health coverage

Welcome Immigrants—Opposing Public Charge Rules Changes

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UPDATE: Over 200,000 comments were received while the public comment period was open. No changes can be made until the regulating body (Department of Homeland Security) responds to every comment. Then they can publish a final rule, which could incorporate changes based on comments received—or they could decide not to publish a rule. After the rule is published there is a waiting period before it takes effect.

Today—in fact—any day—is a good day to tell the world that you welcome immigrants to the United States. The Washtenaw Health Plan and Washtenaw County Health Department have submitted comments opposing the changes in "public charge" regulations. Comments could be submitted until December 10th, 2018.

What Is The Issue?

The Trump administration has published a proposed rule that would force many immigrants and their families to choose between accessing essential public services and keeping their families together. 

There are many reasons why immigrants may be denied permanent residence (aka a “green card”) or not be allowed to enter the United States. Public charge is one of those reasons. Under current laws, the government considers someone a public charge if they are found likely to become primarily dependent on government programs.

Currently, “public charge” is considered very narrowly—an immigrant can only be found to be a public charge if they use cash assistance (like TANF or SSI), or institutionalized long-term care (like living in a nursing home) through Medicaid.

The government is considering changes that would dramatically expand who is considered a public charge. making it much harder to get a green card or visa. These changes include:

  • Expanding the benefits that could classify you as being a “public charge” and

  • Assessing your income differently—meaning that your income would only be viewed positively if you made at least 250% of the poverty level (nearly $63,000 for a family of 4).

  • Adding assessments of age, health, education and skills. Children and seniors could be assessed negatively.

In addition to what the public charge proposed rule actually says (and at this point it is only a proposal), it can also have a “chilling effect,” and make people afraid to access any services, even ones that are not included in the rule. If the “public charge” rule is ­finalized in its proposed form, this would mark a significant and harmful departure from long standing immigration policy. The proposal would make -- and has already made -- immigrant families afraid to seek programs that support their basic needs. These programs help them stay strong and productive, and raise children who thrive. With about one in four children having at least one immigrant parent, this issue touches millions and is critical now and for our nation’s future. And that’s why taking action is so important!

According to the Michigan Immigrant Rights Center, at this point, “If you are applying for a green card within the U.S., the rules have not changed, and there is no reason for you or anyone in your family to stop receiving non-cash benefits (like Medicaid and food stamps) that they are eligible for.”

What Can I Do To Make A Difference?

When the federal government proposes a rule, they have to request comments. We have until December 10, 2018 to submit comments. Your voice matters!

The best way to comment is to go online to the federal public charge comment portal at regulations.gov. Click on “comment now” and either enter your comment in the text box (must be fewer than 5000 characters) or upload your comments as a PDF.

Any comments are good, but it’s best if:

  1. You write comments in your own words.

  2. You share research, experiences, and/or the stories of people you know (friends, relatives, community members). You can even include web links or upload supporting materials (research, or your resume, if you are a content expert).

  3. Look to the Michigan League for Public Policy for some great information about the positive economic impact of immigrants in our communities; use that information in your comments. Talk about why we value immigrants in Michigan!

  4. Talk about the role that access to benefits has played in your life, or the lives of people you know.

More details about comments can be found here.

In fact, there’s even a toolkit with specific comment suggestions. However, don’t worry too much about it, short comments are ok too!

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What Else Can I Do?

Use email, phone calls, and social media to get your friends and family to submit comments. (Hint: Share this post!)

You Are In Good Company

If you comment, you are in good company. Not only did the Washtenaw Health Plan submit a comment, but:

And special, special thanks to our partners at the Michigan Immigrant Rights Center for their knowledge, support, and advocacy. Read more about their campaign to Protect Immigrant Families here!

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Open Enrollment Tips, Part 2: How Much Will I Pay? Best and Worst Case Scenarios

You know what you might pay for your health insurance premium--a fixed, monthly cost.  But what about the rest?  What will you actually pay for health care next year?  Will you pay just your Monthly Premium or will you pay your full Maximum Out Of Pocket Cost?  $1200, $5200, or something in between? 

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Best Case Scenario

One way to think about health insurance is to imagine the Best Case Scenario. Imagine that you have a year where you are healthy, and nothing goes wrong. 

In this scenario, you pay:

Your Premium: $100/month for a subsidized silver plan

Annual doctor's visit (preventive care, covered 100%): $0

Flu shot (preventive care, covered 100%): $0

Birth control pills (covered 100% under the ACA): $0

TOTAL COSTS FOR THE YEAR: $100/month premium x 12 months=$1200

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Worst Case Scenario

Now imagine that you have a year where everything goes wrong. You start out the year with appendicitis, then you fall and break your arm, you have a cancer scare, Lyme disease, and you are hospitalized for pneumonia. You might be wondering--if you have a year like that--what is it going to cost? What is the Worst Case Scenario--not for your health, but for your budget?

