Open enrollment explained at chamber event

By Amanda Manchester, Herald Reporter
Posted 10/30/24

EVANSTON — Enroll Wyoming Southwestern Wyoming Navigator Katie Befus presented information about applying for quality and affordable health coverage during the Evanston Chamber of Commerce …

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Open enrollment explained at chamber event

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EVANSTON — Enroll Wyoming Southwestern Wyoming Navigator Katie Befus presented information about applying for quality and affordable health coverage during the Evanston Chamber of Commerce Lunch & Learn at the Legal Tender on Thursday, Oct. 10.

“You should not pay more than 8.39% of your gross income,” said Befus. “Your household would be eligible to get market place insurance.”

If, however, your place of employment offers an insurance plan, “you legally have to take that insurance, unless it costs more than the 8.39%.”

Enroll Wyoming is a nonprofit organization that helps citizens understand their health coverage options and helps fill out Marketplace, Medicare and Medicaid applications.

Befus, who explained that Enroll Wyoming is under the umbrella of Cheyenne Regional Hospital. It has long offered health plans from Blue Cross Blue Shield and Mountain Health, and it will begin offering a third option with United Healthcare in 2025.

“They are required to offer benefits. No matter what the company is, there is no such thing as a pre-existing condition,” Befus said. “You cannot be denied. They have to cover diabetes medications, pregnancies, birth — they all have to cover it.”

Services covered are: outpatient care, emergency services, treatment during hospitalization, pregnancy, maternity and newborn care, pediatric services, mental health and substance abuse disorder services, prescription drugs, services and devices for recovering from injuries, disabilities or chronic conditions, laboratory tests and preventive and wellness services.

“This is literally a tax-based program, not a health-based program,” Befus said before presenting updated Federal Poverty Guidelines (FPG). “The government is going to pay that much money on your behalf based on what you say you’re going to make. If you or someone you know is looking for health insurance, this document (FPG) is the most important.”

“If minimum income requirement isn’t met, if somebody is really close and they want insurance, if they do an application, but they don’t meet it, the max penalty is $400,” Befus suggested. “They’d rather have the chance of having a tax penalty and having insurance all year long. The only thing that will get someone denied is if they don’t file taxes. You have to file a 1095-A with taxes and income reconciliation.” 

For small business owners, add 20% to last year’s taxes as a buffer, Befus recommended.

“Changes to income will affect tax credit,” she said. “Be as accurate as possible; if anything, [estimate] higher, because you’ll get a tax refund.”

As for an eligibility gap, “Cancel it the day your new benefits start,” Befus said. She also informed attendees that coverage is still available for the remaining weeks of 2024.

The first open enrollment period is Nov. 1 through Dec. 15, for benefits beginning on Jan. 1, 2025.

The second open enrollment period runs Dec. 15 through Jan. 15, for benefits beginning Feb. 1, 2025.

“It’ll automatically renew, but without tax credits — unless you re-apply annually. Tax credits expire Dec. 31,” she said.

Special enrollment periods are available but only for rare occasions, such as households living 100%-150% below the poverty line, childbirth or within 60 days after job or insurance loss, according to Befus.

“I do not recommend waiting for the end of the month [because] they do require identity verification which can take up to ten business days, they won’t backtrack it,” she said. “They will only backdate the birth of a child with a social security number (SSN).”

Navigators help applicants free of charge. They can also file appeals, but Befus cautions, “We can’t do anything about a bill once it goes out.”

For help, contact Befus at 307-352-9109; by email at: katie@enrollwyo.org; or at www.enrollwyo.org.