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What Health Action NM is Reading This Week: April 13-17

What Health Action NM is Reading This Week:

April 13-15

 

California’s state legislature considers extending health coverage options to undocumented immigrants. The Affordable Care Act barred undocumented immigrants from receiving Medicaid benefits, financial assistance on the exchange, and even purchasing coverage on the newly-created health insurance marketplaces.  California State Senator Ricardo Lara recently introduced a bill that would extend coverage to over a million undocumented immigrants in California by providing state funding for this population.  Communities throughout New Mexico are strengthened by families with undocumented immigrants.  And yet so many members of these families lack meaningful access to health coverage.  Is it time for New Mexico to start thinking about how to cover undocumented immigrants in our state?

  • Barbara Webber, Executive Director

 

Congress passed a bill extending funding for the Children’s Health Insurance Program (CHIP). In addition to an historic effort to overhaul Medicare’s payment system, Congress has funded an essential health coverage program for kids, called CHIP, for two years.  While a four year extension would have been preferable, this deal secures protections for children that have been built in to the program that would have been under threat if the program weren’t part of this package.  Senator Udall and Senator Heinrich had the opportunity to champion a four year extension of the bill and stood in support of the measure, for which we commend them.  Health Action NM thanks all of our state’s delegation for supporting access to health care for children in New Mexico and throughout the nation.

  • Colin Baillio, Communications and Outreach

 

Florida achieves remarkable health coverage outcomes by embracing a community-based outreach and enrollment model. Time and time again, we are reminded of the importance of outreach and in-person enrollment assistance.  Advocates in Florida have fully embraced this strategy, with promising results.  Despite opposition from state government, Florida “surpass[ed] enrollment projections and [achieved greater numbers than] much-larger California and even Texas, a state more populous, more uninsured and with similar Republican opposition to the law.”  Florida's model exemplifies the type of program that New Mexico must adopt to ensure that all children and families thrive.

  • Joe Martinez, Consumer Outreach Coordinator

 

New York begins implementing law protecting consumers from surprise out-of-network medical bills. Private insurance plans often allow consumers to access a limited network of health care providers. These are known as “in-network providers.”  If a consumer visits a doctor who isn’t in their network, they’re usually on the hook for the full cost of the services they receive.  New York’s state legislature recognized that people are often in situations where they require emergency services outside of their insurer’s network or aren’t notified that a provider isn’t in their network.  The state passed a law to protect consumers from those unexpected costs.  

As of March 31st, “all health plans must cover at the in-network cost any out-of-network provider bill for emergency services, as well as surprise non-emergency bills for physician services in a hospital or surgical facility when an in-network provider is unavailable; the consumer was not informed in advance; or when a physician refers the consumer to any out-of-network provider,” according to the Governor's Office.  Shouldn’t New Mexico protect consumers who find themselves in a situation when they aren't aware of or able to determine whether their provider is in network?

  • DeAnza Sapien, Administration and Grant Development
Health Action

CONSUMER ALERT: Update your marketplace information throughout the year

The Kaiser Family Foundation recently released a report indicating that nearly half of all consumers who received tax credits in 2014 underestimated their income.  As a result, those individuals will have to pay back part or all of the additional financial assistance.  This unfortunate occurrence is a reminder that marketplace consumers should update their income on a monthly basis in order get an accurate tax credit and avoid having to pay back portions of their tax credits.

Many individuals and families don’t have a consistent month-to-month income.  Because marketplace tax credits are -how-do-the-premium-tax-credits-work">based on income, consumers should be sure to update their financial information on a monthly basis.  To do that, follow these instructions:   

  • Online. Log in to your account. Select your existing application, choose "Report a life change" from the menu on the left, and then click on the "Report a life change" button. Find out how to upload documents
  • By phone. Contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

Important: Do not report these changes by mail.

