Health Insurance Literacy

Hoosier Navigators have a number of responsibilities.  Along with helping customers enroll in the Marketplace and choose a Qualified Health Plan, we are also tasked with teaching customers about the basics of health insurance.  Many of our clients have never had health insurance before or they may have had a plan that they did not fully understand.  Navigators are here to help customers comprehend the more finite details of health insurance such as co-pays, deductibles, premiums, and many other aspects.  Having this knowledge allows customers to better utilize their coverage and take full advantage of it.  Here are some general health insurance terms you will want to know:

•          Premium:  Payment to an insurance company or health care plan for health or prescription drug coverage.
•         Deductible:  The amount you own for health care services your health insurance plan covers before your health insurance plan begins to pay.
•          Co-payment:  A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service.  The amount can vary by the type of covered health care service.
•          HMO (Health Maintenance Organization):  In most HMO plans, you can only go to doctors, other health care providers, or hospitals on the plan’s list except in an emergency.  You may also need to get a referral from your primary care doctor.
•          PPO (Preferred Provider Organization):  In a PPO plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.  You pay more if you use doctors, hospitals, and providers outside of the network.
•          POS (Point of Service):  A POS is a managed health care plan that is a hybrid of HMO and PPO plans.  Like an HMO, participants designate an in-network physician to be their primary care provider.  But like a PPO, patients may go outside of the provider network for health care services.  When patients venture out of the network, they’ll have to pay most of the cost, unless the primary care provider has made a referral to the out-of-network provider.
•          Primary Care Physician:  The doctor you see on a regular basis for check-ups, exams, when you’re sick, or when you have a health care concern that is not an emergency.
•          Preventative Care:  Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

Here are some terms and language that is specific to the Affordable Care Act:

•          Advance Premium Tax Credit:  A tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount.
•          Cost Sharing Reduction:  A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and co-payments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category.
•          Metal Tiers:  The four types of coverage that is available on the Marketplace which are divided into Platinum, Gold, Silver, and Bronze.  If a consumer is eligible for a Marketplace plan, the different tiers will be available for purchase and he can choose the plan that best suits his coverage needs and budget.
•         Medical Loss Ratio:  A financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees.   If an insurance plan does not use 80% of monthly premiums toward health care costs, the insurance company must pay back customers annually. The remaining 20 cents of each premium dollar can pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions.
•          Lifetime Limits on Care:  Before ACA legislation was passed, many health insurance plans had a “lifetime limit on care” meaning that once customers reached that limit they could be excluded from further coverage.  ACA legislation now makes this practice illegal.

If you come across health insurance terms that you do not understand, I strongly recommend that you contact a local Navigator to assist you. Even if you are not interested in a plan from The Marketplace, your local Navigator can answer general questions regarding health insurance literacy, ACA legislation, and requirements for coverage. 

Meridian Health Services has licensed Navigators who are happy to help.  You can call Meridian to set up an appointment with a Navigator by calling (765) 288-1928 or email us at info@meridianhs.org.  We currently have Navigators in the following Indiana counties:  Delaware, Wayne, Jay, Henry, Randolph, Rush, and Fayette.  If you do not live in these counties but still need assistance, you can visit http://www.healthcare.gov to find a list of Navigators near you.  You can also call the Health Insurance Marketplace Call Center at 1-800-318-2596, 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325. You can find a list of Navigators in your area at https://localhelp.healthcare.gov. 

Getting Ready for 2015 Marketplace Enrollment

As the weather starts to get colder, it is a sign for Navigators that Open Enrollment is just around the corner.  We are taking the valuable lessons learned last year and organizing for a successful Enrollment in 2015. 

If you currently have a Marketplace plan or you are interested in a plan for 2015, here are some key dates you should know:

•             November 15, 2014 - Open Enrollment begins. Apply for, keep, or change your coverage.

•             December 15, 2014 - Enroll by the 15th if you want new coverage that begins on January 1, 2015. If your plan is changing or you want to change plans, enroll by the 15th to avoid a lapse in coverage.

