The Times West Virginian

Local News

March 30, 2014

Answers to health-care questions available

Even after ACA deadline passes

FAIRMONT — Though the March 31 sign-up deadline for health care under the Affordable Care Act (ACA) will pass on Monday, Monongahela Valley Association of Health Centers (MVA) wants people to know they will still be here, available to answer residents’ questions.

“We’ll always have somebody on-site at our MVA Fairmont Clinic site,” Kevin Crockett, MPA and assistant administrator with MVA, said.

MVA has had assisters on site, ready to help residents with the ACA since October.

In addition to having assisters on-site Monday through Friday, 8 a.m. to 5 p.m., at the Fairmont Clinic on Locust Avenue, the MVA clinic has been holding events all over the area to help answer people’s questions about the ACA.

“We’ve been trying to reach the public in different avenues and let them know we’re there to help them however we can,” Brandon Williams, certified application counselor with MVA, said.

The MVA will continue to hold events through at least the middle of April, though they would like to continue even longer if they are able. The MVA is available to help answer questions at the Marion County Public Library in Fairmont on Tuesdays from 9 a.m. to 5 p.m., at Fairmont Workforce on Wednesdays 9 a.m. to 5 p.m., Fairmont General Hospital on Thursdays from 9 a.m. to 5 p.m., and Fridays at the Morgantown Public Library from 9 a.m. to 4 p.m.

Even if events stop in mid-April, on-site help will still be available at the Fairmont MVA through the end of the year.

Residents can also ask questions by calling 304-367-8759 or 304-366-0700 extension 8444, or by sending an email to

Williams said that there are a few questions that have come up time and again.

“One of the biggest questions I get is ‘what kind of subsidy will I qualify for?’” Williams said. “And my answer for all those individuals is that it is based off your household income and household size.”

Subsidies can help cut down the monthly cost of attaining health-care coverage.

Williams said that if people want an estimate of their potential subsidy, they can help them do that.

“There is a calculator on the website for an estimate,” Williams said.

The second most popular question is what will be covered under these new health-care plans?

“There are 10 essential health-care benefits required for any health-care plan after 2014,” Williams said. “So any of these plans through the marketplace and expanded Medicaid will cover those 10 essentials, and, depending on which you have, may offer a little additional care as well.”

But the answer to one of the biggest questions may surprise some.

“Another big question we get is ‘when does my coverage start?’” Williams said. Unfortunately, there is a slight time delay when you sign up for health insurance in the marketplace.

“I call it the 15-16 rule,” Williams said. “If you apply the 15th or earlier, you will get coverage the first of the following month. If it is the sixteenth or later, it will be the month following that.”

So, if someone applied for health care coverage on April 15, they would start to receive health insurance coverage on May 1. If they applied April 16, they would receive health insurance coverage beginning June 1.

Which brings up another confusing question: Can you still apply for health insurance after the March 31 deadline?

If you do not qualify for Medicare or Medicaid, the deadline to sign up is March 31. However, if you have tried to apply for insurance on the phone, online or by mail, but have not been able to get coverage, you can get an extension through April 15.

Medicare and Medicaid are available for enrollment anytime, under what’s called “rolling enrollment.”

You can also apply to receive health-care coverage after the March 31 deadline if you experience a life-changing event, such as losing your job, losing your insurance, having a child, moving to a different ZIP code or county, getting married and getting divorced.

But if you don’t have health insurance now, Williams said you should try your best to enroll soon to avoid a big penalty.

“Even though the deadline is looming, it’s best still to make a decision,” Williams said. “The penalty is based on how many months you don’t have insurance, pro-rated.” So, the longer you are uninsured in 2014, the bigger the penalty when you file your taxes next spring.

Williams said that if you are insured for one day of a month, that counts, and that month won’t count against you for the penalty. Williams said that penalties start if you haven’t been enrolled in insurance for at least a three-month period.

The penalty is calculated based on household size and income, and charged per individual in the household who is uninsured.

Williams recommends that anyone who is trying to sign up before the deadline do so in person.

“Individuals can mail in an application, but we very strongly suggest to stay away from that route if you can because there’s a big time lag with those applications,” Williams said.

Williams said that, while they can answer any questions anyone has over the phone, they can only enroll in person. But if someone wants to enroll over the phone, because West Virginia is participating in the national exchange, they can call the national help number at 1-800-318-2596, TTY users: 1-855-889-4325.

And if you didn’t qualify for Medicaid before, you should check again, because the requirements have changed with Medicaid’s expansion.

West Virginia’s Medicaid expansion is called the West Virginia Bridge Plan.

Through this program, people who were previously denied coverage may now be eligible because the yearly income requirements have changed to include people making up to 138 percent of the Federal Poverty Level (FPL). For a household of one, this means a 2013 modified adjusted yearly income of no more than $15,856; for two, $21,403; for three, $26,951; and for a family of four, $32,499.

“We will still be available to help individuals, even beyond the March 31 date,” Williams said.

Crockett said that they hope people will get in touch.

“We welcome people who call in and want to schedule something, or just someone who walks in and needs help,” Crockett said.

Community Care of West Virginia will also be on-hand again on Monday, 9 a.m. to 4 p.m. at the health department in Fairmont, to assist residents with any questions they may have, or to help them enroll in health insurance.

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

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