With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Alaska, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Alaska
The Department of Health and Human Services reported that 12,890 Alaska residents selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.1 In 2015, the number of individuals in Alaska enrolled in a marketplace plan increased to 21,260 during the open enrollment period.2
Alaska placed 26th in United Health Foundation’s 2014 America’s Health Rankings.3 Its strengths include low levels of air pollution, a low prevalence of low birthweight, and a low infant mortality rate. Alaska’s challenges include a high incidence of infectious disease, low immunization coverage among teens, and low immunization coverage among children. In the past year, binge drinking increased by 16 percent; since 1990, violent crime increased by 33 percent.
Alaska individual and family health insurance
When 2014 open enrollment began on Oct. 1, 2013, Alaska defaulted to a federally facilitated health insurance exchange. Alaskans may shop for Obamacare qualified health insurance coverage at the federal marketplace website. They may also find qualified health plans away from the Obamacare exchanges in the private marketplace on websites such as HealthCare.com.
|Alaska’s health insurance exchange:||healthcare.gov|
|Alaska department of insurance:||commerce.alaska.gov/dnn/ins|
Alaska small group health insurance plans
Small business owners who live in Alaska and have 50 or fewer employees may offer them access to coverage through the federal exchange’s Small Business Health Options Program marketplace, as well as in the private marketplace.
Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Alaska’s federally facilitated exchange.
Alaska state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Alaska is among the states without a small group health insurance continuation or mini-COBRA law.
Alaska high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.4
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Alaska’s state-run PCIP program ended April 1, 2014.5 Alaska’s high risk health insurance pool, the Alaska Comprehensive Health Insurance Association, remained open as of December 2014.6
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).7
Alaska did not expand Medicaid to low-income adults without dependents in 2014.8 In 2014, a coverage gap was created in states where Medicaid was not expanded. This coverage gap includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.
An estimated 10,500 poor, uninsured nonelderly adults fall into Alaska’s coverage gap.9 Because Alaska will cover parents up to at least poverty, as of 2014, 100 percent of the individuals who fall into the state’s coverage gap are adults without children. Nationwide, as of November 2014, an estimated 4 million individuals fall into the coverage gap.10
The information below is specific to Alaska’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Alaska Department of Health and Social Services|
|Where to apply||dhss.alaska.gov/dpa/pages/medicaid|
|Eligibility||Based on family structure and income needs|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Denali KidCare, Alaska’s health insurance program for low-income children:
|Program name||Denali KidCare|
|Where to apply||healthcare.gov | coverva.org/main_apply.cfm|
|Eligibility15||Children and teens through age 18 who meet income guidelines; pregnant women who meet income guidelines|
1 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
3 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
6 Alaska Comprehensive Health Insurance Association. State High Risk Pool. http://www.achia.com.
7 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
8 Centers for Medicare & Medicaid Services. “Alaska.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/alaska.html.
9 Garfield, Rachel, et al. “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid—An Update.” The Henry J. Kaiser Family Foundation. Nov. 12, 2014. http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/.
10 Alaska Department of Health and Social Services. Division of Health Care Services. “Denali KidCare — Alaska’s Children’s Health Insurance Program (CHIP).” http://dhss.alaska.gov/dhcs/Pages/denalikidcare/default.aspx.