Lindeen answers questions about Obamacare

A standing-room-only crowd listened to Montana Insurance Commissioner Monica Lindeen answer questions about Obamacare, also known as the Affordable Care Act, at Kalispell Regional Medical Center on Oct. 2.

“I call it Obamacare because people know it as Obamacare,” Lindeen said, adding that even the President doesn’t object to the term.

About 195,000 Montanans currently don’t have health insurance, she said. About 145,000 qualify for health insurance under Obamacare, and at least 80 percent of them qualify for tax credits that will reduce annual premiums.

Obamacare insurance is currently sold in Montana by three companies — Blue Cross/Blue Shield, Pacific Source and Montana Health Co-op.

Lindeen warned about fraudulent companies. If a person gets a phone call from a company seeking health insurance information, or tries to get personal information like a Social Security number, they’re likely fraudulent, she said.

People who are on Medicare or Medicaid or who are already insured won’t use Obamacare, she said. The insurance is intended for people who currently do not have affordable insurance through their employer.

If an employer offers a health plan that meets the federal benchmarks for minimum value and affordability, and if a person decides to waive that coverage, that person will not receive tax credits or cost-sharing discounts for plans purchased on the Obamacare Marketplace, regardless of their income. To find out if an insurance plan meets those benchmarks, people should contact their employer.

Obamacare insurance plans are offered at different levels. Platinum is the best, with 90 percent of health costs paid and a 10 percent deductible. Gold plans are 80-20, silver are 70-30, and bronze are 60-40. The higher the level, the higher the premium costs.

Insurance companies can’t set rates based on pre-existing or other health conditions under Obamacare, but they can change rates based on age and tobacco use.

A gaping hole exists in Obamacare coverage in Montana. Because the state legislature voted against expanding Medicaid coverage in its last session, about 50,000 people — an estimated 7,000 of which are veterans — don’t qualify for subsidies because their modified adjusted gross income is below 100 percent of the federal poverty level.

People in this gap are basically trying to raise families on minimum wage and part-time jobs, Lindeen said, or they are younger people, like college students, who don’t make much money.

Businesses and individuals who don’t sign up could face penalties. The business mandate was delayed by Congress for a year, but the individual mandate requires that people who qualify purchase insurance or pay a tax penalty.

The penalty in 2014 is $95 per adult and $47.50 per child, up to $285 for a family, or 1 percent of family income, whichever is greater. That penalty increases over the next two years, reaching in 2016 penalties of $695 per adult and $347.50 per child, up to $2,085 for a family, or 2.5 percent of family income, whichever is greater.

The penalties don’t apply to people who would have to pay more than 8 percent of their income for health insurance, after taking into account any employer contributions or tax credits, or if family income is below the threshold for filing a tax return.

Several groups of Americans are exempt from Obamacare, including Native Americans, members of a religion opposed to acceptance of benefits from a health insurance policy, or members of a recognized healthcare-sharing ministry. Also exempt are people who are incarcerated or who are not U.S. citizens.

Lindeen’s event was a cordial affair. People had either suggestions on how to make Obamacare better or specific questions about coverage and other details.

To learn more about Obamacare, visit online at http://montanahealthanswers.com. To shop for coverage, visit online at www.healthcare.gov. When the latter Web site first went live last week, it was inundated with users and crashed briefly. But by Oct. 2, it was running smoothly again.