Less expensive coverage comes with more risks “The administration’s rule change is dangerous for Georgia consumers,’’ said Laura Colbert of Georgians for a Healthy Future
With four open enrollment periods completed and a fifth one beginning in the coming weeks, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for thousands of Georgians who do not have access to have insurance at work. The fourth open enrollment period differed from the first three in several important ways, and understanding these variations will be important in ensuring that the Marketplace continues to serve consumers who seek access to affordable comprehensive health insurance. This report examines the characteristics of the consumers enrolled in the Georgia Marketplace, compares open enrollment 4 to the previous three enrollment periods, and provides a preview for open enrollment 5.
Inside you’ll find:
– Key themes in consumer and assister experiences during the 2017 open enrollment period
– A look forward to open enrollment 5
– Policy opportunities to increase enrollment, ensure access to care, address affordability issues, and facilitate continued consumer education and supports
Georgians for a Healthy Future is now several weeks into our training partnership with Enroll America. As you might recall, Enroll America selected GHF as the first organization, nationally, to participate this year in the Leadership Academy in a train-the-trainer model. Enroll America is using the Leadership Academy train-the-trainer model to disseminate their expertise on how to conduct trainings with Enroll America information in order to reach a wider audience.
We have covered topics including list building, reaching the remaining uninsured, and how to design a follow up program. Pranay Rana, GHF’s Consumer Education and Enrollment Specialist, is currently planning several trainings that will take place in October to start the process of imparting our new knowledge to partner organizations. We will also be adding some of the Enroll America training content to our GEAR emails, so keep an eye out for new information on best practices for reaching uninsured consumers, building an outreach plan, and more!
If you have any questions or would like to learn more about the partnership please reach out to Pranay.
Direct consumer support plays an important role in assisting consumers to enroll into and maintain their health coverage. Georgians for a Healthy Future, primarily a health advocacy organization, provided direct enrollment services to Georgians in the last two open enrollment periods through enrollment events, in-person appointments, phone assistance and referrals. GHF continues to engage with other enrollment entities through its Georgia Enrollment Assistance Resources (GEAR) network which is a central hub of Marketplace resources, and provides technical support to assisters through newsletters, e-blasts, trainings, webinars, and forums.
In OE3, GHF primarily focused on post enrollment work undertaking more complex consumer cases such as resolving coverage issues with the Marketplace and insurance providers, payment issues, tax filing and reconciliation issues, and issues with supplemental documents. In this role, GHF provided crucial support to consumers and enrollment assisters to resolve these types of issues and help consumers maintain their coverage, feel free to visit https://syntheticurinereview.com/whizzinator-kit/.
Here is what our consumers reported about their experiences
GHF conducted a post-enrollment consumer satisfaction survey with 25 consumers between April and July 2016. The survey participants reported that they sought a combination of services during their appointments. The table below provides the details for each type of post-enrollment assistance.
Twenty-four out of 25 (96%) participants reported that they were able to resolve the issues that they sought assistance for, as explained by these quotes…
“Paid my premium, sent supplemental documents, added two kids to the application, received delayed cards” – Res# 1, Female, 30.
“My coverage had been suspended for over a month due to a technical issue. GHF helped me reinstate my suspended insurance by advocating on my behalf with both Marketplace and Ambetter. My benefits were reinstated within 3 business days”— Res# 16, Female, 62.
GHF Success Stories:
Tony Caldwell, a consumer with disability, was waiting to get his power wheelchair for over a year. With direct enrollment support from GHF, he was able to get his application completed during SEP and select a plan that covered his wheelchair. Tony quotes, “I finally ended up getting my power wheelchair that I had been waiting for over a year. It has helped me from passing out. Thanks to you all.”
Clyde Mohammed and his wife Sharda (West Indian couple) came to renew their marketplace plan at Switzer Public Library in Marietta. They also wanted to change their current plan since the premium was going up in 2016. Assisted the consumers to complete their application. They were found eligible for subsidies. They enrolled into a health plan with $57 monthly premium and $600 family deductible. The family was able to save over $150 in monthly premium by switching their plan.
The majority of the participants reported the Marketplace application process to be very complicated and that they couldn’t have resolved their issues without the help of an enrollment assister. Those participants who found the process to be comfortable reported the assistance they received to be the key reason. Participants also reported that this page talk about it, from the education to enrollment assisters that made it easier for them to understand and use their new health insurance.
Trends from our direct consumer support experiences and those we have heard from our partners suggested that direct enrollment assistance was crucial for consumers in making enrollment decisions as well as tackling post-enrollment issues. Direct assistance will continue to be crucial for consumers, both new enrollees and re-enrollees, in the days to come as there will be changes in participating insurance providers, premium price, and personal details such as household size and income all of which will require enrollment assisters’ expertise.
