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4/ accessHealthnews.net Spring 2013 Health Insurance Enrollment on the exchange opens in By Tara Broadway allowed Missouri to add an estimated 260,000 adults to its Medicaid rolls have been rejected by Republicans in the state legislature. "The expansion of Medicaid would allow local providers to recoup some of the cost of providing for patients who have no insurance," Davenport said. "For those providers who accept Medicaid, they should see an increase in clinic volume." Missouri will not be exempt from any tax increase if it declines to participate in the expansion. Next year, the Patient Protection and Affordable Care Act (ACA) will require all American citizens to purchase approved health insurance plans or pay a tax penalty of $95 for an individual or one percent of income, whichever is greater. In 2016, these penalties rise to $695 or 2.5 percent of income. Some rural health care providers don't see a down side to this expansion of health insurance coverage. "We should see a reduction in uncompensated care currently provided through the Emergency Department," said Julie Davenport, CEO of I-70 Community Hospital in Sweet Springs, MO. "In addition, we hope to see folks utilize primary care providers for preventive medicine and early diagnosis rather than waiting until the illness becomes a crisis and they have to use the Emergency Department." In order to help consumers comply with the new mandate, each state will open a healthcare exchange to make low-cost insurance more accessible for individuals and small businesses. ACA calls for states to develop and manage their own exchanges, but Missouri and 25 other states failed to submit plans before last February's deadline. As a result, the federal government will develop Missouri's exchange. A healthcare exchange is an online marketplace for low-cost health insurance plans offered by private insurance companies. insurance industry or its customers, and may not receive commissions for selling plans from a certain provider. Navigator training begins in July. This June, CMS will open a 24-hour call center to provide another way for consumers to get assistance. Online materials will be available in English and Spanish, and both navigators and call center employees will offer To use the exchange, consumers multilingual services. will disclose personal information so that an automated system can All plans available on the exchange determine if they qualify for will be approved by state insurance Medicaid or for the Children's Health commissions and will share certain Insurance Program (CHIP). If not, features, called essential health or if they prefer to buy an insurance benefits (EHBs). EHBs include patient services; plan, they will be directed to a ambulatory emergency services; selection of plans. Everyone who does not have insurance available hospitalization; maternity and to them through an employer, or newborn care; mental health and whose employer offers insurance at substance use disorder services, behavioral health more than 9.5 percent of their including treatment; prescription drugs; annual compensation, is eligible to rehabilitative and habilitative use the exchange. services and devices; laboratory Age, family size, location, income services; preventive and wellness level and immigration status are the services and chronic disease and pediatric only demographic factors that affect management; the cost of a plan. According to services, including oral and vision other provisions of ACA, insurers care. may no longer charge higher premiums based on gender or Other features, such as dental pre-existing conditions. care, may differ from one Undocumented immigrants are not provider to another. Each plan will be available in four levels of eligible to use the exchange. coverage; for example, a goldThose who need help with the tier plan will cover 80 percent of application process, or do not have covered expenses. access to a computer, will be able to visit a trained "navigator" to help Another section of the ACA allows them. Funded by a federal grant, states to choose whether to expand navigators educate the public about Medicaid eligibility, with the federal health care options, including walking government picking up 100 percent them through the application of the tab for the first three years. process, if necessary. Navigators So far, five separate Democratmust have a connection to the health backed measures that would have Like a discount travel website such as Travelocity or Expedia.com, the exchange will present plans in a standardized way, according to The Centers for Medicare and Medicaid Services (CMS). This will make it easy to compare price, benefits and other attributes. However, when the exchange becomes active in October, consumers who are not eligible for Medicaid or CHIP most likely will qualify for tax credits to help them buy a low-cost plan. Adults under 30 years of age may purchase a catastrophic-only plan that will covers major health problems and up to three doctor's visits per year. In addition, all individuals and households that earn up to 400 percent of the poverty level ($76,360 for a family of three— more than 60 percent of Missouri residents) will qualify for a tax credit to help pay their premiums. Families may also be eligible for subsidies to pay for out-of-pocket costs. "I hope to see folks taking a more active role in their health care once they have the means to do so," Davenport said. "If we can catch issues at an early onset, we reduce the cost of providing care, improve outcomes and ultimately improve the quality of life for rural residents." More information about Missouri's healthcare exchange will be available in October, when enrollment in the exchange opens. Healthcare plans purchased through the exchange will go into effect January 1. Visit accessHealthnews.net to see how small business and nonprofits can take part in the health insurance exchange and what tax credits they can expect.

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