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Query: Are there better deals than workplace coverage?


Who hasn’t wanted to shop around a little bit?

In this case, a local reader wants to know if people with workplace coverage can look for better deals outside the office.

We also help a computer-averse consumer find ways to reach actual human beings in her quest to change her coverage.

■ Judy of Las Vegas writes: My daughter works for a company that has an extremely bad group policy. It is too expensive for the coverage they have. Are employees allowed to opt out and find their own coverage? She is not allowed to take advantage of her husband’s insurance as the law states if a spouse has coverage from his or her employer, they cannot. What options are open to her?

So, Judy, let’s clear up one misconception. The Affordable Care Act doesn’t say anything about whether people can join their spouse’s workplace plan. It’s still completely legal to do so.

What is true is that more and more employers are voluntarily dumping dependent coverage. If your daughter has access to her own plan, her husband’s company would rather she use that than ride along on its coverage.

It’s a trend that may be linked indirectly to the Affordable Care Act only in that the law mandates considerable numbers of new insurance benefits, and companies are looking for ways to cut some of the higher premium costs that have resulted.

As for whether your daughter can opt out of a workforce plan and buy her own coverage? Sure, she can. Nothing’s stopping anyone from purchasing a plan on the individual market. Just remember that by law, your daughter’s group plan covers at least half of her premium. If she goes it alone on the individual market, she’s on the hook for 100 percent of her monthly cost.

For savings, your daughter would need to turn to the state health insurance exchange. For the most part, though, people with coverage through the office aren’t eligible for the premium subsidies and cost-sharing available through the marketplace. That’s because the exchanges are designed to help people who don’t have affordable coverage from any other source.

There are exceptions, Judy. If your daughter’s workplace plan doesn’t meet the Affordable Care Act’s rules on minimum plan value, she could be able to get subsidized through the exchange. A plan meets the standard if it pays at least 60 percent of the total cost of medical services. Anything below that isn’t considered sufficient under the law.

She could also qualify for exchange-based coverage if her plan is truly too expensive. If her annual premium is more than 9.5 percent of her household’s income, then the Affordable Care Act would classify her coverage as unaffordable. In that case, she could buy through the exchange and potentially get a tax credit.

■ Jan of Las Vegas doesn’t know where to begin changing her Medicaid coverage now that she’s working for the first time in a year. She writes: In March, I received a letter and card (from Medicaid). Finally, a week ago, I found a job with no benefits. I have letters from the Medicaid department but no phone numbers. Do I start over on the exchange again on the computer to change my status, or can I see someone in person or talk to someone over the phone? I am not a computer person and don’t remember my password to log on to the exchange again.

Jan, you didn’t say whether you’re the only person in your household. But if you’re single, you’re right to believe that your new income of nearly $25,000 a year makes you ineligible for Medicaid.

Under the new rules, you need to make 138 percent or less of the federal poverty level to qualify for the public insurance program. For a single person, that’s $16,105 a year. For a household of four, it’s $32,913.

The first thing you need to do is check the back of your Medicaid ID card for the customer-service phone number to the state Division of Welfare and Supportive Services, which runs Nevada Medicaid. If you have trouble finding the number or it’s not listed on your card, call 877-638-3472. Let them know how your circumstances have improved, and ask for guidance on how to change your status.

If you can’t get through because of high waiting times, you can visit a division office. They’re at 700 Belrose St.; 3223 W. Craig Road, Suite 140; 3330 E. Flamingo Road, Suite 55; 520 S. Boulder Highway; 611 N. Nellis Blvd.; 1040 W. Owens Ave.; and 3101 Spring Mountain Road, Suite 3.

Because you found a new job and your income has changed, you qualify to buy coverage through the Nevada Health Link website anytime in the next 60 days. But as you seem to know, getting through won’t be easy. If you’re loath to try buying online, call the exchange at 855-768-5465 to reach a person.

Nevada Health Link doesn’t offer in person contact. If you want to work with a live person — and because the website is still glitchy and waits for help can be long, we’d recommend it — consult the list of insurance brokers licensed to sell coverage through the exchange.

We know your computer isn’t your favorite thing, Jan, but if you hop online, the exchange has a list of brokers who can help you choose and buy the right coverage.

To see the list, visit nevadahealthlink.com. Click on “Get Assistance,” near the top right corner of the screen. Then click on “Find Local Assistance.” To look for a broker by ZIP code, hit your “control” and “f” keys at the same time, and a search box will come up.

 

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