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Actually, it's not that hard to figure this out either--there is a mathematical formula for it. 

Start with the cost of your premium.

We'll use the same premium: $100/month for a subsidized silver plan. 

Your deductible is $2000, but that turns out to be more important (in a worst case scenario) for the pace at which you pay bills, and less important for the actual Worst Case Scenario.

What is important is the line marked Maximum Out Of Pocket Costs. We'll say, in this case the Maximum Out of Pocket number is $4,000. Once you spend that maximum number, you pay nothing more. 

TOTAL COSTS FOR THE YEAR= Total premium cost + Maximum out of pocket amount

In this scenario, you would pay: ($100/month)*12 + $4000 = $1200 + $4000 =$5200

So with this plan, under the best case scenario you would pay $1200 and under the worst case scenario you would play $5200. Try out these formulas on any plan. 

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Just one caveat: In some cases, the maximum out of pocket number applies only to in-network spending; or out-of-network spending may be subject to a higher maximum out of pocket number. Except for emergencies, try to stay in network. 

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Health Care Olympics: Go For The Silver!

The Olympics are going on! Olympic athletes will tell you that not only is it important to be in good shape and fine tune your athletic skills, it is also important to know the rules of engagement. For instance, in gymnastics, what will give you a small points deduction, and what will give you a large deduction? What if you have a false start in swimming or track?

Jesse Owens won 4 gold medals at the 1936 Olympics.

 

In the Olympics, Go for the Gold!

And while in preparation for the Olympics, athletes may be trained to "Go for Gold," understanding the rules of engagement for health care coverage may lead you to a surprising conclusion:

In Health Care, Go for the Silver! (Maybe)

1896 Silver Olympics Medal

1896 Silver Olympics Medal

The advice that you "go for the silver" might be surprising to you, considering that health care plans are ranked as Bronze (covers 60% of health care costs); Silver (70%); Gold (80%) and Platinum (90%). Surely gold and platinum plans, then, are better bets than silver or bronze plans?

That might be true if you are a mere mortal, and not a true Olympian.

Zeus and Hera, two of the original Olympians!

Zeus and Hera, two of the original Olympians!

But if your income is below 250% of the poverty level ($29,700 for a single person, or $60,750 for a family of four), then the rules of engagement change, and you get a special Super Power! (And no, it's not steroids, and it won't disqualify you from the Olympics or from health care coverage.)

If your income is below 250% of the poverty level, then you qualify for special cost-sharing, and the silver plans will cover more than their usual 70% of the cost of the health care. In this case, by choosing a silver plan you will get lower co-pays, deductibles, and maximum out of pocket costs.

If your income is below 150% of the poverty level ($17,820 for a single person, $36,450 for a family of four), the silver plans will cover 94% of the costs, even better than a platinum plan!

If your income is between 151% and 200% of the poverty level ($23,760 for a single person, $48,600 for a family of four), the silver plans will cover 87% of the costs, even better than a gold plan!

If your income is between 201% and 250% of the poverty level (maximum $29,700 for a single person, and $60,750 for a family of four), the silver plans will cover 73% of the costs, better than a regular silver plan. [However, at this point the cost sharing is not better than a gold plan, and if you have a lot of health needs you may be better off choosing a gold plan. You will pay a higher premium but you will get more coverage.]

If you are curious about particular plans and how much they would cost for you, take a look at these estimating tools:

Marketplace Estimator healthcare.gov/see-plans

HealthSherpa

Prepare, Predict, Go for it!

So--just like an Olympic athlete, you can:

Prepare: Understand how to calculate your family size and your household income is (here's how to do that);

Predict: Whether a silver plan will offer special cost-sharing benefits for you;

Go for it: During Open Enrollment or a Special Enrollment period, fill out your application and choose the best health plan for yourself and your family!

Open enrollment begins November 1, 2016 and ends January 31, 2017

--R. Kraut

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Enroll Anytime: Domestic Violence and Special Enrollment Periods

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Life changes happen, and they will qualify you for a Special Enrollment Period. There are some Special Enrollment Periods that are less typical, and the details are important! 

Survivors of domestic violence are eligible for enrollment in the Marketplace when they leave their batterer, regardless of the time of year. This special enrollment period is available to both men and women, and goes by the "honor system," meaning that no proof (like medical report or court documentation) has to be submitted. It is important that the individual uses the specific term survivor of domestic violence.

Not only are victims of domestic violence eligible for special enrollment periods, but they are also allowed to "break" a big rule that applies to most others. Normally, if you are married you must file joint taxes with your spouse to receive tax credits. Domestic violence survivors, however, are able to get tax credits even if they are filing taxes separately while still married. 