With three annual open enrollment periods completed and a fourth one just around the corner, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for roughly half a million Georgians. This report builds on last year’s Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommendations from the Second Open Enrollment Period and focuses on understanding the characteristics of the people who have enrolled in marketplace plans and the experiences of consumers and the enrollment assisters who helped them. Their insights can inform the work of advocates, stakeholders, and policymakers to reach shared goals of reducing the uninsured, improving access to care, and addressing affordability for consumers.
Inside you’ll find:
- Key themes in consumer and assister experiences during the 2016 open enrollment period
- Best practices for outreach, enrollment, and reaching eligible Georgians who remain uninsured
- Policy opportunities to increase enrollment, improve access to care, and address affordability issues
Does a strong consumer voice make a difference in health policy outcomes? According to a Mathematica Policy Research evaluation of state-level consumer health advocacy projects supported by the Robert Wood Johnson Foundation (RWJF), yes!
At Georgians for a Healthy Future, consumer engagement is woven into each of our initiatives to bring the needs – and voices – of Georgia health care consumers into the public policy process. Over the past two years, one of our top priorities has been maximizing health insurance enrollment and ensuring that, once enrolled, consumers can access the care they need. Our work in this area, along with that of similar efforts in seventeen other states, was recently evaluated by Mathematica. The evaluation focused on the activities and outcomes of the eighteen Consumer Voices for Coverage (CVC) projects funded by RWJF.
Georgians for a Healthy Future was a CVC grantee in 2014-2016. Through this program, we focused on outreach, education, and enrollment in coverage and used this work to inform and strengthen our policy work. The CVC evaluation found that coalitions, such as the one led by GHF in Georgia, played a central role in successful outreach, allowed consumer advocates to work together to help maximize enrollment and retention, and helped identify policy issues needing attention.
These coalitions worked to increase enrollment in health coverage programs by building alliances with diverse stakeholders, mobilizing and engaging consumers, identifying achievable policy options to address issues arising from consumer experiences, designing and implementing communication strategies, and securing resources to sustain these efforts.
While the CVC program is winding down, Georgians for a Healthy Future’s work in this area will continue through our Georgia Enrollment Assistance Resource (GEAR) network and through our ongoing policy work around coverage, access to care, and health care value. As we continue this health policy and advocacy work, we will leverage the advocacy infrastructure and ability to translate consumer voices strengthened through CVC into concrete policy actions.
To read the complete Mathematica evaluation, click here.
The weather is heating up and the official start of summer is just around the corner, but here at Georgians for a Healthy Future we’re already looking ahead to one of the hallmarks of fall: open enrollment! The fourth health insurance open enrollment period, known as OE4, will run from November 1, 2016 through January 31, 2017. Stay tuned for an announcement soon about our enrollment summit – an opportunity for Georgia assisters, advocates, and other enrollment stakeholders to reflect on OE3 and plan for OE4 – scheduled for this coming August.
Earlier this spring, new renewal policies and consumer shopping tools were announced (see a roundup of these changes from Georgetown University’s Center on Health Insurance Reforms) and health insurance plans released their initial rate filings (see Georgia Health News’s coverage here, including comments from GHF’s Executive Director Cindy Zeldin), giving us early insights into what we might expect in the upcoming open enrollment period. It’s important to keep in mind that initial rate filings provide important information to regulators, stakeholders, and consumer advocates but they aren’t a good predictor of what consumers will actually pay for health insurance this fall. That’s because proposed rates must first undergo scrutiny by regulators and don’t take into account consumer shopping behavior or the availability of premium tax credits.
While we’re busy preparing for OE4, we also know that health insurance enrollment does happen year-round (if you are engaged in enrollment activities this summer, please tweet about them using #enrollment365). Life changes like marriage, moving, or job loss can happen during any season, triggering special enrollment periods (SEPs). Awareness of SEPs is low, and assisters play an important role in helping consumers who qualify navigate the process. Despite low enrollment during SEPs, however, the Centers for Medicaid and Medicare Services (CMS) recently issued a new rule further tightening them. GHF is concerned these changes could dampen enrollment among qualified uninsured individuals. If you are an assister and are finding that qualified individuals are having difficulties enrolling in an SEP, please let us know.
Finally, if you or your organization helps consumers navigate the health coverage or health care landscape, please consider joining GEAR, the Georgia Enrollment Assistance Resource network. GHF formed GEAR last year to help members of Georgia’s enrollment community learn from each other, share consumer-facing educational materials, and stay apprised of best practices from around the country. Joining GEAR is free, and through it we provide networking and learning opportunities for individuals and organizations that assist health care consumers. And it helps GHF keep our finger on the pulse of what consumers and assisters are experiencing so we can be better advocates. Learn more here.
