medicaid) and get your health coverage mostly for free.
One easy tool to determine how much you’d have to pay for insurance on the Health Insurance Marketplace is the nonprofit Kaiser Health Foundation’s Health Insurance Marketplace Subsidy Calculator, which only takes about a minute to use. The short form lets you input your age, income and location, and estimates how much coverage will cost and how much of that you’ll actually have to pay. You can also play with different income ranges to estimate how much health insurance will cost in your future or for other people you know. (You can also get a more official estimate through the “See Plans” page at healthcare.gov.)
Sign up ASAP while enrollment is open
Since pre-existing conditions aren’t an issue anymore, you may tempted to put off getting health insurance until you get sick. Don’t do that— subsidized health insurance plans are only available during the open enrollment period between November 1 and January 31 to purchase coverage for the following year. Otherwise, you’d need a “qualifying life event” such as losing your job and previous insurance in order to enroll during the rest of the year. For those who qualify for OHP by earning less than $16,000 a year, coverage is determined on a month-to-month basis and you may be able to sign up at other times a year.
That means that if you developed a serious health issue in the beginning or middle of the year, you’d be several months or most of a year until you’d be able to get health coverage for your illness. That could wreak havoc on your finances or even delay your treatment for not being insured.
The process of signing up is fairly easy:
In Oregon you must use the federal health insurance exchange, www.healthcare.gov, to shop for a health insurance plan. The exchange will tell you if you qualify for Medicaid based on your income, marital status and dependents, or if you already know you qualify (if you make less than $16,000 a year as an individual) you can go straight to Oregon Health Plan, http://www.oregonhealthcare.gov, to apply there.
For most people the process of applying for coverage takes about 15 minutes. If you are still confused by the process, want help understanding your best options choosing a plan or if you think there are special circumstances that affect your situation, you can contact CAP’s Insurance Outreach Enrollment Team for help:
Michael Lee Howard: 503-278-3878
Nashoba Temperly 503-278-3877