Key health care dates
Dec. 15: deadline for new federal marketplace customers to apply for insurance to start Jan. 1
Dec. 31: current federal policies expire
Jan. 1: beginning of new policy year
Feb. 15: end of open enrollment in federal marketplace
April 15: deadline for federal income tax returns, which will charge a penalty for the first time on those without insurance the previous year
Rahab’s Rope would like to offer its employees health insurance, but as a small nonprofit organization, the Gainesville ministry is finding it hard to offer that benefit.
“I’m always a big proponent of insurance,” said David Moore, the organization’s chief operating officer. “I don’t care how much it costs or how you get it. You’ve got to have it. I was raised that way.”
So he encourages his employees to find coverage some way, with options including through their spouse’s workplace or the federal health insurance marketplace, established through the Affordable Care Act.
Nailing down health coverage for 2015 is a crucial decision that millions of Americans are struggling with now, most either through open enrollment at their job or their spouse’s policy or other means, such as the marketplace at healthcare.gov.
The aim is to get insurance of some kind that meets the health care law’s individual mandate, which, starting in 2015, will levy penalties on the uninsured through their federal tax returns.
Others may qualify for Medicare, a federal health program that pays for some of the medical and hospital expenses of people older than 65 using Social Security money, or Medicaid, a public health program funded by the U.S. and state governments for people who meet low-income guidelines.
The pressure is on now in the federal marketplace, which opened enrollment Nov. 15.
New customers must sign up by Dec. 15 if they want their coverage to take effect Jan. 1. To continue health coverage in 2015, Americans can renew their current plan or choose a new one through the marketplace until Feb. 15.
The decisions are frequently hard, with some finding it hard to go without coverage, even in the face of premium hikes.
“What we have found is that most of our employer clients are either changing carriers or renewing their plan,” said Rob Fowler, executive vice president of Turner, Wood and Smith, a Gainesville insurance firm.
“We haven’t had anyone who has said we’re just going to get out of providing health insurance. I think they still see it as a benefit in recruiting, retention and as part of the total compensation package for employees.”
Fowler, whose firm helps sponsor an annual community forum updating the health care law, said “we are starting to see some shift of where an employer might have covered dependent costs ... to the employee because dependents can get coverage individually or on the exchange.”
He urges caution, though, for anyone considering the exchange.
“In addition to price, they need to look at the network of providers,” Fowler said. “There is still a number of doctors and hospitals that may not take the exchange coverage, and then the coverage may not match up with the employer coverage.”
For example, exchange plans may have high pharmacy deductibles up to $1,500.
All private health insurance plans offered in the marketplace offer the same set of “essential health benefits,” including emergency services, hospitalization, maternity care and mental health and substance use disorder services.
But comparing them on the exchange can be a daunting task.
In one snapshot look at the marketplace website, parents in their 30s with two young children in Hall County can view up to 65 health plans.
Premium amounts vary from about $600 per month, with the family absorbing costs until a $12,600 deductible is met, to $1,590 per month, with copays as low as $10 for generic drugs and a maximum out-of-pocket of $4,000.
Marketplace policyholders may qualify for federal subsidies depending on income, reducing their overall costs.
Premiums for the most popular type of plan are going up an average of 5 percent in the 35 states where the federal government is running the exchanges, states a Health and Human Services Department report.
However, White House officials have countered by saying the new federal law has worked to rein in health care costs.
The Republican National Committee, meanwhile, is reporting on its website, “Sticker shock from Washington, D.C. to Wyoming.”
Those wrestling with costs also must consider what they’ll pay if they don’t get insurance.
Tax penalties will first show up with 2014 federal returns. Those who didn’t sign up in 2014 could face a penalty of $95 per person, or 1 percent of yearly household income.
The penalty increases rises the next year to the higher of $325 per person or 2 percent of yearly household income.
Also on the horizon is the employer mandate, “Play or Pay,” which requires businesses with 100 or more “full-time equivalent” employees to offer insurance coverage to 70 percent of their workers for 2015. Under the law, a full-time employee is defined as someone who works at least 30 hours per week.
Failure to offer coverage subjects the business to a possible tax penalty.
Businesses with 50 to 99 workers will have to comply in 2016.
So, while small businesses, or those under 50 full-time workers, don’t have to worry about complying with the law, offering affordable insurance to their employees is still an issue.
Companies that have stuck with same carrier are looking more carefully for plans that can save them money, said Tim Evans, vice president of economic development for the Greater Hall Chamber of Commerce.
“It’s like changing cable companies,” he said, with a laugh. “Every year, you’ve got a new opportunity at making a change.”
Providing employees with health insurance isn’t even considered at some businesses.
“There are four of us here and two of us are on Medicare,” said Linda Orenstein of Gem Jewelry on the Gainesville square. “(Health policies) are something that, over the years, we have never offered.”
But she said she has listened to the stories on talk radio about high insurance costs and people debating whether to forego coverage and pay doctor bills out of money they have set aside for health expenses.
“I get so frustrated because I can think, off the top of my head, things that would be simple solutions,” Orenstein said. “If you are working, making a decent living and can take care of your bills, then all you need is a catastrophic health insurance plan.
“You can pay for your visits to the doctor and you don’t need this other junk, and to force people who don’t need it to buy it runs the costs up.”