Navigating the system

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March 28, 2014 | 11:58 pm

Editor’s note: Jeff Tourdot is the Linn County outreach specialist overseeing assistance for those applying for health care insurance under the federal Affordable Care Act. Sixteen Linn County groups are collaborating by either directing people to certified insurance counselors or providing a counselor on site. The Gazette Editorial Board invited him to write about the county’s efforts, his perspective on the situation and advice for residents seeking insurance.

By Jeff Tourdot

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Currently in Linn County, there are approximately 20,000 people waking up this morning without health insurance, subconsciously worried about getting sick, being in accident, or being diagnosed with a health condition they know will compromise their financial stability.

A University of Iowa Public Policy report indicated 70 percent of the uninsured population in 2011 were full-time employees. This further implies that individuals are trying but simply not acquiring the additional means to afford health insurance.

While it is understood there may not be a satisfying solution for every person seeking options, we do anticipate being able to considerably reduce the number of uninsured individuals in our community through our enrollment, outreach and educational efforts.

Over the past several months, it would have been difficult to go anywhere without hearing discussions concerning the impact of the federal Affordable Healthcare Act (ACA). There is no doubt the changes provided through this health care law have sparked many emotions, from relief to anxiety.

Being sensitive to the needs expressed, community partnerships throughout Linn County have been working diligently to ensure individuals and families are provided the opportunity to get educated on their health insurance options.

AVOID POLITICAL DEBATE

In providing integrity to our work, there has been an emphasis placed on leaving the debate and politics out of the discussion regarding this effort. Instead, we are focused on what the law states today and then helping others become educated.

For starters, if an individual is on Medicaid, Medicare, has Veteran Affairs Benefits including Tricare, or has an approved insurance plan they are satisfied with, they do not need to apply, enroll or purchase plans through the ACA’s Marketplace Exchange.

The benefit of pre-existing conditions no longer being a factor to consider in policies implemented in 2014 forward provides relief to anyone who has experienced a major illness or surgery. Moreover, many young adults have benefitted from continuing to be covered under their parent’s health insurance plan.

Finally, the expansion of Medicaid, along with the provision of premium assistance and tax incentives, will help offset many of the individual and family insurance premium costs provided they apply through the Marketplace Exchange.

While there have been many issues enrolling online through HealthCare.gov, several alternative options exist.

Any individual or family that has an income above 134 percent of the federal poverty level and is seeking premium or tax incentives will need to apply through the Marketplace Exchange. Individuals who will not qualify for tax incentives are able to enroll directly with Wellmark, CoOportunity, Coventry, United, etc., as examples.

Although the common statistic being shared notes only 136 individuals enrolled in an insurance plan statewide in Iowa, that stat is somewhat misleading. The Department of Health and Human Services reported during the month of October 5,547 applications were processed representing 10,884 individuals in need of health insurance coverage are now eligible to chose a plan. These individuals and families have up to Dec.. 15 to weigh their options before making a final decision for Jan. 1 coverage. (see http://www.iid.state.ia.us/node/7106447)

APPLICATION ADVICE

The following tips are provided when applying through HealthCare.gov:

First, establish an online account on healthcare.gov. If and when a glitch occurs, save the online application and call into the Marketplace Exchange using the phone application process at (800) 318-2596. In most cases, the phone application process will be able to pick up where you left off on the online application.

Once the applicant has completed the phone application, his or her information is now ready for verification by the IRS. Expect the verification process to take a minimum of two weeks before receiving a notice of decision via mail or email stating any incentives the applicant may qualify for.

The applicant will then need to choose a Coventry or CoOportunity plan that best meets their needs as these are the only two carriers available in our area through the exchange. We do not recommend sending a paper application as it presents more opportunities for delays to occur — even as simple as illegible information.

Individuals who have an income that falls between zero and 133 percent of federal poverty guidelines should apply through the Iowa Department of Human Services Portal online at https://dhsservices.iowa.gov/apspssp/ssp.portal. This streamlines the process by being able to bypass the healthcare.gov website.

In most cases, provided they meet the income eligibility guidelines, individuals will qualify for Iowa’s Medicaid Expanded Program known as either the Iowa Wellness or Iowa Marketplace Choice.

For individuals who are current Iowa Care members, please note that program is ending effective Dec. 31 and information letters have been sent out describing the next steps. This population group represents 3,900 Linn County residents who will be auto-enrolled in the Iowa Wellness and Iowa Marketplace Choice Plan by the Iowa Medicaid Enterprise (IME). About 1,000 additional members will have insurance options provided through the federal Marketplace Exchange.

WHERE TO GET HELP

We encourage applicants in need of enrollment assistance to please contact United Way 2-1-1, Community Health Free Clinic, Hawkeye Area Community Action Program, Linn Community Care or Linn County Public Health.

Mercy Medical Center and Unity Point/St. Luke’s Hospital are also providing certified application counselor assistance for individuals needing care predominately in the hospital setting.

We are here to help our community, understanding at some point that each of us will have a family member or friend who will be affected by a costly medical condition. It is that common thread that has stitched this effort together with so many willing partners.

Jeff Tourdot is the Affordable Care Act outreach and education specialist with Linn Community Care and also assistant coordinator for Service Coordination and Client Counseling with Linn County Mental Health and Developmental Disabilities. He has previous work experience with the Iowa Department of Human Services as a social worker and in Scott County’s community services. Comments: jtourdot@linncc.org

 

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