The Times West Virginian

July 6, 2014

Support, assistance with health care available

Those who did not enroll in a plan prior to March 31 may still have some options

By Colleen S. Good
Times West Virginian

FAIRMONT — While the open enrollment phase for the insurance marketplace of the Affordable Care Act closed March 31, support and assistance are still available for community members.

Monongahela Valley Associates (MVA) Health Centers Inc. wants residents to know that even if they did not enroll in a health care plan prior to March 31, they may still have options.

MVA will continue to have a Certified Application Counselor (CAC) and an In-Person Assister (IPA) available during regular business hours at the MVA Fairmont clinic through both walk-ins and scheduled appointments.

Expanded Medicaid enrollment will continue throughout the year. Ninety-five thousand have already enrolled in the program, which has expanded Medicaid eligibility to cover any who make up to 138 percent of the federal poverty level. This means that a four-person household with an annual modified adjusted gross income (MAGI) of $32,913 would qualify to enroll.

Brandon Williams, CAC with MVA, said staff will be available to help interested community members fill out the application.

“We’re the middle man between the DHHR (Division of Heath and Human Resources) and the individual applying for coverage,” Williams said. “We can’t tell them that day if they’ll be approved, but we have some guidelines we can look at and tell them whether or not we think they would be approved.”

They can also help if a resident has applied and thinks he was wrongly denied Medicaid coverage.

“If they got a denial notice, I have actually reached back to the DHHR on behalf of that individual and figured out what was wrong,” Williams said. “Some cases were incorrectly determined, and we were able to give them assistance.”

And if you don’t qualify for Medicaid and need coverage, that doesn’t mean you’re out of options.

“We’re currently in closed enrollment, but there are still situations where an individual can sign up,” Williams said. “There is a special enrollment period, and there are various situations that would qualify.”

Such situations are called “Life Change Events.” Life Change Events include any change to an individual or family’s household size (such as through the birth or adoption of a child), marital status, job or income, or a move to a different state.

Or if your employer decided they were no longer going to offer insurance.

“Then you would have 60 days from the time the coverage expired to sign up through the marketplace,” Williams said.

Another situation when an individual would qualify for the special enrollment period: if they got a raise or a new job and no longer qualified for Medicaid.

Williams said computer assistance is also available.

“It can seem daunting or a big task if they don’t have computer literacy or a connection to the Internet,” Williams said. “We can walk them through the steps.

“People will come to us who have never had an email, and we will create one for them and walk them through step by step. We make sure to detail and explain how it can affect them so they understand what they’re looking at and what they’re signing up for.”

MVA staff will also be available to try to answer any general or specific questions residents may have about the ACA and how it may affect them and their families.

If residents haven’t signed up for insurance through the marketplace and do not have insurance through something else, such as their job, they may be assessed a fee.

“In order to be assessed the fee, you would have to go three consecutive months without insurance within the year,” Williams said.

The fees are also proportionate. So if a resident was uninsured for three months of the year, she would be assessed only one-fourth of the full-year fee. This year, the fee will be 1 percent of the household’s yearly income, or $95 per person, whichever is higher. But this year, it has also been capped to the average national cost of a bronze plan, which is $285.

“Each year, it is going to continually get higher, so the percentage is going to increase,” Williams said.

Penalties are assessed at tax time each year.

The next open enrollment period for the health insurance marketplace will be from Nov. 15 to Feb. 15. While during this year’s enrollment period, only one insurer entered into West Virginia’s health insurance marketplace, during the 2015 open enrollment period, Highmark West Virginia will be joined by the Kentucky Health Cooperative.

“I think it will be beneficial,” Williams said. “It will create some competition now and give individuals options.”

Assistance will be available at the MVA Fairmont Clinic from 8 a.m. to 5 p.m. Monday through Friday. Representatives will also travel to locations throughout the community and will be available at the Fairmont WorkForce office from 9 a.m. to 4 p.m. Tuesdays; at the Marion County Health Department from 11 a.m. to 4 p.m. Wednesdays; and at Fairmont General Hospital from 9 a.m. to 4 p.m. Thursdays.

There are also two locations in neighboring counties, with representatives in Shinnston at the MVA Shinnston Clinic in Harrison County from 9 a.m. to 4 p.m. Mondays, and in Monongalia County at the Morgantown Public Library from 9 a.m. to 4 p.m. Fridays.

“All of these organizations are familiar that we are there, so if they were to come in and ask, they would know where to send them,” Williams said.

Email Colleen S. Good at or follow her on Twitter @CSGoodTWV.