 

There are other factors that affect your household income for tax purposes, such as having a child or getting married.  Below is a list of life changes that should be reported to the marketplace.  Report changes if you:

  • Get married or divorced
  • Have a child, adopt a child, or place a child for adoption
  • Have a change in income
  • Get health coverage through a job or a program like Medicare or Medicaid
  • Change your place of residence
  • Have a change in disability status
  • Gain or lose a dependent
  • Become pregnant
  • Experience other changes that may affect your income and household size
  • Have a change in tax filing status
  • Have a change of citizenship or immigration status
  • Become incarcerated or released from incarceration
  • Have a change in status as an American Indian/Alaska Native or tribal status
  • Need to correct your name, date of birth, or Social Security number

If you have any questions regarding marketplace tax credits, please contact Health Action NM by calling (505) 322-2152 or email colin@healthactionnm.org 

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Health Action

Get Covered and Avoid Tax Penalties for 2015

Health Action NM has created a bilingual resource for New Mexicans who find that they owe a penalty for lacking insurance for part or all of 2014.  From March 15th to April 30th, uninsured families and individuals can sign up for health coverage with financial assistance.  The resource provides information about how to connect with in-person assistance to sign up for health coverage and avoid penalties for 2015, which increase to the greater of $325 per person or 2% of household income.   See the bottom of this page to view the resource as a JPG or click here for the PDF version.

 

Who is eligible for the “Tax Season” SEP?

Consumers are eligible for this SEP if they:

  • are not currently enrolled in 2015 coverage (whether through New Mexico’s Health Insurance Exchange (NMHIX), an employer, the off-exchange individual marketplace, or other forms of minimum essential coverage),
  • attest that they are or will be subject to the fee for not having health coverage for all or part of 2014 when they file their 2014 taxes, and
  • attest that they first became aware of, or understood the implications of, the requirement to maintain minimum essential coverage (MEC) after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

What does “subject to the fee” mean?

  • Eligible consumers must be required to pay the fee for at least part of 2014.
  • Consumers do not have to have paid the fee before enrolling through the SEP. In other words, consumers who have not yet filed their 2014 income tax return (including those who have an IRS extension to file their 2014 return) may still be eligible for this SEP so long as they will have to pay the fee when they do actually file their taxes.

Who is not eligible for this SEP?

  • Consumers who are exempt from the fee for the entire year in 2014 or who had coverage for the entire year in 2014.
  • Consumers who completed their tax filing prior to February 15, 2015 or otherwise became aware that they would be subject to the fee in 2014 before the end of open enrollment.
  • Consumers who do not have to pay the penalty but are subject to reconciliation and have to repay Advance Premium Tax Credits received in 2014.

How long does this SEP last?

  • This SEP will begin on March 15th and end on April 30th.
  • Consumers who qualify must complete the entire enrollment process (that is, including selecting a plan) by 11:59 pm E.S.T. on April 30th.
  • Similar to during open enrollment, consumers who enroll in an initial plan during this SEP can switch to a different plan through April 30th. Note, however, that all plan selections and enrollment processes must be completed by 11:59 pm E.S.T. on April 30th.

How will eligible consumers open or unlock this SEP?

  • As of March 15th, the online application includes questions about the attestations in the third and fourth eligibility requirements listed above. 
  • Consumers can also access this SEP through the Call Center.

When will coverage begin?

  • Normal coverage effective dates apply. If a consumer enrolls in coverage on or before the 15th of the month, coverage will be effective on the first day of the following month. In order to have coverage begin April 1st, consumers must enroll on March 15th.
  • Note that consumers who enroll through this SEP will be subject to the fee for the months they did not have coverage and were not exempt in 2015 when they file their taxes in 2016. For example, if an eligible consumer enrolls on March 15th his coverage will begin April 1st. When he files his 2015 taxes in 2016, he will be subject to the fee for January through March (3 months) unless he qualifies for an exemption.

Are undocumented immigrants or Native Americans subject to the shared responsibility payment if they don’t have health coverage?

Undocumented immigrants and Native Americans do not have to pay any fees or penalties for lacking health coverage.  The IRS recently clarified this rule, stating “Individuals who are not U.S. citizens or nationals, and are not lawfully present in the United States, are exempt from the individual shared responsibility provision and do not need to make a payment.  For this purpose, an immigrant with Deferred Action for Childhood Arrivals (DACA) status is considered not lawfully present and therefore is exempt.  An individual may qualify for this exemption even if he or she has a social security number (SSN).”

If an improper penalty has been charged, tax filers will need to amend their tax return by filling out Form 8965, which can be found at http://www.irs.gov/pub/irs-pdf/f8965.pdf.

