Niagara Gazette

February 23, 2014

Health care navigators are here to help with Affordable Care Act

Niagara Gazette

Niagara Gazette — If you find yourself a little confused about the Affordable Care Act and what’s available to you, the new health care law provides for health care “in-person assisters/navigators” – who can explain how to sign up, point out the differences in the health insurance plans available and guide people and small businesses in setting up coverage.

For Niagara County, Niagara Falls Memorial Medical Center was awarded a grant last summer from the New York State Department of Health to serve as a navigator agency to help consumers apply for health insurance through NY State of Health, the official state health plan marketplace.

The marketplace also offers financial assistance provided by the federal government to lower the cost of health coverage. Individuals and families may also qualify for free or low-cost coverage from Medicaid or Child Health Plus. Anyone who needs health coverage can apply.

Individuals, families and small businesses can get information and enroll in a plan either online at, by calling toll-free at 1-855-355-5777.

Or they can set up a meeting in-person with a navigator by calling 278-4264 or emailing It’s free but appointments are required.

Navigators are based throughout the county, including Niagara Falls Memorial, Lewiston Town Hall, Wheatfield Community Center, United Way of Greater Niagara on Inducon Drive West in Sanborn, and the Doris W. Jones Family Resource Center in the Falls.

Here are a few of the common questions the navigators get, along with some answers from the navigators themselves.

Q: How long can the registration process take when someone is sitting in your office?

A: The enrollment process is anywhere from 60 to 90 minutes.


Q: What should someone bring with them when they have an appointment with a navigator?

A: We will need any and all tax return information, such as 1040s, W2s, any type of income statement, in some cases, we do need pay stubs, passports or drivers licenses, social security number, date of birth; for all members in the tax household. Rent, S/E filing, business expenses, deductions, etc.


Q: Is it better to register yourself or use a navigator? What are the benefits?

A: The benefit of using a navigator is that we are right there in front of you if you have any questions or concerns. We are able to walk through the application step by step to ensure that all information entered is as accurate and precise as possible. At this point in time, we have seen a number of different scenarios, so even a complex situation can be easily addressed by a navigator if they have been exposed to a similar situation.


Q: Can you tell which doctors are covered by what plans?

A: Yes, we can check the websites of the carriers to determine the provider network and drug formularies.


Q: Is there a penalty if you want to cancel the insurance?

A: The penalty applies to individuals who are uninsured for more than three months. The penalty in 2014 is calculated one of two ways. You’ll pay whichever of these amounts is higher: either 1 percent of your yearly household income or $95 per person for the year ($47.50 per child under 18 years of age.) The maximum penalty per family using this method is $285.

The fee increases every year. In 2015 it’s 2 percent of a household income or $325 per person. In 2016 and later years it’s 2.5 percent of a household income or $695 per person. After that it is adjusted for inflation.

If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured.


Q: Can you change plans once enrolled?

A: You are only able to change your plan during the open enrollment period. Open enrollment for 2014 is Oct. 1 (2013) through March 31. The open enrollment period for 2015 will be Nov. 15 (2014) to Jan. 15, 2015.


Q: What if my employer offers a plan?

A: If your employer offers a plan and it is considered affordable (meaning premium will cost 9.5 percent or less of your income,) then you will not be eligible for tax credits or cost share reductions in the Marketplace. If your employer coverage is not affordable (which is premium costs greater than 9.5 percent of your income) then you can come to the Marketplace and will be eligible for tax credits and cost share reductions.