The exception allows people in these situations to still get help with health coverage without compromising their safety. In order to push the application through, the individual must mark on their application that they are not married.

Chart developed by the National Health Law Program and Community Catalyst

Chart developed by the National Health Law Program and Community Catalyst

If you are in a domestic violence situation, help is available. In Washtenaw County call (734) 995-5444 or visit safehousecenter.org. Anywhere else, call (800) 799-7233 (799-SAFE). 

Note also: For safety reasons, survivors of domestic violence may choose to use two addresses: a safe mailing address and a home address.  The home location should be where the applicant is living in order to access the correct health plans.

Have any tips or tricks to share about the Marketplace? Comment below so we can blog about them!

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WHP Profile: Meredith Buhalis

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Meredith Buhalis began working at the WHP just weeks before the April 1st, 2014 start of the Healthy Michigan Plan. She hit the ground running, doing her first application on her own on opening day! Since then, Meredith has been an asset to the WHP, doing a very high volume of enrollments.  As part of the WHP team, Meredith works to help a diverse group of clients navigate the complexities of the current health care system.

Although getting health care coverage is the main focus of the WHP, educating people about their options and supporting clients to become their own advocates is her passion.  A client wrote this about Meredith.

 "She is amazing and she will help you! She has put the power back into my hands. These programs are funded and if you are eligible they should NOT ever be out of your reach. Call Meredith. Get the help you need to gain the coverage you deserve."
Check out the website and subscribe to our blog!

Check out the website and subscribe to our blog!

During the Coverage Counts CMS grant, Meredith worked out of the Livingston County Department of Public Health and has helped many community members in both Livingston and Washtenaw counties. Now, Meredith is full-time at the Washtenaw Health Plan offices in Ypsilanti.

Meredith first studied education and human development at Antioch College where she fully absorbed the founder's pleas to graduates, "Be ashamed to die until you have won some victory for humanity." After college and brief careers in house painting and restaurants, Meredith attended the School of Information at the University of Michigan. As part of hi-ce, she taught school librarians to use the Internet and helped organize the World Wide Web, pre-google.  She worked with nonprofits, technology and social workers before moving on to the wonderful world of school libraries.  Now she puts her organizational, creative, and people skills to good use at the Washtenaw Health Plan.  

Times change. Now, Meredith and family are covered by employer insurance!

Times change. Now, Meredith and family are covered by employer insurance!

For instance, Meredith designed the healthcarecounts.org website. Recently, our website and blog has been commended for its amazing marketing team. And that team is primarily Meredith!

Meredith lives in Ann Arbor with her husband, the singer/songwriter Chris Buhalis, daughter and dog. 

--Haley Haddad and Ruth Kraut

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Help! I missed the December 17th deadline. Now what?

DON'T PANIC!

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The December 17th deadline was to get onto the Marketplace and enroll in a health plan that would start on January 1, 2016. Open Enrollment continues until January 31, 2016. Enrolling after December 15 changes the date your 2016 insurance starts.  

(medicaid is always open for enrollment.  If you qualify for medicaid, you can apply online at MiBridges.michigan.gov Anytime.  check your income here.)

 

I had Marketplace insurance in 2015 but I didn't update my application. 

If you had Marketplace insurance in 2015 and you didn't get onto the Marketplace, you have been re-enrolled into the same plan with a new tax credit based on your 2014 Tax Return.  You can still change plans before January 31, 2016.  If you waited you will have your auto-enrolled plan for January and new plan starting on February 1 (if you enroll before January 15) or March 1 (if you enroll after January 15). 

I did not have Marketplace insurance in 2015.  

If you didn't have health insurance in 2015, you still have time to enroll.  Enroll before January 15, 2015 and your coverage will start February 1.  Enroll before January 31 and your coverage will start March 1.  Not sure if you qualify for the Marketplace?  If your income is above the Medicaid income guidelines and you don't have an employer offer of coverage, you need to go on the Marketplace (healthcare.gov).

My employer offers insurance but I think it is too expensive.

Employer coverage tool from healthcare.gov  

Employer coverage tool from healthcare.gov 

If you have an offer of insurance from your employer, you must enroll if it is considered affordable.  The rules are slightly complicated, so you may want to visit an organization that can help you figure this out. Before you come to an appointment or call, have your employer fill out an employer coverage tool.  Having complete information about your employer's insurance offer is necessary in determining your options.  Find an agency here.

If the insurance meets minimum standards, and the cost of the insurance for the individual is less than 8% of the household income, it will definitely be considered affordable.

To find out if your employer insurance is affordable, have your employer fill out an employer coverage tool.  

I don't know what health coverage is right for me.  What do I do? 

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Find an agency who assists with health care and call them.  Nonprofit agencies in Washtenaw County are listed  Looking throughout Michigan? Look here.

