SHERIDAN — Wyoming Insurance Commissioner Tom Hirsig made a guest appearance at Sheridan City Hall Thursday morning to give an overview of the Affordable Care Act.
Hirsig’s presentation explained basic regulations slated to go into effect in the coming months and how to operate the new national health care marketplace.
Hirsig began by explaining the four metallic levels of health care coverage offered on the national exchange, starting with platinum coverage, which covers 90 percent of health care costs down to bronze, where 60 percent of medical expenses are picked up by the insurance policy. The “benchmark” plan is the silver level, where the consumer pays 30 percent of medical costs they incur.
The marketplace also features a “catastrophic” coverage option, which is only for major, but unlikely medical expenses, for people under age 30 along with an option for child-only plans to suit the insurance needs of nontraditional families.
Hirsig then explained that while Wyoming premiums are among the highest in the nation, that phenomenon is not new, and most Wyoming residents will qualify for tax credits toward insurance premiums. The federal government has set up a tiered system for those who fall between 150 and 400 percent of the federal poverty level. People who fall below the subsidy qualification category are exempt from having to purchase insurance, as are those above the threshold whose premiums would encompass more than 8 percent of their total income.
Hirsig said insurance companies are further mandated to spend 80 percent of an individual’s premiums either directly on their care or improvements to their policy. Otherwise, the consumer is entitled to a refund of the excess funds.
Hirsig said because the Affordable Care Act is largely feared and misunderstood, some members of the population are vulnerable to fraudsters. Hirsig said common scams are framed around a scenario where people get cold calls asking them to enroll in the health care marketplace. He emphasized that those on Medicaid and Medicare will not have to do anything different to be in compliance with the reform.
Others exempt from the individual mandate include tribal members, those with religious objections, members of a health care sharing ministry, prisoners, illegal immigrants, those with a three-month or less gap in coverage, and those who belong to a government-sponsored medical program such as the Veterans Affairs system.
Hirsig also reminded the group navigators of the new policy can be reached in Wyoming by dialing 211, and further consumer advocacy is available by calling 1-800-318-2596.
Hirsig appeared as a guest speaker invited by the Sheridan County Chamber of Commerce. The morning’s presentation was recorded and will be re-broadcast on Sheridan’s local public access channel and will be available on the Chamber of Commerce website.
The Sheridan Press will publish a special insert with detailed information about the Affordable Care Act Dec. 14.