GHF helped over 100 people get covered
Open enrollment formally concluded on January 31, 2016 and 587,845 Georgians enrolled in the Marketplace (healthcare.gov).
Throughout open enrollment, GHF worked to get Georgians enrolled through direct service and the creation of GEAR (or the Georgia Enrollment Assister Resource Network). GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners who work with consumers to educate them on their health and health care coverage options. If you are interested in learning more about GEAR or want to sign up for the newsletter, email Whitney. Additionally, during this open enrollment period we have provided enrollment assistance to 78 applicants and their families, totaling 141 Georgians. Of those, 91% received financial assistance.
Georgians for a Healthy Future is excited to release our new enrollment toolkit! The toolkit is a comprehensive compilation of fact sheets, neatly organized, that are designed to walk consumers through each step of the enrollment process – from how to get health insurance (enrollment) to how to use health insurance once they have it (post enrollment). You can download it here.
Need more information like this? You’re in luck! GHF has created the GEAR Network for people just like you. GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners that are working with people to educate them on their health and health coverage options. We’ll send out weekly emails full of local resources and the information you need to know through OE3 and beyond. For more information on GEAR, check out this presentation.
Who, what, when, where and why
By Pranay Rana
Pranay is GHF’s Consumer Education and Enrollment Specialist. A certified application counselor, he assists consumers with enrollment into health insurance through the Marketplace. Pranay can also help you once you have enrolled with questions about how your coverage works. To set up a meeting with Pranay you can email him or give him a call at 404-567-5016 x4.
Open Enrollment 2016 (OE3) is less than 10 days away! Open enrollment is an annual period when individuals and families can choose from a variety of coverage options in the marketplace, apply for tax credits, and purchase a health plan that best meets their needs. Consumers can get 24/7 over-the-phone enrollment assistance via the Health Insurance Marketplace at 1-800-318-2596 or can find local in-person assistance at localhelp.healthcare.gov. Individuals and families with incomes between 100% and 400% of the 2015 federal poverty level (FPL) may be eligible to receive financial assistance to help pay for their monthly premiums (see the chart below for what FPL means in real dollars). Consumers with lower incomes (between 100% and 250% of the FPL) may be eligible for additional help with out-of-pocket costs if they choose a “silver bars” plan. In 2015, 9 out of 10 Georgians who enrolled into marketplace plans were able to access tax credits. Consumers who do not qualify for subsidies may still be able to purchase plans through the marketplace at a full price.
So, when does my coverage start?
|Coverage Dates||Enrollment Deadlines|
|January 1, 2016||December 15, 2015|
|February 1, 2016||January 15, 2016|
|March 1, 2016||January 31, 2016|
The marketplace will discontinue subsidies for those consumers who did not fulfill their tax filing requirements for 2014 in order to reconcile their income and subsidies at the end of the year. Consumers are advised to fulfill their tax filing requirements every year and call the marketplace or local assisters for help if subsidies are being dropped without any legitimate reasons. Consumers who do not qualify for subsidies because their income is too low are also advised to obtain an Exemption Certificate Number (ECN) to avoid tax penalties.
What do I need to do to renew my existing plan?
You may simply call the marketplace for 2016 application renewal if you need to change plans for 2016 or update your information. If you are happy with your existing plan and have no updates to make then you do not need to do anything. The marketplace will simply auto-renew your application for 2016.
What if I need help?
- You can call GHF’s enrollment assister at 404-331-9981 or email firstname.lastname@example.org
- You can call the marketplace 24/7 at 1-800-318-2596
- You can also find local help at healthcare.gov.
Federal Poverty Level Table, 2015
Do you or does your organization work directly with consumers to help get them covered? Do people in your community come to you with questions about how to make sense of their health insurance? If so, GEAR is for you! Please join us for a webinar to introduce the new Georgia Enrollment Assistance Resource Network — GEAR! GEAR is the new central hub of resources for Georgia’s enrollment assisters and stakeholders who work to educate people on their health and health coverage options. GEAR is full of handouts, interactive consumer tools, important updates, and other materials that will help enrollment assisters and community organizations better educate Georgians on health insurance enrollment, health insurance literacy, and more.
Want to learn more about GEAR and how you and/or your organization can benefit? Join us on October 19th for a webinar where we will demonstrate how to access GEAR and review some of the materials that can be found there. We will also get your feedback about other resources you would like to see included on GEAR in the future. GEAR is built to help more Georgians connect to health coverage and we want it to work for you!
You can register for the October 19th GEAR webinar here.