With an open enrollment deadline looming Feb. 15, the online Health Insurance Marketplace can be a confusing trail to trek. Gold, silver and bronze aren’t just precious metals in this jungle of decisions. They’re tiered health plans – with wildly swinging deductibles, benefits and out-of-pocket costs.
What kind of policy should you buy? Do you qualify for a subsidy? How do you estimate your income?
The experts in Spectrum Health’s Financial Counseling offices can not only provide an individualized map to a health plan that is right for you, they’re willing to take your hand and walk you through the thickets – all free of charge.
You don’t even have to be a Spectrum patient, past or present, to participate.
“We can explain the unknowns,” said Rhonda Hedlund, one of Spectrum Health’s 40 financial resource advisors, who are all certified application counselors for the Affordable Care Act. “A lot of patients come in and they’ve never had to worry about a deductible or co-insurance. It’s a whole different language they’ve never had to speak.”
Hedlund works out of Spectrum Health’s Gerber Memorial Hospital in Fremont. She and her fellow certified application counselors have mastered 20 hours of training to understand the nuances of what is commonly called Obamacare.
Hedlund estimates 90 percent of patients she helps are eligible for a government subsidy. People are ecstatic when they learn insurance won’t cost as much as they thought, according to Hedlund.
“And the beauty is you can have a pre-existing condition and that’s not held against you,” she said. “Those who are unhealthy can actually buy insurance now.”
Hedlund said she will sit down with a patient and navigate the healthcare.gov site together.
“We want to reach out to all those individuals who need medical care,” she said. “That’s the goal of the program. This is just one more thing that shows our organization is on top of it, which is so nice.”
Have questions? Perhaps yours is among those most frequently asked of Spectrum Health’s financial resource advisors/certified application counselors.
Q: What’s the penalty if I don’t do this?
A: That varies by income and household size. Hedlund advises checking with your tax preparer. But as a guideline, if you don’t have coverage in 2015, you’ll be gored with penalties equal to 2 percent of your yearly household income or $325 per person and $162.50 per child, whichever is higher. Maximum penalty is $975.
If you weren’t covered in 2014, you’ll have to pony up whichever is higher – 1 percent of household income or $95 per person; $47.50 per child.
The fines will continue to ramp up each year.
Q: Is my doctor covered?
A: Hedlund said she will be able to quickly determine if you will be able to stay with your current provider under the plan you choose. If not, you always have the option of choosing a plan based on your choice of physician.
Q: Will it cover my diabetes or special need?
A: Hedlund said she can narrow choices down to plans that best cover your specific needs. If you take a lot of prescription medication, she can guide you to coverage that won’t siphon your savings at the pharmacy window.
Q: What would you do?
A: Hedlund and her crew aren’t allowed to answer that one. “But we can certainly guide them into their needs and help explain which plan covers their needs,” she said.
Your best choice will depend on your health, prescription medication needs, risk tolerance, financial situation and physician preferences.
Q: How do I get help?
Lots of options here. Connect with a financial resource advisor near you:
Big Rapids 231.592.4347
Blodgett 616.774.7890
Butterworth 616.391.2667
Center for Integrated Medicine & Community Medicine 616.391.2420
Continuing Care 616.486.3009
Gerber Memorial 231.924.1821
Helen DeVos Children’s Hospital 616.267.0296
Helen DeVos Children’s Practices 616.267.0935
Integrated Care Center on East Beltline: 616.447.1112
Kelsey 989.352.1507
Lemmen-Holton Cancer Pavilion 616.486.2059
Ludington 231.843-2591
Meijer Heart Center 616.391.2667
North Office Building 616.391.3617
Reed City 231.832.6696
South Pavilion 616.486.5420
Special Care Hospital 616.486.3009
United Memorial 616.225.6562
West Pavilion 616.486.5420
Woman’s & Children’s Building 616.391.3617
Zeeland Memorial 616.772.7566
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