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LAKE WALES – People who need help comparing plans or filling out an application on the Health Insurance Marketplace can get that help at either Heart of Florida Regional Medical Center in Davenport, or at Lake Wales Medical Center. The two hospitals are once again offering free assistance during Open Enrollment, which runs from Nov.  1, 2016 through Jan. 31, 2017.


Appointments may be made with the certified assisters at Heart of Florida Regional Medical Center by calling 800-353-1380 or at Lake Wales Medical Center by calling 863-678-2734. Appointments also can be booked online for either location at: www.GetCoveredAmerica.org/connector.


The Affordable Care Act (ACA) was passed in 2010, and this year’s Open Enrollment marks the fourth annual campaign to extend healthcare coverage to citizens who would otherwise be uninsured. More than 13 million people enrolled in Marketplace plans for 2016.


News of several large insurers either reducing their participation in the Marketplace, or exiting it altogether, has spurred concern about rising premiums and higher deductibles.


However, Kaiser Health News (KHN) reports the majority of enrollees will be insulated from premium increases, since eight in 10 receive subsidies based on income/household size. As premiums rise, subsidies increase.


“There are always questions concerning changes to premiums, deductibles and out-of-pocket limits before Open Enrollment launches each year,” said Heart of Florida Regional Medical Center CEO Ann Barnhart. “This will always be the case as insurers enter and exit different markets. But what is consistent, year-to-year, is the value of the Marketplace. Millions of people are able to sign up for insurance who otherwise wouldn’t have access to care, or who would face a financial crisis due to medical bills.”



Majority of enrollees will receive assistance


To help make health insurance affordable, the government uses household income to determine who is eligible for financial assistance. As in past years, a majority of enrollees are expected to qualify for some type of financial support in 2017.


“I think this is where our certified assisters add so much value,” said Rebecca Brewer, CEO of Lake Wales Medical Center. “They know how to explain the pros and cons of each option, and they carefully screen each person to make sure any subsidies toward premiums, or any discounts available for deductibles or co-pays, are accessed.”


All health plans on the Marketplace must offer a comprehensive set of benefits, and coverage cannot be denied for individuals with a pre-existing health condition. Some of the health benefits include free preventive care and wellness services; doctor visits, prescription drugs, hospital and emergency department care, lab services, pediatric services, and mental and behavioral health treatment.



Individuals who are eligible for health insurance who do not purchase coverage not only pay a penalty when filing their tax return, but they also forfeit financial help with healthcare expenses throughout the year. The penalty is either 2.5% of family income or a predetermined flat rate, whichever is higher. The 2016 penalty was $695 per adult, $347.50 per child, with a maximum fee of $2,085; these fees will be adjusted for inflation in 2017.

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