 

 ENGLISH VERSION

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Health Action

Health Action NM Releases Health Coverage Resource for Native Americans

In collaboration with the National Indian Council on Aging and the Diverse Elders Coalition, Health Action New Mexico has released a resource to help explain how the Affordable Care Act affects Native Americans between the ages 50 and 64.  “There is still a great deal of work to be done to raise awareness among tribal communities and urban Indians about new coverage options available through the new health reform law,” said Barbara Webber, Executive Director of Health Action NM.  “Our hope is that this fact sheet will be helpful for Native Americans who need health services that can’t be provided by the Indian Health Service.”

Nationally, about one of three Native Americans and Alaskan Indians lack health coverage, according to a 2013 report by the Kaiser Family Foundation.  The only other recourse is to use the Indian Health Service (IHS), which provides primary care for members of Federally Recognized Tribes.  But with severely limited capacity for specialty services and consistent underfunding from the federal government, IHS is often unable to meet the health care needs of the population it serves.  Many tribal members are acutely aware of the link between the lack of access to care and the lower-than-average life expectancy among Native American populations.

New coverage expansions provide benefits for tribal communities and urban Indians that can extend crucial health care services to populations in need.  The Medicaid Expansion provides free health coverage to Americans making under $15,655 per year ($1,305 per month) as an individual.  The New Mexico Health Insurance Exchange is a marketplace where those making above that amount can shop for a private health coverage plan, with financial assistance available to help make coverage affordable.  Native Americans are eligible for premium discounts if they make below about $46,680 per year as individuals ($3,890 per month) and face no out-of-pocket costs if, as an individual, they make below $35,310 per year ($2,943 per month).

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Native Americans ages 50-64 stand to gain from these new benefits, especially if they live with chronic conditions that require routine treatment.  Health Action NM’s new resource acknowledges that being able to manage a condition with a doctor is crucial to the health of older adults, which is why IHS and health coverage can lead to a synergy between primary and specialty care providers.  “We made sure to explain how new coverage options can be used in addition to IHS services,” according to Barbara Webber.

With the release of this fact sheet, Health Action NM seeks to make this information available in its most accessible form. “We held an incredible group discussion with members of tribes throughout the state to ensure that this fact sheet is useful for Native Americans in New Mexico,” said Joe Martinez, Outreach Coordinator for Health Action NM. “That discussion will be the basis for future collaborations with Native Americans who want to see their communities thrive.”

Click here to view the fact sheet.

Please contact Health Action NM if you would like copies of the fact sheet for your community:

Health Action New Mexico
3700 Osuna Rd NE, Ste 504, Albuquerque, NM  87109
(505) 322-2152
info@healthactionnm.org
www.HealthActionNM.org

 

Health Action

Young Invincibles Release New Qualifying Life Event Infographic

You may qualify for this years Special Enrollment Period into the NM Health Insurance Exchange if any one of the following occured in your life during 2014 or 2015: 

1) You moved addresses

2) Your income changed or you lost/gained employment

3) You got married 

4) You had a baby 

5) You filed for a divorse

6) You turned 26 and lost your parent's insurance 

</a> Q2: What types of events qualify you for special enrollment? <a href="https://twitter.com/hashtag/MillennialMon?src=hash"></a> <a href="http://t.co/EewSckfEhj">pic.twitter.com/EewSckfEhj</a></p>&mdash; Families USA () <a href="https://twitter.com/FamiliesUSA/status/577549211778043904">March 16, 2015</a></blockquote> <script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script> ">

</a> Q2: What types of events qualify you for special enrollment? <a href="https://twitter.com/hashtag/MillennialMon?src=hash"></a> <a href="http://t.co/EewSckfEhj">pic.twitter.com/EewSckfEhj</a></p>&mdash; Families USA () <a href="https://twitter.com/FamiliesUSA/status/577549211778043904">March 16, 2015</a></blockquote> <script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script> ">

If you think you qualify for any of these life changing events and would like to still sign up for health coverage, you can either visit www.bewellnm.com (where you can apply online right from the comfort of your home, office, school, etc.) or you can reach Health Action NM at 505-322-2152 and we can get you in touch with your nearest Healthcare Councelor who can set up an appointment to get you covered today! 

