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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

What consumers should know about healthcare enrollment for 2015


  Last week marked the beginning of open enrollment for the federal health insurance marketplace, and on the surface it appears not much has changed. By some measures premiums before tax credits are just as affordable as last year - decreasing on average by about one percent according to a report by the Kaiser Family Foundation. But to be a savvy shopper, many consumers should give the marketplace a second look.

In many ways the 2015 marketplace is very different from last year. Karen Politz, Senior Policy Analyst with the Kaiser Family Foundation, said many insurance companies have changed the cost of their plans and even more companies have joined the marketplace, which has made prices more competitive.

“It is still substantially new and I would expect it will probably be a couple of years before we get to kind of whatever the new equilibrium,” Politz said. “There probably will be adjustments and for that reason alone, it's too early for people to take for granted that they know everything that there is to know.”

How those adjustments will affect people depends on where they live and how much they make. For example, in St. Louis the base cost of the second-lowest-cost plan increased by almost five percent. But some consumers that qualify for tax credits will pay almost one percent less than they did in 2014. That’s because tax credits are tied to the Federal Poverty Level, which increased by almost 200 dollars over the past year. But in several states consumers who aren’t eligible for tax credits will be paying more this year, which is why Politz said people who bought insurance through the marketplace last year should think about reevaluating their current plans.

“Even if they are very satisfied with their plan, and in that case they probably will want to stay, it's still a good idea to check back in and just see what else might be offered and have that compares with where you are now and also check back in on the cost,” Politz said.

And this year marketplace navigators are hoping to make some concepts - like how tax credits work - less confusing for consumers.

According to a poll from Kaiserin October, two-thirds of the uninsured said they know little to nothing about the health insurance marketplace. Ryan Barker is the Vice President of Health Policy at the Missouri Foundation for Health.

“It's a confusing product, all of these different terms are difficult for folks to understand,” Barker said. “So trying to present it in a very plain language sort of way that helps people understand the concepts is really important for them being able to pick the right plan for their family situation.”

While the marketplace may continue to be a fluctuating space, one thing will consistently increase in the coming year: the penalty for those who don’t have insurance. In April, people who didn’t have health insurance in 2014 will pay a penalty of $95 or one percent of income, whichever is greater. Next year, that penalty increases to $325 or two percent of income. Politz said it only goes up from there.

“The cost of doing nothing if you can get affordable coverage is and it will increase again in 2016,” Politz said. “People do need to be aware that there are tax consequences for not being insured.”

But like last time, exemptions to this penalty still exist. For Missouri, many uninsured qualify for an exemption because the state has so far chosen not to expand Medicaid coverage.

Medicaid expansion is yet another way this year’s enrollment period is different from the last. Since the last open enrollment period, New Hampshire, Pennsylvania and Ohio have expanded their coverage. Wisconsin rearranged their Medicaid system to better fit the marketplace system. And several other states have received Medicaid waivers to begin expansion. But 21 states, including Missouri, have yet to expand their coverage.

Hope Kirwan left KBIA in September 2015.
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