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Help to navigate health insurance marketplace


Carolyn Poirot
Special to the Business Press

Help is on the way for low-income Texans looking to get the most bang for the buck when they buy government-mandated health insurance coverage over the next few months.
The U.S. Department of Health and Human Services awarded United Way of Tarrant County nearly $6 million to set up a network of navigators to help uninsured Texans find affordable insurance in the Health Insurance Marketplace, also known as the federal health insurance exchange.
Texas is one of 27 states that defaulted to the federal exchange rather than set up a state-run exchange.

The goal of the navigators is to explain the options available through the federal exchange and help those who are eligible compare options, apply for coverage and enroll in subsidized health insurance plans.
Navigators will meet with eligible residents individually and at group meetings beginning Oct. 1, said Tim McKinney, president and CEO of United Way.

“We are helping with outreach and awareness,” McKinney said. “The goal is to provide 55,200 face-to-face meetings and reach 450,000 [uninsured consumers] through community events, such as health fairs and health clubs, in the next six months.”
“Navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans and public programs including Medicaid and the Children’s Health Insurance Program,” said U.S. Health and Human Services Secretary Kathleen Sebelius in a statement announcing the navigator grants.
Texans under age 65 whose income is between 100 and 400 percent of poverty level will be eligible to buy discounted health insurance on a sliding fee scale from companies in the private sector. Currently, the federal poverty level is $11,000 per year for a single individual and $24,000 for a family of four.

Nearly half of the 2.4 million uninsured Texans will be eligible for sliding-scale subsidies to help them purchase health insurance, said Donald R. Smith, vice president of community development for United Way of Tarrant County.
While providing tax credits for small businesses and subsidies for individuals who maintain “minimal essential coverage,” the Affordable Care Act also provides penalties for those who fail to buy health insurance by April 1, 2014.
Final rules just released Aug. 27 call for $95 penalties for failure to register the first year, increasing to $695 per year beginning in 2016.
Those 65 and older are eligible for Medicare health insurance.
More than 100 insurance companies already have applied to provide their products in the federal marketplace that was established as part of the 2010 Affordable Care Act, McKinney noted.

At present, no one knows what plans will be included or how much they will cost, but the Department of Heath and Human Services began providing online training for navigators Aug. 28, McKinney said.
“We are targeting small businesses as well,” said Alexandra Cisneros, deputy director and manager of finance and compliance for the Area Agency on Aging.
Businesses are required to maintain minimum essential coverage for employees or pay the penalty.
“Already we are close to overloaded with inquiries of all kinds from the community,” Cisneros said. “Those we can’t help [such as people who qualify for Medicaid or Medicare], we pass along to the appropriate agency. There is no wrong door.”
United Way is the lead agency for a 17-member collaboration that includes 10 councils of government, five community-based agencies and two United Ways. The collaboration covers most of Texas.
The $5,889,181 federal grant is the largest of 105 such grants presented to organizations throughout the country and one of eight totaling $10.8 million awarded in Texas.

United Way is hiring and training about 80 navigators state-wide to help consumers shop for and enroll in health care plans offered through the Health Insurance Marketplace. Open enrollment starts Oct. 1.
“Navigators will be among the many resources available to help consumers understand their coverage options in the marketplace,” Sebelius said in announcing the grant in Austin on 
Aug. 8.
“A network of volunteers on the ground in every state – health care providers, business leaders, faith leaders, community groups, advocates and local elected officials – can help spread the word and encourage their neighbors to get enrolled,” Sebelius said.
Dedicated phone lines are still being set up to handle inquiries. For more information, Texas residents should go to

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