Don’t wait to get ACA plans

Daily Southtown - - FRONT PAGE - Francine Knowles

Don’t pro­cras­ti­nate. That’s the ad­vice coun­selors have for con­sumers shop­ping for Af­ford­able Care Act health in­sur­ance plans this open en­roll­ment sea­son.

The sign-up pe­riod for ACA plans be­gan Nov. 1. As was the case last year, the time in which con­sumers have to en­roll is only six weeks. That’s down from 12 weeks in ear­lier years. En­roll­ment ends Dec. 15.

“Don’t put it off and wait un­til the last minute,” said San­dra Clark, a cer­ti­fied ap­pli­ca­tion coun­selor with Fam­ily Chris­tian Health Cen­ter based at the health care provider’s Har­vey site.

If help is needed in en­rolling, call right away to make an ap­point­ment with a nav­i­ga­tor or cer­ti­fied ap­pli­ca­tion coun­selor who can help in choos­ing the right plan, Clark said.

Fed­eral fund­ing for nav­i­ga­tors was cut na­tion­ally this year to $10 mil­lion, down from $36.1 mil­lion last year and from $62.5 mil­lion two years ago. In Illi­nois, fund­ing has been sliced to just over $389,000 from nearly $1.8 mil­lion in 2017 and from close to $2.6 mil­lion in 2016.

In an­nounc­ing the fund­ing re­duc­tions ear­lier this year, the Cen­ters for Medi­care & Med­ic­aid Ser­vices said it’s pur­su­ing a more cost-ef­fec­tive ap­proach to the nav­i­ga­tor pro­gram that takes

bet­ter ad­van­tage of vol­un­teers and com­mu­nity part­ners.

Statewide, the num­ber of nav­i­ga­tors and cer­ti­fied ap­pli­ca­tion coun­selors li­censed in Illi­nois re­mains con­sis­tent with last year, ac­cord­ing to the Illi­nois Depart­ment of In­sur­ance.

But those who coun­sel con­sumers worry the fund­ing cuts will have neg­a­tive reper­cus­sions.

“I think it’s go­ing to be harder for peo­ple to get in-per­son as­sis­tance,” said Karen Pol­litz, se­nior fel­low with the Wash­ing­ton, D.C.-based health pol­icy non­profit Kaiser Fam­ily Foun­da­tion.

“I think we’re all con­cerned about that,” said Jan Dow­ers, who is work­ing as an ACA en­roll­ment spe­cial­ist at the Planned Par­ent­hood of Illi­nois Floss­moor Health Cen­ter. “But we’re all com­mit­ted to work­ing as hard as we can to help as many peo­ple as we can.”

Planned Par­ent­hood of Illi­nois re­ceived a $208,000 grant to fund three nav­i­ga­tors in Cook and Kane County, she said.

De­spite the fact that the ACA pro­gram is now in its sixth year, many peo­ple still need help in pur­chas­ing in­sur­ance through the so-called ACA mar­ket­places or ex­changes, Clark said. In­deed, sur­veys of ACA mar­ket­place as­sis­ters have con­sis­tently found that con­sumers seek­ing help had lim­ited un­der­stand­ing of the el­i­gi­bil­ity and en­roll­ment process and lacked con­fi­dence to ap­ply on their own, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion.

“It’s com­pli­cated par­tic­u­larly if you’re ap­ply­ing for sub­si­dies or if you have other kinds of com­pli­ca­tions like maybe you work sea­son­ally or are self­em­ployed,” Pol­litz said.

For those for whom English isn’t their first lan­guage, it can be par­tic­u­larly dif­fi­cult to nav­i­gate the process on their own, she and oth­ers said.

Re­duced mar­ket­ing fund­ing this open en­roll­ment pe­riod com­pared to year’s past also is spark­ing wor­ries that will be a bar­rier to peo­ple en­rolling. The state has provided $1 mil­lion in fund­ing for ed­u­ca­tion and mar­ket­ing this year mir­ror­ing last year, ac­cord­ing to Illi­nois Depart­ment of In­sur­ance Di­rec­tor Jennifer Ham­mer. But that com­pares to $5 mil­lion in fed­eral fund­ing that was avail­able two years ago.