•             December 31, 2014 - Coverage ends for 2014 plans. Coverage for 2015 plans can start as soon as January 1st.

•             February 15, 2015 - This is the last day you can apply for 2015 coverage before the end of Open Enrollment.

Since none of us have filed our 2014 taxes, it may be difficult to remember the Individual Responsibility Payment for qualifying people who do not have health insurance coverage.  This “fee” or “fine” will increase for the 2015 tax year.  For your 2015 taxes, the penalty will be 2% of your income or $325 per adult/$162.50 per child, whichever is more.  Many Hoosiers will not be responsible for paying this fee even if they don’t have a Qualified Health Plan (QHP), but you can find out more by checking here. 

As you are deciding which date will work best for you to enroll in a Marketplace plan, keep in mind what dates the coverage will start.  During Open Enrollment, if you enroll:

• ·     Between the 1st and 15th days of the month, your coverage starts the first day of the next month.
• ·     Between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll on March 16, your coverage starts on May 1.

You can apply four ways:  online, by phone, by mail, or in-person with the help of a trained assistor or Navigator.  Meridian Health Services has licensed Navigators who are happy to help.  You can call Meridian to set up an appointment with a Navigator by calling (765) 288-1928 or email us at info@meridianhs.org.  We currently have Navigators in the following Indiana counties:  Delaware, Wayne, Jay, Henry, Randolph, Rush, and Union.  If you do not live in these counties but still need assistance, you can visit http://www.healthcare.gov to find a list of Navigators near you.  You can also call the Health Insurance Marketplace Call Center at 1-800-318-2596, 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325.

Life May Change...Still Keep Health Insurance

If you have been approved for a Medicaid program for you and/or a family member, it is important to update your local Medicaid office (known as Family and Social Services Administration [FSSA] in Indiana) when you have major changes in your life. The same applies if you have purchased a health insurance plan through The Marketplace.   I realize that this can be difficult.  When you are moving, changing jobs, or bringing a new child into your life, notifying the FSSA office or Marketplace may be the last thing on your mind.  However, it’s important to remember that your health insurance coverage can depend upon reporting these changes quickly and effectively.  Here are a few examples of major life changes:

•Get married or divorced

•Have a child, adopt a child, or place a child for adoption

•Have a change in income/get a new job

•Get health coverage through a job

•Change your place of residence

•Have a change in disability status

•Gain or lose a dependent

•Become pregnant

•Experience other changes that may affect your income and household size

•Other changes to report: change in tax filing status; change of citizenship or immigration status; incarceration or release from incarceration; change in status as an American Indian/Alaska Native or tribal status; correction to name, date of birth, or Social Security number.

If you fail to report these changes FSSA you can risk losing Medicaid coverage.  If you fail to report changes to The Marketplace, you risk higher tax fines when you file your taxes at the end of the year.  Reporting these changes is quick and easy to do, just follow these steps:

For The Marketplace, you can report these changes 2 ways:

•Online –  Log in to your account at www.healthcare.gov.   Select your application, then select “Report a life change” from the menu on the left.

•By phone –  Contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

For Medicaid Programs (in Indiana these programs include HIP, Hoosier Healthwise, and Medicaid Disability):

•Phone –  call 1-800-403-0864.  Follow the prompts and let the FSSA representative know that you have a life change you would like to report.  She will instruct you what to do next and explain what steps you will need to take to verify information

If you receive paperwork from The Marketplace or from FSSA, make sure you respond to the letters as quickly as possible.  More than likely, they are requesting information to verify something you have said (i.e. your income, your address, number of people living with you, assets you may have, etc.).  There is often a deadline you have to meet and if you surpass that deadline, you may risk losing coverage.  As always, if you have a question you should call the phone number listed on your letter.

Life is always changing.  One thing that does not change is the fact that you and your family need dependable health insurance.  There are Navigators all over the United States who are willing and able to help you find the health insurance coverage that best suits your needs—no matter what life may throw at you.  You can find a list of Navigators in your area by going to https://localhelp.healthcare.gov/.  If you live in Indiana and you think you may qualify for a Medicaid program, you can call 1-800-403-0864.  They can direct you to your local FSSA office (there’s one in every county) or answer your questions directly. 

