Details critical in ACA enrollment

As the Feb. 15 Open Enrollment deadline for the Affordable Care Act looms, here are a few things to keep in mind:

• If you already are covered through a job, Medicare, Medicaid, or the VA, you most likely won’t qualify for tax credits and other discounts that would make an ACA pol icy affordable. You are considered already insured and won’t be penalized by the IRS.

• If you are not insured but have an income that falls below the Federal Poverty Level for Alaska, you are exempt from the penalty and don’t have to be insured. (For other exemptions, please go to Healthcare.gov.)

• If you need insurance and want to see if an ACA policy would be doable for you, do not wait until February 15 to enroll! I can guarantee you that the healthcare.gov website and the Call Center will be so swamped they probably won’t be functional. I suggest enrolling by at least Feb. 13 to avoid system crashes and long Call Center wait times.

• Be sure to double check the 2014 Poverty Guidelines for Alaska to make sure you have the minimum projected adjusted gross income for 2015 based on tax household size to qualify for the Advanced Premium Tax Credits that will help cover your premium cost and also possibly the cost-sharing reductions that will reduce your deductible and other out-of-pocket costs at the Silver level. If your income falls below 100 percent of the poverty level, you won’t be able to get those discounts and probably won’t qualify for Medicaid until Medicaid Expansion is implemented here later this year.

• If you are tackling the healthcare.gov website yourself (without the assistance of someone like me), make sure you are on the official site. There are some dummy sites out there. Make sure the URL has the green lock symbol to the left of the https:// and that the whole address is: https://www.healthcare.gov/

• When you are creating a Health Insurance Marketplace account on that website, write everything down so you’ll be able to access your account later. Don’t assume you’ll remember your password and security answers three months from now or even next week.

• When you’re picking your three security questions, stay away from any that involve numbers, such as phone numbers or dates. Stick with simple nouns. If you ever have to reset your password, you will be asked to write down the answers to your security questions exactly the way you typed them on the computer the first time.

• Once your healthcare.gov account is created, the Health Insurance Marketplace will send you an email to the address you used as your username. You will need to open that email and click on a link, then you’ll need to log back into your account to continue with your application.

• When you log back in, you will be asked “Where would you like to go?” You will always click on the big green bar that says “Visit the Marketplace for individuals and families.” This is true even after you finish your application and enroll and want to access your application later.

• Keep in mind that if your children are on Denali Kid Care insurance and your income is between 100 percent and 138 percent of the poverty level, the computer might automatically assume that you, too, might qualify for Medicaid and it won’t let you enroll in a health plan. To get around that, you might try going back to your application and adding in more income to get you over that income hump. Also, if you have ever applied for Medicaid and been denied or know for sure you would be denied because your income is too high, be sure to check the box next to your name and other adults seeking coverage when asked if anyone has been denied Medicaid. This will keep you from falling into that Medicaid hole again and you will most likely then be awarded tax credits and be able to enroll in a plan.

• When putting in your income, remember you are projecting what you think it will be in 2015 (before taxes are taken out). What you made last year or in 2013 won’t matter if your income is going to be different this year. Be careful when choosing the “how often” selection for that income. If you are making $15 an hour but don’t work 40 hours per week or don’t work every week, it is best to figure out what your actual annual income will be and put in that total amount or else your yearly amount won’t be calculated correctly if you put in your hourly rate.

• If you will be getting a PFD this year, be sure to include at least $1,800 per adult under “other income.” You do not need to include your children’s PFDs as part of your total income.

• Write down how much income you are claiming for all the adults in your tax household and/or print out the application summary page that includes the income so that you will be able to check those figures for accuracy later in the year and know if you need to update your application before the end of the year.

• Once you have completed and submitted your application, you will get your “Tax Credit Eligibility Determination” as a pdf document. Open that letter to see what your tax credit will be each month and whether you are asked to send the Marketplace more information, such as proof of income. If you have to send proof of income, you can still enroll before Feb. 15 and will have 90 days to send that information to Kentucky. If you can, print out that letter so you will know what to send and where to send it, etc.

• You can then proceed to the enrollment stage. You will be asked how much of the tax credit you want to be applied directly to your premium each month. Most people use all of it so that they will pay as little as possible each month, but you are given the choice of using all, some, or none. If you use, say, 80 percent of it, you will pay more for your premium, but you’d get the other 20 percent back when you do your taxes in 2016. This option might be the best for those who are self-employed and aren’t sure what their income will be.

• Remember: The Silver plans are the only ones that incorporate both the tax credit and the cost-sharing reduction for those making between 100 percent and 250 percent of the poverty level. Bronze plans might have a lower monthly cost, but have a much higher deductible. For those in the upper levels of income, a gold plan might be the best choice. They would pay more per month, but the deductibles can be quite a bit lower and they’ll have a higher level of coverage.

• Once you choose a plan, you can add a separate dental plan for more money per month, but be sure to read the conditions and limitations of those dental plans before enrolling in them. Some people don’t think they are worth the money. Be sure to scroll through every page and continue confirming your plans until you get the “Congratulations!” message at the end.

• Be sure to either print out the screens that contain information about your premium, the effective date, and the insurance company’s customer service number or write everything down. You should hear from the insurance company within two or three weeks and get your insurance card(s). Then you can arrange to make your first payment with the insurance company (if you owe a monthly premium).

• If you have any questions, you can call me at Mat-Su Health Services at 352-3225, 211, or local insurance brokers at either The Wilson Agency or Enroll Alaska. You also can call the healthcare.gov Call Center at 800-318-2596, but you likely will be on hold for at least 30 minutes, so be sure to allot enough time for that and make sure your phone is charged if you’re using a cell phone.

• Good luck!

K.T. (Kate) McKee is a Certified Application Counselor for the Affordable Care Act at Mat-Su Health Services Inc., in Wasilla.