Finding solutions to health care enrollment problems

February 9, 2015




By Brooke Baitinger

Health Care 2015: How To Solve Enrollment Issues
The Feb. 15 deadline for the current health care enrollment period is less than one week away. Until that time, organizations such as the Epilepsy Foundation of Florida, WellFlorida Council and Enroll America will host sign-up events and offer services to assist with enrollment.
Still, users may continue to experience issues with the process. If you still need to enroll for coverage, here are some problems you may run into and steps to deal with them.

Understanding the Terminology
Ronnie Lovler, a bilingual health care navigator for the Suwannee River Area Health Education Center, said major problems can result from users’ inability to understand the terminology behind the Affordable Care Act.

“I think if we understand some of the terminology, we can understand what is behind all this,” Lovler said.

For example, she said she has worked with confused customers who thought words like  “tax credits” and “subsidies” meant they would get money back at the end of the year. But Lovler said what it really means is that you can qualify for lower premiums based on your income.

“Cost sharing reduction” can seem unclear as well, but it simply means users qualify for lower out-of-pocket costs — such as copays and deductibles.

This affords people in lower income brackets a lower copay, like $5, to see a doctor or receive generic drug prescriptions rather than a higher rate, such as $25.

The term “shared responsibility payment” refers to a fine that people who do not sign up for health insurance will have to pay. Because individuals in the lower income brackets do not make enough money to afford health insurance, they can fill out an exemption form to avoid paying the fine.

The “Medicaid Gap”
The “Medicaid gap” occurs when a potential user’s income is too high to qualify for Medicaid or other financial assistance but not high enough to afford health care.

Lovler said anyone hoping to qualify for health care assistance in Florida must have a minimum income of $11,670 per year, roughly $1,000 per month. Those who make more than that are not eligible for Medicaid assistance and have to pay for their insurance independently.  However, they may not be able to afford the premiums of $200 and above that will likely be offered. Even if these individuals fill out an exemption form, they will still be unable to receive coverage.

Kristofer Engeman has experienced this problem

When the 27-year-old full-time University of Florida student used the estimator tool, it indicated he qualified for subsidized silver plans based on his estimated income. However, upon filling out an application, he was asked to purchase an insurance plan at $230 per month without subsidies. He received the differing plan options because he is unsure of what his annual income will be based on future employment opportunities.

In short, he fell into the Medicaid gap, which Engeman said he found odd.

“If I calculate my income based on the minimum I expect to make, I’m too poor to receive health care subsidies,” he said, “yet if I calculate it based on the maximum I expect to make, I qualify?”

Engeman said he will remain uninsured after the Feb. 15 deadline until he can find a job that offers health care coverage.

Lovler said the best thing to do in that situation is explore the options. Mobile and free clinics, like the University of Florida’s Mobile Outreach Clinic or the ACORN clinic, offer services based on a customer’s ability to pay.

Lauren Vagelakos, associate planner at WellFlorida Council, said the council provides individuals who fall into the Medicaid gap with a safety net health care provider guide, a handbook of places people can get low-cost health services in the area. She said the facilities are federally qualified health centers, and individuals will be charged for service based on their ability to pay.

“It’s unreasonable to think everyone in America is going to understand insurance,” she said, “so get help if you need it at all.”

Middle-income Levels
Individuals in the middle-income brackets may have trouble choosing appropriate health care coverage.

Lovler said these individuals will typically receive some tax credits, but the cost of the insurance will likely be high. Individuals who fall into the middle-income bracket must often choose between low copays and deductibles but a higher monthly payment, or vice versa.

Lovler said this is where each individual must figure out what is most important and what they want from their insurance. For instance, those with chronic ailments which require frequent check-ups would likely benefit from paying more monthly because they can have lower copays and deductibles. On the other hand, people who consider themselves generally healthy and do not have to see a doctor often might be able to wait until they experience a health problem to pay higher deductibles and copays, saving them money on a monthly basis.

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