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Knowing the rules of health care marketplace

POSTED: December 9, 2013 7:33 p.m.
Photo by Paul Floeckher/

Certified application counselor Robert Campbell discusses the health insurance marketplace at a recent meeting hosted my Effingham Health System at the Effingham College and Career Academy.

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Speaking at a recent community meeting in Effingham County about the Affordable Care Act’s health insurance marketplace, Robert Campbell began with a caveat.

Campbell, a Savannah-based insurance broker and ACA-certified application counselor, was not there to get into the politics of the health care reform law commonly known as “Obamacare.”

“This is purely educational,” he said. “Think of it as a football game; we are just playing by the rules.”

Starting next year, the Affordable Care Act will require most Americans to have health coverage or pay a penalty. With a few exceptions, people who do not have coverage in 2014 through their job, on their own or through a government plan such as Medicare will be penalized when they file their tax return in 2015.

“When an uninsured person requires urgent, often expensive, medical care but doesn’t pay the bill, everyone else ends up paying the price,” Campbell said. “That’s why the health care law is required — all people who can afford it to take the responsibility of their own health insurance by getting health coverage or paying that fee.”

The federal government’s online marketplace has been said to be running smoother since its widely-criticized kickoff in October. The “open enrollment” period to sign up for health insurance at is under way and continues through March 31, but people must sign up and pay their premium by Dec. 23 for coverage to take effect Jan. 1.

To assist people who need to sign up for health coverage, the United Way Effingham Service Center will host an Affordable Care Act enrollment session Dec. 17 from 4-7 p.m. Health navigator Martha Weston will help people select the best health insurance coverage for their needs.

“(With the marketplace) you’ll get unbiased help and customer support provided,” Campbell said. “That’s Miss Martha, your United Way …. All of those entities are required to give unbiased advice. They do not get compensated whatsoever from the choice you make in the marketplace.”

The ACA enrollment session will help meet a need in the community, according to Destiny Bradshaw, the program manager for e-CONNECT (the Effingham Community Network Navigation Center).

“One of the comments that I hear on a regular basis is, ‘Why do I need health care coverage? I can just go to the clinic,’” Bradshaw said. “The problem with that outlook is the focus; it is not on prevention. Many people only go to the doctor when a problem arises, not for routine check-ups for preventive maintenance.”

The online marketplace provides “apples-to-apples comparisons” of available health plans, Campbell said. He added that the QHPs (qualified health plans), as they are known, are required to provide “essential health benefits” such as emergency services, hospitalization, prescription drugs, preventive and wellness services, and maternity and newborn care.

People who do not have health coverage in 2014 face a penalty of 1 percent of their yearly income or $95 per person, whichever is higher. The fee for having uninsured children is $47.50 per child.

“People who choose not to obtain health coverage also have to pay the entire cost of the medical care,” Campbell said. “They will not be protected from the kind of very high medical bills that can sometimes lead to bankruptcy.”

ACA enrollment session
• What: UGA health navigator Martha Weston will be available to help people choose the best health insurance coverage for their needs.
• When: Dec. 17, 4-7 p.m.
• Where: United Way Effingham Service Center, 711 Zitterour Rd. in Rincon
• What to bring: Social security numbers, employer and income information (i.e., pay stubs, W-2 forms) for every member of the household who needs coverage, policy numbers for any household members’ current health insurance plans.
• What to do: Call 826-5300, ext. 116 to schedule an appointment.


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