Big Changes in Indiana Medicaid

Lately, Indiana Medicaid seems just like Indiana weather—it’s always changing.  These changes are due to federal regulations, annual updates to the Federal Poverty Level (FPL), new state legislation, and other policy changes.  If you are already enrolled in an Indiana Medicaid program, it’s important to stay updated on any changes to your policy.  If you are interested in being enrolled in an Indiana Medicaid program, these changes may help you be applicable for a program for which you were previously denied.

The Supreme Court ruling on the Affordable Care Act (ACA) allowed states to option of accepting the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.  Indiana, along with 23 other states, chose to not expand Medicaid.  States that chose to expand Medicaid (including our neighboring states of Illinois, Ohio, Michigan, and Kentucky) are able to offer a wider variety of health insurance programs for their low income residents.  Navigators in Indiana need to be a little more creative in finding coverage programs for low income residents in our state. 

Indiana state and federal officials in September 2013 finalized a deal for a one-year extension to the Healthy Indiana Plan (HIP), which serves low-income residents that do not qualify for Medicaid and resembles a health savings account. Gov. Mike Pence (R) has said that any future expansion of Medicaid would be through a plan that resembles HIP, and state officials said that the extension negotiations with the federal government left the door open for such a move in the future.  Just this month, Governor Pence revealed a snapshot of his plans for a HIP expansion entitled “HIP 2.0.”  HIP 2.0 would raise the number of low income Hoosiers who can participate in HIP by raising the FPL for this program from 100% to 138%.  HIP 2.0 is contingent upon the approval of the State’s waiver by the Federal Centers for Medicare and Medicaid Services and approval of a final financing plan by the state budget committee. The State’s goal is to secure these necessary approvals and begin HIP 2.0 enrollment in 2015.  You can find more information about this program at http://www.in.gov/fssa/hip/2445.htm.

There have also been major changes in the Medicaid Disability program in Indiana as we shift from a 209b to a 1634 state effective June 1^st.  A familiar program referred to as “spend-down” will cease to exist, SSI recipients will automatically be enrolled into the Medicaid program, and current members over 100% FPL will no longer have access to intensive community-based mental health services provided under MRO.  As a response to this change, Indiana introduced the BPHC (Behavioral and Primary Health Coordination) program also referred to as 1915 program.  There are a number of stipulations and requirements for eligibility into this program, but it is intended to provide supportive and intensive community based services to individuals with serious mental illness who demonstrate impairment in self-management of healthcare needs.  If you believe you or a loved one may be eligible for this program, you should contact your local CMHC (Community Mental Health Center) for more information.  Meridian Health Services, my employer, is such a facility.

For more information about health insurance enrollment, please see a Navigator in your area.  You can search for local Navigators at www.healthcare.org or you can check your state Department of Insurance (here is Indiana’s:  www.in.gov/idoi).  You can also find out more information about CHIP at www.insurekidsnow.gov.  Medicaid enrollment is available all year round.  If you are eligible for health insurance, you have not missed out.  Don’t wait—do it today!

"Thanks, Mom."

As Mother’s Day approaches, I often think back on the advice my Mom gave me.  Things like, keep your feet clean, wash behind your ears, milk is good for you, eat some more vegetable, and so on.  When I was a kid those words flowed into one ear and out the other.  Now that I’m grown with a child of my own her words seem to have more resonance in my life.

My Mom has always taken good care of herself.  She gets regular check-ups with her physician and various specialists.  She eats good food, exercises, and always gets a flu shot in the fall.  Because of this she is able to enjoy her age and her life.  My brothers and I have lived healthier lives by following her example.