Health Action

Be on the Lookout for Fraudulent Insurance Activity

Some consumers in New Mexico have been purposely misdirected to private insurance brokers when they thought they were visiting the official Health Insurance Exchange website, healthcare.gov, or calling a qualified broker or enrollment counselor.  This is a serious issue because the official exchange is the only place to get financial assistance for premiums and out-of-pocket costs.  In addition, brokers continue to offer plans that do not meet the standards for a qualified health plan, leaving consumers with weak insurance that doesn’t shield them from tax penalties.

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An enrollment counselor at the Southwest Women’s Law Center reports that she has seen an influx of consumers that have been victims of this scam.  The center’s Staff Attorney, Paige Duhamel, talked to a number of consumers who said that the brokers “talked at a rapid pace to pressure the consumer, refused to answer questions and caused a great deal of confusion and stress about the enrollment process.”  

It is important that consumers know what to do to avoid these types of issues.  Below are signs of fraudulent activity to keep an eye on when seeking enrollment assistance:

1) You are being charged an enrollment or sign-up fee

2) Your plan’s deductible is more than $6,350

3) The assister has you pay for the first few months’ premiums in advance

4) The assister does not speak to you about financial assistance or Medicaid eligibility

5) The assister asks you if you have a pre-existing condition

6) If you do enroll, the assister does not send you any documentation about your enrollment

7) The assister a) is unwilling to give you their name and direct contact number, b) has an out-of-state contact number, c) has a non-1800 number, or d) has a direct contact number that is anything other than the number for healthcare.gov (1-800-318-2596).  Always take down the name and phone number of the person with whom you are speaking

8) The assister only talks to you about one health insurance carrier’s plan

 

Health Action

Get Covered. Stay Covered. Keep Your TV!

Health Action NM teamed up with local Albuquerque Theatre company, Blackout Theatre, to produce a Young Adult enrollment video! Check it out, share it with your friends, and tell us what you think!

 

Get Covered. Stay Covered. Keep Your TV!, by HealthActionNM
Health Action

Joseph Martinez Accepts the Health Equity Advocate of the Year Award!

Health Action NM's team member, Joseph Martinez, graciously accepted Families USA's Health Equity Advocate of the Year Award for 2015! Joe was joined by other advocates from all over the United States to brainstorm and share strategies at the annual Families USA conference held in Washington D.C. on Jan 22-24.

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Joseph Martinez works tirelessly to ensure that all people living in the state of New Mexico have access to affordable, accessible, and accountable health coverage, no matter what. He truly is an advocate in every sense of the word and here at Health Action NM we are proud to say that Joseph Martinez is a part of our advocacy team.

Congratulations Joe!

Health Action

Deck the Halls with Health Action NM

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Health Action

Open Enrollment Season is Here: November 15, 2014 – February 15, 2015!

By: Colin Baillo (Central NM Apprentice- Health Action NM)

The open enrollment period for purchasing individual or family coverage through the NM Health Insurance Exchange has arrived!  Beginning November 15, 2014 the exchange, www.bewellnm.com, will once again be available for those seeking coverage, this time without the technical difficulties that plagued the website during the last enrollment season.  The enrollment period is only three months long, ending February 15, 2015.  Here are some important things to keep in mind if you intend to purchase or renew coverage on the exchange:

Before shopping on the exchange, see if you are eligible for Medicaid

You can visit https://www.yes.state.nm.us to sign up for Medicaid.

Medicaid is a public health coverage program that provides cost-free insurance to low income Americans.  Individuals making less than $16,105 a year and families of four making less than $32,913 a year are eligible for Medicaid.  Medicaid is available throughout the year, unlike plans acquired on the exchange, which can only be purchased during the open enrollment period.  If you are 1) between the ages 19-64 and 2) are a U.S. citizen or lawfully present immigrant and meet household income requirements, you may be eligible for free health insurance.

Visit http://kff.org/interactive/subsidy-calculator/ to see if you qualify for Medicaid.  You will need to provide your zip code, annual income, and the number of people in your family. 

