Millions of uninsured Americans, including tens of thousands of Arkansans, once again have the chance to enroll in health coverage and apply for subsidies to help pay for it.
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Today is the beginning of the annual open enrollment period for people who buy coverage on their own, rather than through employers.
According to a report from the Menlo Park, Calif.-based Kaiser Family Foundation, about 32.4 million Americans, including 285,000 Arkansans, lacked insurance as of early this year.
The research organization estimated that 127,000 of the uninsured Arkansans are eligible for Medicaid, and 60,000 are eligible for tax-credit subsidies.
The remaining 98,000 are ineligible for assistance because their incomes are too high, they are eligible for employer-sponsored coverage, or they lack the proper immigration status, according to the report.
For coverage starting Jan. 1, Minnetonka, Minn.-based Unitedhealth Group is joining Arkansas Blue Cross and Blue Shield, the national Blue Cross and Blue Shield Association, Little Rock-based QualChoice Health Insurance and St. Louis-based Centene Corp. in offering plans on the state's federally run health insurance exchange.
According to the U.S. Department of Health and Human Services, the premium for Arkansas' second-cheapest silver plan -- designed to cover 70 percent of medical expenses -- will increase an average of 4.3 percent next year, compared with an average increase of 7.5 percent for such plans among the 37 states that use the healthcare.gov enrollment portal.
The price of the second-cheapest silver plan determines the amount of tax-credit subsidy an eligible consumer receives. For instance, if the consumer's income is 150 percent of the poverty level, the premium is calculated so that he would not have to pay more than 4 percent of his income for that plan. He would receive a subsidy for the rest. That subsidy could then be used to help pay the premium for whichever plan he chooses.
The tax-credit subsidies are available to those who don't qualify for Medicaid, don't have access to employer-sponsored coverage and have incomes of less than 400 percent of the poverty level: $47,080 for an individual, for instance, or $97,000 for a family of four.
Information on the healthcare.gov website advises those who are already enrolled to log into their accounts, update their household and income information, and shop around for other insurance plans.
According to a report by the Health and Human Services Department, 91 percent of Arkansans enrolled in coverage on the exchange could reduce their premiums, before tax credits are applied, by an average $234 a month by switching to a cheaper plan in the same coverage tier.
penalty increases
Under the 2010 federal Patient Protection and Affordable Care Act, those who don't have coverage face the potential of having to pay tax penalties.
The penalty started in 2014 at $95 per uninsured adult, $47.50 per child, or 1 percent of a family's income that exceeds the tax filing threshold, which was $10,150 for an adult or $20,300 for a married couple filing a joint return.
This year, the penalty is the greater of $325 per adult, $162.50 per child or 2 percent of household income above the tax filing threshold.
Next, year the penalty will rise to the greater of $695 per adult, $347.50 per child or 2.5 percent of household income above the tax filing threshold.
The penalty is capped at the national average annual premium for a bronze plan, designed to cover 60 percent of a typical patient's expenses.
This year the cap is $2,484 per individual or $12,420 for a family with five or more members.
The penalty is prorated based on the number of months the individual lacked coverage and is not assessed against those who would have to pay more than 8 percent of their incomes for insurance.
According to preliminary data released by the Internal Revenue Service in July, about 7.5 million taxpayers nationwide paid the penalty with their tax returns for 2014. The average penalty was about $200.
An additional 12 million taxpayers claimed a financial hardship or other circumstance exempting them from paying the penalty.
IRS Commissioner John Koskinen said in a letter to Congress that the agency was investigating returns submitted by 5.1 million taxpayers who did not check a box attesting that they had insurance in 2014 but also did not pay penalties.
help with premiums
Arkansans who qualify for the state's expanded Medicaid program can enroll in exchange coverage without having to pay premiums.
Under the private option, Medicaid pays the premium and provides additional subsides that reduce or eliminate out-of-pocket costs for medical care.
The expansion extended eligibility to adults with incomes up to 138 percent of the poverty level: $16,242 for an individual or $33,465 for a family of four.
More than 234,000 Arkansans were covered under the expanded Medicaid program as of Sept. 30, and more than 53,000 people were covered by non-Medicaid plans on the exchange as of Oct. 1.
Those who don't qualify for Medicaid and buy coverage on their own, rather than through employers, can sign up only during an annual enrollment period or after certain events, such as marriages, divorces, births of children or losses of jobs.
The period for coverage taking effect next year starts today and ends Jan. 31.
Those who qualify for Medicaid can sign up at any time, but they can change plans only during the open enrollment period.
Arkansans can shop for plans and apply for assistance by visiting the federal healthcare.gov website, by calling a federal call center at (800) 318-2596, or by mailing an application to the Health and Human Services Department's Centers for Medicare and Medicaid Services.
Medicaid applications can also be submitted through a state website, access.arkansas.gov.
Enroll the Ridge, a Jonesboro-based nonprofit organization, will be offering one-on-one help with enrollment from noon to 5 p.m. today at its call center at 107 E. Jackson St. in Jonesboro.
Consumers across the state also can make appointments to meet with outreach workers at the website arenroll.org, which also has a link to a calendar of enrollment events.
small business coverage
Today also is expected to be the first day that small businesses can sign up for coverage through a state-based exchange set up by the Arkansas Health Insurance Marketplace, a nonprofit organization created by the state Legislature in 2013.
The exchange, set up under a $7.2 million contract with Reston, Va.-based hCentive, is expected to have an online enrollment portal at myarinsurance.com.
The exchange is open to businesses with up to 50 employees. Businesses that have fewer than 25 employees and pay average wages of less than $50,000 can claim tax credits of up to half of their premium expenses for up to two years if they help their employees buy coverage through the exchange.
Covenant Medical Benefits in Jonesboro became the first business to enroll through the website last month in an early test run for the site.
Jim Miles, owner of the business, which helps hospital patients apply for Medicaid, said eight of his 10 employees enrolled with the help of an insurance agent in about an hour.
One employee already had coverage through her employer, and another has coverage through the private option, he said.
"For us, the amount of time it took, I thought was very reasonable," said Miles, who is also director of Enroll the Ridge.
He said the company will pay 90 percent of the employees' premiums for employee-only coverage. He expects to qualify for a tax credit equal to 35 percent of the company's premium expenses.
Previously, Arkansas small businesses could apply for the credit through healthcare.gov.
Alicia McCoy, a spokesman for the state marketplace, said businesses that are covered through the federal exchange will switch to the state-based exchange when they renew their policies.
As of Jan. 14, about 20 employers were using the federal exchange, with plans covering a total of 156 employees, according to a spokesman for Arkansas Blue Cross and Blue Shield, the only company offering plans on the exchange.
Metro on 11/01/2015