In Indiana, we have a number of Medicaid programs.  Two of them are the Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW).  HHW is a program intended for children, pregnant women, and families with low income in Indiana.  HHW covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, surgeries, and family planning at little or no cost to the member or the member's family.  You can find more about both programs at http://indiana.gov/fssa

HIP is an affordable health insurance program for uninsured adult Hoosiers. The program is sponsored by the State and only requires minimal monthly contributions from the participant. HIP is for uninsured Hoosiers between the ages of 19-64. It offers full health benefits including hospital services, mental health care, physician services, prescriptions and diagnostic exams.  If you qualify for the HIP program, you are set-up with a POWER Account.  POWER Accounts give participants a financial incentive to adopt healthy behaviors that keep them out of the doctor's office. When they do seek health care, plan participants will seek price transparency so they can make value conscious decisions to better manage the funds in their account.

Both of these programs make me think of the advice Mom has given me for years:  take care of yourself and your health.  If you do not live in Indiana or you need information about other Medicaid programs, you can contact a Navigator (like me) or by calling 1-877-KIDS-NOW.  You can also visit healthcare.gov to find information about the Affordable Care Act and find a Navigator in your area.  And if you have a mom or caregiver in your life that has made a big difference, take a minute to say, “Thanks, Mom” this Sunday. 

Me, Mom, and her dog, Bella.

My Hoosier Healthwise Story

About 5 years ago I had a job as a real estate agent.  Like most real estate agents, I worked as a private contractor and health insurance was not available through my company.  I went to a private insurance agency and since I had a pre-existing condition, the insurance plans that were available to my family were over $500 per month.  This was unaffordable.  Even though I was concerned about my own healthcare, I was more concerned about my daughter.  I wanted to be sure that my daughter received the services she needed like annual check-ups, dental cleanings, vision checks, vaccinations, and the ability to see a doctor if she got sick.  I didn’t have the money to pay for an expensive insurance plan, but I also didn’t have the money to pay for an emergency room bill if things got really bad.  I didn’t know what to do and I was worried.

Luckily a friend told me about Hoosier Healthwise.  I had no clue what Hoosier Healthwise was or how CHIP (Children’s Health Insurance Plans) worked.  At first I didn’t see any point in applying because I didn’t think our family would qualify.  I didn’t make a ton of money, but I made enough to pay my bills.  I thought Medicaid was only for people who weren’t able to work.  I did a little research and my friend told me to go ahead and apply.  What did I have to lose? 

After I submitted my application online, I received a letter asking for a bunch of other stuff:  verification of income at my job, verification of my rent, etc.  I faxed the information and in a few weeks, I got an insurance card for my daughter.  I was so excited!  I could finally take her to get her teeth cleaned, update her vaccinations, get her annual check-up, and not be worried about what I would do if she fell and broke her arm.  Having health insurance for my daughter gave me a wonderful “peace of mind” and was one less thing I had to worry about. 

Later, I got a different job that offered employer sponsored health insurance, but even if that wouldn’t have happened the Affordable Care Act makes sure that people are no longer charged more for health insurance due to pre-existing conditions.  It’s good to know that this new rule will help many who could never afford health insurance in the past. 

I hope that you will not hesitate to enroll your children in a health insurance plan.  If you do not live in Indiana and are therefore not offered our Hoosier Healthwise program, please check with your local social services office or call 1-877-KIDS-NOW to learn about Medicaid and  CHIP programs in your state.  Having health insurance is important for all families—for you and your kids.  Children and teens up to age 19 may be eligible for Medicaid or CHIP, but if you are enrolling you children, please make sure you talk to a Navigator about enrolling yourself as well.  When families are enrolled in health insurance it makes them more financially secure, more productive at work, and allows them receive preventative care to help avoid emergencies.

For more information about enrollment, please see a Navigator in your area.  If you are in Jay or Randolph Counties in Indiana, you can email me directly at sara.hall@meridianhs.org.  You can search for local Navigators at www.healthcare.gov or you can check your state Department of Insurance (here is Indiana’s:  www.in.gov/idoi).  You can also find out more information about Medicaid and CHIP at www.insurekidsnow.gov.   Medicaid and CHIP enrollment are available year round.  If you are eligible for health insurance, you have not missed out.  Don’t wait—do it today!