Thousands of Louisianians who are uninsured or who buy their own health insurance can start shopping next week for new, subsidized coverage options under the federal health overhaul.
State officials say they expect significant confusion and endless phone calls as open enrollment begins Tuesday in the health insurance marketplace, where people can sift through dozens of health plans that vary by cost and coverage.
"You have to do your own homework," said Patricia Duhon, a Lafayette resident who plans to buy insurance through the marketplace.
Premiums for Louisiana customers range from $15 a month to more than $900, depending on what's included and how much a family makes.
Federal subsidies are available to many low- and middle-income families to help cover costs. At the same time, a new requirement will kick in that mandates most Americans must have health insurance or face fines.
Louisiana residents who get health insurance through their jobs, Medicare or Medicaid don't have to do anything. The marketplace is for people without insurance or who pay for individual policies.
Decision-making through the marketplace can be complex, with families having to determine how much they can afford, what type of medical conditions they want covered, what they are willing to accept in out-of-pocket costs and what level of subsidy they can get to help cover premiums.
Even supporters of the expanded coverage available through the Affordable Care Act acknowledge that people could be overwhelmed by the choices. Opponents say there's too little information and assistance to help navigate the new system, pushed by President Barack Obama.
"The complexity of it is mind-boggling," said Insurance Commissioner Jim Donelon, a Republican who opposed the federal health revamp but whose consumer assistance office is hosting events around the state to provide enrollment information.
Rochelle Payne, an uninsured, part-time professor at Southern University in Baton Rouge, said the decision requires research, but it's worth the effort.
"I had a sinus infection about a week and a half ago. My nose was bleeding, and I was just suffering. And I just had to go buy some items over the counter when I probably should have gone to see a doctor," said Payne, 37.
Payne's 11-year-old daughter gets coverage through the state's Medicaid program, and Payne said she's looking for a full-time job with benefits. Until then, she's looking to the marketplace. She said her research suggests she'll pay about $100 per month for a health plan after the federal subsidy.
Payne said she'll be online signing up for insurance early Tuesday, but the decisions don't have to be made quickly. People have six months to enroll for health coverage through the insurance marketplace, until March 31.
Coverage under the new options starts Jan. 1.
Duhon said she isn't going to rush her choice.
The 52-year-old bookkeeper from Lafayette knows her subsidy eligibility and said she has a good sense of what she might have to pay through the marketplace. But she said she wants to consider the plans when she can do side-by-side comparisons.
"I think it's better to wait and weigh all your options first," she said.
Duhon said she lost her health insurance in March 2011, when she got divorced and was no longer covered by her husband's employer. She applied for personal policies through several insurers, but said she was turned down because of medical conditions, including high blood pressure.
With three part-time jobs and no insurance, Duhon said she's been left to negotiate with doctors over what prescriptions are needed to keep costs manageable.
"It's difficult. I still see a doctor for my yearly checkup, and you have to budget. And medication is a problem. You have to explain you need cheaper prescriptions," she said.
In the new marketplace, no one can be rejected for pre-existing health conditions, so Duhon knows she can find coverage.
Louisiana won't run its own marketplace, leaving that to the federal government, under a decision by Gov. Bobby Jindal, a Republican who strongly opposed the Affordable Care Act.
Two companies plan to sell insurance plans statewide through Louisiana's marketplace: Blue Cross and Blue Shield of Louisiana and the Louisiana Health Cooperative, a nonprofit that is still working to start up its operations.
Vantage Health Plan will offer plans on the marketplace in many Louisiana parishes, while Humana will do so only in Jefferson Parish.
In addition, four organizations in Louisiana are splitting $1.8 million in federal "navigator" grants to help with education and enrollment across the state.
State lawmakers have questioned whether less tech-savvy residents will have enough access to assistance in choosing a plan, particularly in rural areas.
"You're going to have to have a lot of foot soldiers if you're going to meet the needs of our people," said Sen. Gerald Long, R-Winnfield.
Companies that offer plans also will advertise them. Insurance agents also will have information, and federally qualified health centers will help with enrollment. Community organizations will provide information as well.
Despite the new marketplace, gaps in health care coverage will remain.
Part of the planned fix envisioned by Obama's health care law included states expanding their Medicaid eligibility to allow more working poor to qualify for free coverage.
Jindal, like many Republican governors, refused to expand Louisiana's Medicaid program, citing long-term cost concerns and philosophical disagreements with federally run insurance.
While more than 353,000 Louisiana residents are expected to be eligible for federal financial subsidies to help them pay for coverage through the marketplace, thousands more below the poverty line don't qualify for subsidies because they were expected to get Medicaid.
They won't face penalties for going without coverage, but they also won't be able to afford an insurance card.
People can compare options and make selections at www.healthcare.gov or by calling 800.318.2596.
Story by Associated Press writer MELINDA DESLATTE
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