Navigating the Patient Protection and Affordable Care Act (PPACA)
Starting on October 1, 2013, uninsured consumers or consumers looking to buy their own coverage can enroll for health insurance through the Health Insurance Marketplace for coverage beginning as soon as January 1, 2014. The Marketplace allows you to compare and select plans. Those plans must be a Qualified Health Plan approved by the federal government to serve Indiana consumers.
As these changes draw nearer, consumers should watch for individuals looking to take advantage of the new system by scamming consumers. You can learn more about the Health Insurance Marketplace though several resources:
- www.HealthCare.gov: This is the federal government’s official website for the Health Insurance Marketplace. Here, consumers can enroll in health insurance plans starting October 1st, get information about the Marketplace, company plans, and see available coverage options. Consumers will be able to find Navigators in their area to assist with enrollment.
- Help Center: 1-800-318-2596: The Help Center is available 24 hours a day, 7 days a week to answer questions about the Marketplace, as well as to enroll consumers for coverage starting October 1. TTY: 1-855-889-4325
- Navigators: Navigators are trained and certified by the government to answer Marketplace questions, discuss eligibility and options, and prepare electronic and paper applications to establish eligibility and enroll in the Marketplace. Starting October 1, consumers will be able to find Navigators throughout the State of Indiana by using the federal government’s website (www.HealthCare.gov), and they can search for Navigators or verify their Navigator’s certification at http://www.sircon.com/resource/layout.jsp?page=indianaLps&type=indiana. The Indiana Department of Insurance provides more information about Indiana Navigators on its website: http://www.in.gov/idoi/2823.htm.
- Certified Application Counselors: These counselors will perform many of the same functions as Navigators, including educating consumers and helping to complete applications for coverage. Counselors will be available at community health centers, hospitals, or social services agencies to assist. Starting October 1, consumers will be able to find Certified Application Counselors at www.HealthCare.gov or by calling a Help Center.
- Agents and Brokers: State-licensed health insurance agents and brokers who meet Health Insurance Marketplace requirements may enroll individuals, small employers, and employees in coverage through the Marketplace.
Medicare is not Part of the Health Insurance Marketplace
Medicare recipients do not need to do anything to be enrolled under the new Marketplace system. The Marketplace will not affect Medicare choices and benefits will not change.
To avoid being scammed by individuals working to take advantage of a new system, it is important consumers are educated about the new Marketplace. In some cases, criminals may try to collect personal or financial information.
Dishonest sales people may try and sell “discount medical plans” or pose as federal government trained and Indiana certified Navigators.
Tips to Avoid Scams
- The government will never call or e-mail consumers to solicit enrollment plans. Marketplace options and additional information is available at www.HealthCare.gov or at the Help Center, available 24/7, at 1-800-318-2596.
- Anyone claiming to be enrolling consumers in coverage through the Marketplace before October 1 is not legitimate. Be wary of individuals contacting you with a “limited time special”.
- Navigators, by law, may not charge a fee for service; however, licensed health insurance agents and brokers receive commission from insurance companies for plan enrollment.
- Navigators are there to assist you during the enrollment period.
- Navigators will ask you questions about your income, family size, and other relevant personal information to help you make a decision about the type of coverage you want.
- Navigator will ask for the size of the family to determine coverage options and for income information to determine eligibility for tax credits or Medicaid
- Navigators WILL NOT call you to enroll you in health insurance.
- Navigators WILL NOT notify you about special limited time offers.
- You can find your local Navigators at: http://www.healthcare.gov/, and http://www.sircon.com/resource/layout.jsp?page=indianaLps&type=indiana.
- If a salesperson aggressively pressures you into buying insurance by telling you that you will face jail time if you do not have health insurance, this is not true. A penalty of $95 or 1% of your income in the first year will be imposed, but no jail time.
- Be cautious with providing your personal information! If you are called by an individual and asked to verify your personal information for enrollment in the Marketplace or a new Medicare card, hang up! (Medicare is NOT a part of the Marketplace and no replacement card is needed to be enrolled.) Individuals seeking Social Security numbers or bank account information may be scammers.
- Often, scammers create sound-alike company or government names in order to confuse consumers. Remember, you will never be called or e-mailed to enroll in the Marketplace.
For more information on this topic, go to www.in.gov/attorneygeneral/. To file a complaint, contact the Attorney General’s Consumer Protection Division by going to www.IndianaConsumer.com or calling (317) 232-6330.
- Indiana Code 27-19 et seq., Health Benefit Exchange
- Indiana Code 27-19-4, Health Benefit Exchange Navigators and Application Organizations
- http://www.in.gov/idoi/2823.htm: Information about Navigators on the Indiana Department of Insurance’s website.
- http://www.in.gov/idoi/files/Health_Care_Coverage_Current_and_Changing_Processes_v8_Aug_2013.pdf: Information about the role of Navigators, how to become a Navigator, information about enrollment centers. Also covers the Medicaid expansion.
- www.in.gov/aca: Indiana’s website for the Patient Protection and Affordable Care Act. It provides general information about the Act, news, and resources.