What you need to know: Navigating new health exchanges

What you need to know: Navigating new health exchanges

New health care exchanges started selling the now-mandatory health insurance Tuesday, Oct. 1. Below, Problem Solver Shellie Bailey-Shah walks you through what you need to know to navigate the state exchanges.

Websites and phone numbers to Oregon and Washington exchanges:
Cover Oregon
Washington Health Benefit Exchange

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Nuts and bolts of Cover Oregon

Right now Oregonians cannot yet buy insurance on Cover Oregon. To purchase a plan, you need to work with a certified community partner, tribal organization or insurance agent.

To find one, you can go online to coveroregon.com. Or call the service center at 1-855-COVER-OR (1-855-268-3767).

There's no additional cost to use a community partner or agent.

You could just hold off and purchase the plan directly through the website later this month when the system becomes fully operational.

If you purchase by Dec. 15, your coverage will kick in at the beginning of 2014. You'll also avoid paying a possible penalty.

You don't have to purchase insurance at your state's exchange website, but it's the only way that you possibly can qualify for financial assistance. That’s the topic of the next section.

Getting Financial Aid

While you could buy your new insurance policy directly from a provider, the only way to take advantage of the government's financial assistance program is to purchase on a state exchange site.

Tax credits to help you afford your premium:

To qualify, you can't receive health insurance from your employer, you can't receive Medicare and your income has to fall within these parameters:

  • For a single person, a yearly income of $45,960 or below.
  • Family of two, a yearly income of $62,040 or below.
  • Family of four, a yearly income of $94,200 or below.

That being said, if your income is just above those amounts, the state says you may still qualify.

The second kind of financial break is cost-sharing assistance to pay for actual medical expenses, like deductibles and co-pays.

You may qualify if you're somewhere in between an individual earning up to $29,275 a year or a family of six, earning up to $78,975 a year.

Qualifying for Oregon Health Plan and Washington Apple Health

People may now qualify for these no-cost health care plans who didn't qualify in the past.

In Oregon, individuals earning up to $15,856 a year or a family of six, earning up to $43,594 may now qualify for free health care coverage.

The only way to know for sure is to work through the process with your state health exchange. There are counselors at those call centers who can help get you started.

Cover Oregon
Washington Health Benefit Exchange

Whether you qualify for the Oregon Health plan, Washington Apple Health, or another insurance plan, you should be signed up by Dec. 15 or you may be penalized by the IRS.

Penalties if you don't have insurance

You need to select a plan by Dec. 15. The coverage would start Jan. 1.

So what happens if you don't?

You'll have to pay a fee or penalty when you file your taxes.

It's 1 percent of your yearly income or $95 per person, whichever is higher.

For an uninsured child, it's half that amount: $47.50.

The most a family would have to pay in 2014 is $285.

Also know the fee increases every year.    

There are a number of people who are exempt from the penalty.

  • If you're uninsured for less than 3 months of the year.
  • If the lowest-priced coverage available to you would cost more than 8 percent of your household income.
  • You don't have to file a tax return because your income is too low.    
  • You're a member of a federally-recognized tribe or eligible for services through an Indian health services provider.
  • You're a member of a recognized health care sharing ministry.
  • You're a member of a recognized religious sect with religious objections to insurance.
  • You're incarcerated.
  • There are also a number of hardship exemptions, including eviction, foreclosure and bankruptcy.

Small businesses and the exchanges

Small businesses are also wading into the new territory of state health exchanges.

There is financial assistance available for businesses in the form of tax credits.

  • Your business needs to have fewer than 25 employees.
  • You have to pay at least 50 percent of employee-only premiums.
  • And your average annual wages need to be less than $50,000.