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5/ accessHealthnews.net Fall 2015 Health Insurance Marketplace Insured 11.4 Million Regardless of the pros and cons, 2014 marked the biggest drop in uninsurance since 2008, according to a study conducted by the U.S. Census Bureau. The number of people without health insurance in 2014 was 10.4 percent, compared with 13.3 percent in 2013. In actual numbers, the number of people without health insurance declined to 33 million in 2014 from 41.8 million in 2013. Some contend this drop is unprecedented since the creation of Medicare and Medicaid over 50 years ago. Diane Rowland, who heads the Kaiser Family Foundation's (KFF) Commission on Medicaid and the Uninsured, said the gains among those newly insured were among the demographics that traditionally had the highest rates of uninsurance: younger, working-age adults and people with low and moderate incomes. The biggest gains consisted of people who got coverage through Medicaid and people buying their own health plans. Employers still remain the largest single source of health insurance at about 55 percent. States that expanded Medicaid – unlike Missouri and Kansas – saw overall gains in insurance, and not just Medicaid, than states that opted not to expand. Coincidently, this decline among the uninsured comes during a time when the nation's 2014 poverty rate (14.8 percent or 46.7 million people in poverty) and median household income ($53,657) was not statistically different from the 2013 estimate. Missouri's Federal Marketplace In 2014, 253,969 Missourians purchased on the Affordable Care Act's (ACA) federal exchange known as the Health Insurance Marketplace. This is an increase of 101,634 enrollees from the very first open enrollment. The third open enrollment period runs from November 1, 2015 through January 31, 2016. The last day to make changes to current plans is December 15, 2015. Julie Bartley, an ACA Health Insurance Navigator, gives a word of caution to anyone enrolled who received a subsidy through the Marketplace last year. "If you have not filed your 2014 taxes by the end of this year, you will lose your tax credit for the 2015-2016 enrollment period," she said. "It's a requirement…If you received an Advanced Premium Tax Credit (APTC), you need to file those taxes. That's how the government reconciles that you received the correct subsidy amount to offset the cost of your insurance." Those who haven't filed may still be able to purchase insurance through the Marketplace but will not be eligible for the tax credit, also referred to as a discount or subsidy, to help cover the cost of their insurance. Additionally, Bartley said anyone who received enrollment assistance last year may not necessarily need assistance with the enrollment process this year, but it may be a good idea to get it anyway. "If the plan they enrolled in last year is no longer offered, the Marketplace will roll them over to a plan that is similar," Bartley said. "They would then lose a bit of control when it comes to selecting Open enrollment is November 1, 2015 through January 31, 2016 what's best for their current situation, and their tax credit, if they received one, could differ." Because the tax credit is based off of Federal Poverty Level guidelines, it is important to make any necessary adjustments and updates in order to help families and individuals receive subsidy amounts that are as close to accurate as possible. If not, a consumer could be paying the difference during the 2015 tax season. Tax Penalties and Exemptions Just as in previous years, there is a penalty for most people without "minimal essential coverage." Depending on household income, it could cost $325 per adult and $162.50 per child – or 2 percent of income, whichever is greater. This year, individuals and families that earn under $48,750 could pay a "flat dollar amount" of up to $975 per household. Some people may be exempt from paying the penalty. "If they go through the process and don't qualify, they will receive documentation with an exemption number," Bartley said. "They just take the document and include it with their taxes and they are good to go." Marketplace Help for Lafayette County The Health Care Collaborative (HCC) of Rural Missouri and its Live Well Community Health Centers have helped over 400 people with Marketplace or Medicaid enrollment and encourage anyone uninsured to contact them for help. "If you don't qualify for ACA or Missouri Medicaid, but still need primary, mental or oral health care, there are several locations to get help," Bartley said. The Live Well Community Health Centers are Federally Qualified Health Centers (FQHCs) that base doctor visit fees on income. "The goal is to provide as many people as we can with the services they need," said Toniann Richard, HCC executive director. For anyone interested in learning more about the Marketplace, HCC will hold an enrollment open house on November 1, 2015 from 10 a.m. to 2 p.m. The community is invited to visit and pick up useful information or they can enroll that day. To ensure an enrollment spot that day, call 660.259.2440 to schedule an appointment. Last year, 7.5 million households paid penalties totaling $1.5 billion. Another 12 million households claimed a penalty exemption.

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