By Tim Darragh, Of The Morning Call, November 3, 2013
Joanne Robles needed help. Her individual health insurance policy from Capital BlueCross will expire at the end of the year, so the 62-year-old Allentown resident sought face-to-face help last week from one of the region’s most informed Obamacare leaders, Dot Hartman, an official Affordable Care Act “navigator.”
But in an all-too-common occurrence, Hartman couldn’t get logged into the website set up to register and enroll those seeking Obamacare coverage. Robles could see only estimates of her possible costs and left the session at the Allentown Health Bureau office at Alliance Hall with instructions and a paper application.
“I feel good saying it won’t be worse than what you’re paying now and you’ll have very low out-of-pocket costs,” Hartman told Robles. “Once you get a letter give me a call.”
So it went last week as Lehigh Valley residents tried first to understand and then explore Obamacare’s many options. There would be some success, but in most cases, residents could take only baby steps toward securing coverage.
At one session where an applicant could only work with a paper application, Hartman didn’t downplay the uncertainty of Obamacare applications, a month into its disastrous rollout. “How long will I have to wait?” asked the Allentown applicant, who did not want her name used.
“That’s a big question,” Hartman said, trying to maintain a hopeful attitude.
It’s not this way everywhere, but in states like Pennsylvania, which chose not to operate its own Obamacare marketplace and instead rely on the federal government, enrollments have been hard to find. The federal online system has been a “debacle,” admitted Health and Human Resources Secretary Kathleen Sebelius in testimony during a House hearing last week. The system locked up immediately upon its debut Oct. 1, and officials in Washington now say it won’t be until the end of this month that it will work smoothly.
Federal officials also have refused to disclose enrollment statistics.
In private meetings and a public session last week, it was clear that the demand for insurance and the need for education and help to get enrolled exceeded the supply of helpers. It also was clear that help is on the way — volunteers are stepping forward to train consumers to do their own navigating.
In a one-on-one session last Monday, Beverly and Bob Zakos of Catasauqua sat as Hartman worked online through their application. This time, the online connection worked “like a charm,” Hartman said, as Nancy Dy and Anita Mitchell of Easton and Lydia Reynolds, a Moravian College student, looked on. The women were watching with the intention of becoming application assistants who could provide the kind of personal touch Beverly Zakos sought.
“I want someone to sit with and say, ‘This is what I want,’ ” she said.
Once it is finalized, Zakos will get a plan that will be more than $500 a month less expensive than the COBRA coverage she had been purchasing for $1,200, even without subsidies. At 62, Zakos is hoping that with some adjustments to her income and her husband’s Medicare, she could qualify for hundreds more a month in subsidies, she said Friday.
Zakos’ application — her husband already gets Medicare — moved through the process as it is designed to work, but it’s not speedy. Zakos, who came to her session armed with the personal information needed to complete an application — Social Security numbers, income documentation, lists of medicines, names of health care providers — still needed about 90 minutes to get verified and have her application completed.
“You don’t want to try and do it in one setting,” Hartman told an audience at a meeting at the Allentown Public Library Wednesday evening. “It’s a lot.”
It’s a lot because applicants have many choices. Do they want a plan that costs less and has a higher deductible? What percentage of the cost of medical services are they willing to pay? Are their health- care providers in the plan they can afford? Do they qualify for subsidies to cover part of the premium and out-of-pocket expenses?
According to Hartman, insurance shoppers have raised several issues repeatedly: Can Obamacare be used to cover Medicare premiums? (No. Obamacare does not cover Medicare costs.) What income gets counted when considering subsidies? (Wages, taxable interest, Social Security benefits, dividends, alimony and more — called modified adjusted gross income.) How much will it cost me? (It depends on your income and the plan you choose.) When do I have to apply? (Open enrollment is through March 31, but a premium payment must be paid by the 15th of the preceding month for coverage to begin on the first of the new month.)
For some, the coverage can work out to be a good deal. Hartman said she counseled one Berks County resident recently who would pay, after subsidies, $0.97 a month for his premiums.
Others who had been denied coverage because of a pre-existing condition questioned if they really would be able to get insurance this time, she said. “They tell me, ‘I have diabetes.’ It’s hard for them to believe they’ll get coverage.”
But some at the community session Wednesday were disappointed to learn that their retirement income, as well as income for their working spouse, would be considered before determining whether the household qualifies for a subsidy. Others said plans with $6,000 deductibles were essentially unaffordable, even with subsidies.
“I think they’re very high,” said Terry Oswald of Emmaus.
But Paul Dolinsky of Mahoning Township said people who qualified for subsidies and cost-sharing had attractive options. “You can make out very well,” he said. “It’s a hard thing. You got to piece it all together.”
That Dolinsky had to make the trip to Allentown from his Carbon County home illustrates another problem facing those looking for face-to-face help. Lawmakers writing the Affordable Care Act assumed states would prefer to run their marketplaces, not give the responsibility to the federal government. But Pennsylvania and 33 other states chose the federal option, leaving only a relative handful of official navigators available for large areas. Most counties in Pennsylvania, including Carbon and Northampton, do not have an assigned navigator.
Hartman shuttles between Berks and Lehigh counties, holding one-on-one sessions by appointment. A navigator is available through the Neighborhood Health Center in Allentown as well.
There is objective in-person help available elsewhere, as hospitals — including Easton Hospital and St. Luke’s University Health Network hospitals — and some community agencies offer assistance, according to the federal website, healthcare.gov.
Hartman said it’s important for shoppers to have their information together when they meet counselors. Shoppers who want insurance coverage to begin at the earliest date, Jan. 1, will have to have their applications completed and their first premium paid by Dec. 15.
But with the website not expected to function properly until Nov. 30, it likely will be slow going for the month.
Indeed, for the whole week, Hartman said Beverly Zakos’ application was the only one that she was able to see to completion.
“We did a lot of paper apps,” she said.
Before you apply for coverage, make sure you have at hand:
•Social Security numbers
•Employer and income information for every member of the household who needs coverage (for example, pay stubs or W-2 forms)
•Policy numbers for any current health insurance plans covering members of your household
•A completed Employer Coverage Tool for every job-based plan for which you or someone in your house is eligible. The tool can be found online.
•Berks and Lehigh County residents can schedule appointments at 610-741-5453.
•Public information sessions will be held 7 p.m. Thursday at the Souther Lehigh Public Library, 3200 Preston Lane, Center Valley; 6:30 p.m.. Nov. 13 at the Lower Macungie Township Library, 3450 Brookside Road; and 6 p.m. Nov. 21 at the Parkland Community Library, 4422 Walbert Ave., South Whitehall Township.
Source: Berks Encore