“That af­fects out­reach, how wide you can cast the net,” Clark said. “Sur­pris­ingly, even after all these years, still so many peo­ple are not fa­mil­iar with the ACA and the op­por­tu­nity to get in­sur­ance. Every year, I’m stunned by how many peo­ple don’t know about it.”

In Illi­nois, 356,403 peo­ple en­rolled in ACA plans for 2017. That fell to 335,000 for 2018.

“We are op­ti­mistic the en­roll­ment will re­main steady this year,” Ham­mer said.

Some pre­mi­ums have fallen this en­roll­ment pe­riod. Aver­age rates for the 2019 low­est cost sil­ver ACA plans de­clined 4 per­cent from last year, and the low­est cost gold plans slid 6 per­cent, ac­cord­ing to the Illi­nois Depart­ment of In­sur­ance. But over­all rates for the low­est cost bronze plans rose 6 per­cent. Still, that was less than last year’s 20 per­cent rise.

Na­tion­ally, about 85 per­cent of peo­ple en­rolled in the plan qual­ify to re­ceive sub­si­dies or tax cred­its to lower pre­mi­ums, ac­cord­ing to an Illi­nois Depart­ment of In­sur­ance spokes­woman.

In Illi­nois, con­sumers can pur­chase in­sur­ance for cov­er­age that be­gins Jan. 1, 2019 on the Get Cov­ered Illi­nois web­site, the of­fi­cial ACA mar­ket­place in the state, at get­cov­ered.illi­ Con­sumers also can search for op­tions by zip code to find lo­cal, free ap­pli­ca­tion help and sched­ule ap­point­ments for as­sis­tance on the site. Help also is avail­able by call­ing 866-311-1119.

When seek­ing help, among in­for­ma­tion and doc­u­ments needed are So­cial Se­cu­rity num­bers of each fam­ily mem­ber, cit­i­zen­ship doc­u­ments, proof of in­come for the most cur­rent 30 days and ex­pec­ta­tions for your an­nual in­come next year, Dow­ers said.

When weigh­ing pur­chas­ing op­tions, fac­tors to con­sider in­clude “what can you af­ford per month for the monthly pre­mium in ad­di­tion to what is the over­all out-of-pocket ex­pense, co­pays, de­ductibles, any cost shar­ing,” Clark said.

“Peo­ple who have estab­lished med­i­cal treat­ment from a par­tic­u­lar doc­tor, spe­cial­ist or hos­pi­tal want to make sure that the plan cov­ers your estab­lished health care provider.”

Con­sumers should check to see if they are el­i­gi­ble for sub­si­dies or tax cred­its, Pol­litz said. She and oth­ers also ad­vised con­sumers look­ing at less ex­pen­sive short-term plans, which some com­pa­nies are mar­ket­ing as al­ter­na­tives to Af­ford­able Care Act plans, pro­ceed with cau­tion.

In­deed, the Illi­nois Depart­ment of In­sur­ance has put out a buyer’s guide to in­form con­sumers. The guide notes that un­like Af­ford­able Care Act plans, short-term plans don’t re­quire manda­tory cov­er­age of es­sen­tial health ben­e­fits, which in­clude such things as hos­pi­tal­iza­tion, pre­scrip­tion drugs, emer­gency care and re­ha­bil­i­ta­tion ser­vices. The short-term plans also aren’t re­quired to cover pre-ex­ist­ing con­di­tions, men­tal health ser­vices and sub­stance abuse treat­ment, which ACA plans are re­quired to cover. So for con­sumers con­sid­er­ing such plans be crys­tal clear on what they do and don’t cover.


San­dra Clark, left, a cer­ti­fied ap­pli­ca­tion coun­selor with Fam­ily Chris­tian Health Cen­ter in Har­vey, speaks with Eboni Mearieweather about Af­ford­able Care Act open en­roll­ment.

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