You can also use the chart below to determine whether you and your family qualify for Medicaid:

 

Household Size

Income per Month/Year

1 person

Less than $1,342/$16,105

2 people

Less than $1,809/$21,707

3 people

Less than $2,276/$27,310

4 people

Less than $2,743/$32,913

5 people

Less than $3,210/$38,516

6 people

Less than $3,677/$44,119

 

Is this your first time buying health insurance? 

If you don’t qualify for Medicaid, the next step is to visit http://www.bewellnm.com, where you can shop for health coverage.  It is important to keep in mind that the window for obtaining coverage through the exchange is limited, lasting from November 15, 2014 to February 15, 2015.  Shopping for insurance can be a daunting task.  Luckily there are experts available to help you find the plan that is right for you. 

The New Mexico Health Insurance Exchange Enrollment Assistance Center is offering free assistance and advice on finding appropriate coverage, tax credits, and more.  You can even purchase coverage on site.  The enrollment center is in Albuquerque, located at 2301 San Pedro NE near Indian School.

Visit http://bewellnm.com/find-an-hcg/ to find a Health Care Guide near you.

You can also contact New Mexico’s consumer hotline by calling 1-855-99-NMHIX.

You may be eligible for a tax credit that acts as a discount on your insurance premiums and out-of-pocket costs.  You will need to know your household income to determine your eligibility.  Check out the Kaiser Family Foundation’s subsidy calculator to see how much you can save on your health plan. Right now, you can view price estimates for plans that you can purchase that factor in tax credits at https://www.healthcare.gov/see-plans/.  Insurance lingo can often be confusing.  If you run in to any terminology that you are unfamiliar with, check out BeWell NM’s healthcare glossary.

Shop around before renewing your health plan

If you purchased a plan on the exchange last year then you will be re-enrolled in to the same plan for 2015 unless your insurance company stops offering your plan or you choose to purchase a new plan.  If you like the coverage you received you should still be sure to review your plan before renewing it, as the premiums, co-pays, and other aspects of your plan’s cost may have changed.  In other words, you may pay more than you did last year for the same plan, so be sure to review your plan and shop around.  There may also be new plans offered on the exchange that are more affordable or better suit you and your family’s needs.

Sign up by December 15th if you want your coverage to start January 1st

While the enrollment period lasts through February 15th, you can start using your coverage at the beginning of 2015 if you sign up by December 15th.  If you wait until the end of the enrollment period to sign up for coverage, your insurance will kick in on March 1st, 2015.

Premiums in New Mexico are lower than they were last year

New Mexico has announced that premiums on the exchange will be lower than last year’s, which is great news for state residents shopping on the exchange.  According to the Albuquerque Journal, “premiums will drop on average by 7 percent at Molina Healthcare, 1.5 percent at New Mexico Health Connections and 1 percent at Blue Cross and Blue Shield of New Mexico.  Premiums will be unchanged at Presbyterian Health Plan.”  A new insurance company, Christus Health Plan, has entered the marketplace this year.

The penalty for lacking insurance is higher than it was last year

If you don’t obtain some form of health coverage, you may have to pay a shared responsibility fee.  The penalty was the greater of $95 per adult or 1% of income in 2014.  This year the penalty has increased to the greater of $325 per adult or 2% of income.  You can avoid the penalty by finding health coverage.

A hardship exemption exists for those who truly cannot afford insurance.  To see if you qualify for a hardship exemption, visit https://www.healthcare.gov/fees-exemptions/exemptions-from-the-fee/.

89% of uninsured Americans don’t know about the upcoming open enrollment period… so spread the word!

It is crucial that the uninsured know about the limited window of opportunity to obtain health insurance through the exchange.  According to a survey conducted by the Kaiser Family Foundation, 89% of the uninsured population doesn’t know about the upcoming enrollment period.  Be sure to do your part by telling everyone you know and care about that coverage is available to them and that they may be eligible to receive discounted insurance premiums.  It is estimated that, so far, 28 million Americans gained health insurance as a result of the ACA.  Tens of millions stand to gain from the law this year as well.  We are approaching another historic moment in which Americans are finally able to obtain the security of meaningful, affordable, and non-discriminatory health insurance.  Let’s do all we can to make sure that moment is realized.

Health Action

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