Call the Marketplace (1-800-318-2596) or go to their website healthcare.gov/see-plans.

Start here to see what you and your family may qualify for.  It is not unusual for parents to be on the Marketplace and children to qualify for Medicaid or MIChild.

M. Buhalis


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The Marketplace deadline has been extended to Thursday, December 17 at 11:59pm PST.

The Marketplace deadline has been extended to December 17, 2015 at 11:59pm PST.  

You can still apply and enroll in a health plan and start coverage on January 1, 2016.

Call the Marketplace 

1-800-318-2596

or

login at healthcare.gov

If you need help or have questions, call 734-544-3030 or look here for a nonprofit agency near you.

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2015 Medicare Open Enrollment - October 15 through December 7 - Get Help

MedicareCard

It's time to review your Medicare Plan!  

October 15, 2015 to December 7, 2015, is the annual Medicare Open Enrollment Period. During Open Enrollment you may:

  • Change from original Medicare to a Medicare Advantage Plan
  • Change from a Medicare Advantage Plan back to original Medicare
  • Switch Medicare Advantage plans
  • Join a Medicare Part D Prescription Drug Plan
  • Switch Medicare Part D Prescription Drug Plans

It is important to review your Part D coverage every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

The Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1770/month and you must have less than $10,930 in assets.  For single people, your income must be less than $1313 and you must have less than $7280 in assets.  If you think you qualify, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor.  

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There is help available from a MMAP counselor.* 

MMAP offers information and assistance with plan comparisons and enrollment throughout the election period.  You can get help from a MMAP counselor by calling the MMAP assistance line at the Area Agency on Aging 1-B (800-803-7174).  

*MMAP Counselors are background checked, trained and certified by the State MMAP office and provide confidential unbiased information; they are not connected with any insurance company.  MMAP is the State Health Insurance assistance Program (SHIP) for Michigan. 

Scheduled Events for Washtenaw County:

  • Milan Senior Center  Thursday October 29,  9:30am - 3pm    

Call 734-508-6229 to reserve a spot. 

  • Washtenaw ISD Computer Lab - Ann Arbor     Wednesday November 11 OR Wednesday December 2,  10am - 7pm  

Call 800-852-7795 to reserve a spot.

  • Salem-South Lyon District Library Monday November 16, 10am - 2pm  

Call 800-852-7795 to reserve a spot.

If you can't make one of the above sessions, you can make an appointment at a partner site. Appointments are scheduled either by the host agency or by calling the Area Agency on Aging 1-B.  

Partner Sites where appointments are available in Washtenaw County:

  • Catholic Social Services - Ann Arbor  734-712-0523
  • Chelsea Senior Center - Chelsea  734-475-9242
  • Dexter Senior Center - Dexter  734-426-7737
  • Hope Clinic - Ypsilanti  800-852-7795
  • Jewish Family Services - Ann Arbor  800-852-7795
  • Salem- South Lyon District Library - South Lyon  800-852-7795
  • Saline Senior Center - Saline  734-429-9274
  • Turner Senior Wellness Program - Ann Arbor  734-764-2556
  • Washtenaw Health Plan - Ypsilanti  800-852-7795

It is confusing but there is help!  To get help, contact an agency or call MMAP directly.   Remember, most people can only change plans during Open Enrollment, October 15, 2015 to December 7, 2015.

And Wish Medicare a Happy Birthday!  

Medicare and Medicaid: keeping us healthy for 50 years

On July 30, 1965, President Lyndon B. Johnson signed into law legislation that established the Medicare and Medicaid programs. For 50 years, these 2 programs have been protecting the health and well-being of millions of American families, saving lives, and improving the economic security of our nation.

President Lyndon B. Johnson signs the Medicare bill at the Harry S. Truman library in 1965.       Source:  Truman Library

President Lyndon B. Johnson signs the Medicare bill at the Harry S. Truman library in 1965.       Source: Truman Library

Happy Autumn-  

M. Buhalis

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Want to Subscribe to this Blog/News Feed? It's As Easy as 1, 2, 3!

Are you interested in getting regular updates of articles in this news feed? We generally post once or twice a week, and it is easy to subscribe. 

1. On our home page, healthcarecounts.org, look in the top right-hand corner. Find the BLOG button, and click on it. (Alternatively, go straight to healthcarecounts.org/blog.)

2. Once you are on the news page, In the right-hand, upper corner, there is a black box that reads: "SUBSCRIBE TO OUR BLOG!"  Click on that button and fill in your email address.

3. Last, but not least--don't miss the last step! You will get an email confirming that you want to subscribe. Don't forget to confirm your interest. (If you've gotten this far, you may also want to make sure these posts don't go into your spam filter.)

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Still Going Without Health Coverage?

It's might not be too late to GET COVERED in 2015!

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