Local ‘navigators’ offer help finding health insurance plans
HUDSON—If the new health insurance marketplace seems more like a maze, call a navigator.
As of October 1, an estimated 1.1 million uninsured and underinsured New Yorkers were able to begin their search for health insurance through NY State of Health, the official online health plan marketplace.
The website: nystateofhealth.ny.gov identifies itself as “the only place where you can check your eligibility and apply for financial assistance” a “one-stop shop where you can compare costs and coverage, and buy a plan from a certified group of health issuers.”
These health-insurance buyers are individuals—615,000 of them and 450,000 small business members, according to the New York State Department of Health.
The opening of New York’s health insurance exchange is part of the implementation of the Affordable Care Act (ACA), also called Obamacare, intended to give all Americans access to affordable health insurance.
With all these New Yorkers trying to figure out what’s going on and how to get what they need it’s no wonder State of Health Executive Director Donna Frescatore said in a statement Tuesday, “Today with the launch of New York State’s Health Insurance Exchange over 9,000 New Yorkers, including business owners and individuals, shopped online for low cost health insurance for the first time. Since its launch, nystateofhealth.ny.gov has gotten approximately 10 million web visits, far more than was anticipated, causing login problems for users. In response to these issues, operators at the state’s call center have assisted thousands of callers while our technicians have increased the site’s capacity and are looking into the cause of this abnormally high traffic.”
Here in Columbia County (and also Greene), health plan seekers can turn to the Columbia County Community Healthcare Consortium, Inc., which has been awarded a New York State Health Department grant to provide In Person Assistors/Navigators for residents trying to find the health plan best suited to their health and pocketbook needs.
Lisa Thomas, the consortium’s senior program director for the IPA/Navigator program, told The Columbia Paper Tuesday that she is among the consortium’s five full-time navigators (four of them new hires) available to “assist individuals, families, small business owners and employees to shop for, compare and enroll in health insurance plans.” Residents can reach a consortium navigator at 518 822-9600. The current open enrollment period ends March 31, 2014. Health plan coverage purchased before the end of the year becomes effective January 1, 2014.
Navigators can also assist people with Medicaid and Child Health Plus, said Ms. Thomas, who has been with the consortium since 2003 working in the facilitated enrollment program. People who have health insurance through their employer can keep it and the new health plan marketplace is generally not for people with Medicare, but anyone with questions should call the consortium office.
The health plans available through the marketplace are all from commercial insurance companies that have been certified, said Ms. Thomas. All the plans provide coverage of 10 essential health benefits:
•Ambulatory patient services
•Emergency services
•Hospitalization
•Maternity and newborn care
•Mental health and substance use disorder services
•Prescription drugs
•Rehabilitative and habilitative services and devices
•Laboratory services
•Preventative and wellness services
•Chronic disease management
•Pediatric services, including oral and vision care.
A list of the names of the available insurance plans can be found on the marketplace website.
Plans are categorized in “Metal Tiers”: Bronze, Silver, Gold and Platinum, with bronze having the least expensive monthly premiums but highest out-of-pocket costs or deductibles, and platinum having the highest monthly premiums and lower deductibles.
Prospective health plan purchasers can compare plans “on an apples-to-apples” basis to find the coverage that is right for them on the marketplace website and make a decision on their own. Anyone who needs assistance right off the bat or starts the process and get stuck can sit down with an impartial consortium navigator to complete the enrollment process, Ms. Thomas said.
People who need assistance must call the consortium to set up an appointment. Navigators will be available for appointments at the consortium office at 325 Columbia Street, Hudson and at off-site locations around the county during early morning, day, evening and weekend hours. The schedule will be announced soon.
Speaking from her experience with the facilitated enrollment program, Ms. Thomas said many people who have not been able to get health insurance due to pre-existing conditions can now get covered. “I think it will help a lot of people.”
Depending on income, some New Yorkers can get help paying for health insurance. Help is available to individuals earning up to $45,960 annually and a family of four with an annual income up to $94,200.
Starting in January 2014, most people will be required to have insurance. Most people who do not have insurance in 2014 will have to pay a penalty to the Internal Revenue Service when they file their taxes. Some people will not have to pay this penalty if they qualify for a special circumstance, according to the marketplace website.
Columbia Memorial Hospital Spokesperson Bill Van Slyke said Monday, healthcare reform is “extraordinarily, experimental legislation, which has lots of potential opportunities and risks.
“A million more New Yorkers with health insurance will have a positive impact,” he said, noting these newly-covered New Yorkers will have access to primary and preventative care so they don’t wait to get treatment.
Now, many people without insurance wait too long and their illness has become advanced.
Referring to the four levels of insurance plans, Mr. Van Slyke said the potential downside is that while the least expensive of the plans may cost just $200 to $300/month, such plans also come with very high deductibles that can reach thousands of dollars. The purchaser of such a plan is taking the risk that he or she will not need much healthcare.
Providers are concerned that people who understandably opt to purchase the lowest cost plans will continue not getting primary or preventative care because they still will not have the means to pay for it. There can still be a barrier to getting healthcare depending on the package, he said.
“The Affordable Care Act has already had a profound impact on the way care is delivered,” said Mr. Van Slyke, but headded that’s a topic for another time.
To contact Diane Valden email dvalden@columbiapaper.com.
