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Experts weigh in on healthcare options

With the coming of the New Year many Hays County residents are feeling the pressure to enroll in Marketplace healthcare plans or Medicaid.

However, lower income families attempting to obtain healthcare through the market place can find it an overwhelming process.

Available healthcare options for lower income residents and families can get confusing to navigate, said Kit Abney Spelce, Senior Director of Eligibility Services with Communicare Collaborative, which is jointly owned by Seton family of hospitals, and Central Health.

The biggest issue, said Spelce, is that when the Marketplace was created, it was designed to give tax credits to individuals and families that fall above the poverty level while expanding Medicaid services to those below the poverty line for affordable healthcare.

The hiccup in the design occurred when the state decided it was not going to expand Medicaid services to include families below the poverty line. It meant those families aren’t eligible for Medicaid, but also aren’t eligible for government tax credits through the Marketplace because they technically qualify for Medicaid services.

Spelce said people who aren’t eligible for tax credits through the government to get a Marketplace health plan will not be penalized by the government for not being insured.

Even though the introduction of the Healthcare Marketplace has been a cause for confusion, the tax credit buffer being paid toward the total premium to insurance companies helps to make health insurance affordable, she said.

Spelce said the flaw in the Marketplace Healthcare system was that lower income families are less likely to qualify for the tax credits, which meant they can’t get insured through the Marketplace.

“Health insurance companies continue to raise premiums, and if the government doesn’t pay for the tax credits then no one will be able to afford health insurance independently,” Spelce said.

The Marketplace healthcare system presents Doctors with two separate issues, Spelce said.

The first issue is that insurance companies contract with doctors for services and the rates at which those services cost. Doctors will go over their options with different insurance agencies and plans to decide which insurance company will pay them the most for services rendered.

The second issue is with Marketplace healthcare plans and not Medicaid programs.

Since the Marketplace gives people a 90-day grace period to pay their premium while still covering the cost of services, an individual could keep going to the doctor even after the 90-day limit without paying their premium. However, if they receive medical treatment after the 90-days, the cost falls to the doctor.

Doctors then struggle with deciding which health insurance companies are offering the most compensation for services, and whether doctors want to take the risk of accepting Marketplace insurance plans.

But Hays County residents have a few more options.

Neal Kelley, vice president and chief operation officer at Seton Medical Center Hays, said Communicare clinics offer primary care, outpatient and dental services on a sliding cost scale based on income to residents.

Kelly also said Hays County operates a health clinic outside of Seton to offer affordable healthcare options.

Seton will also host the Ascention’s Medical Mission at Home event, which is a free healthcare event held Jan. 28. 

“We are going to be offering services like blood testing, vision exams, dental exams, diabetic foot care and other screening services, as well as providing healthcare resources to individuals and families in need of them” Kelley said.

Kelley also said that the event was most likely going to encompass the entire first floor of the Seton of Hays hospital and that every service offered at the event is free that day.

“It’s not just about providing care, it’s about providing available resources to people as well,” Kelley said.

Be Informed
The free Medical Mission at Home event will be held on the first floor of the Seton of Hays Hospital in Kyle the entire day on Jan. 28.

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