Who are you going to call for help when it comes to figuring out your health insurance?
Next year, when insurance marketplaces open under the federal health law and many job-based and individual plans have to meet new standards for coverage and costs, chances are that lots of people are going to need a hand navigating the system.
Depending on where they live, some will probably have an easier time of it than others.
What states will do to help people vary widely. Twenty-one states and the District of Columbia have consumer assistance programs in place to handle questions and complaints about all aspects of private health insurance. The federal funds for these insurance helpers come through the Affordable Care Act.
Many Republican-led states didn’t apply for the grants, however, and funding remains uncertain. In states that don’t have an assistance program, people can call their state insurance department or ombudsman’s office. Some community-based organizations offer help with health insurance issues as well.
Consumers and small businesses will also be able to get help learning about and signing up for the online health insurance exchanges through so-called navigators that will be named later this summer. In addition, the exchanges will have toll-free call centers.
The extent to which comprehensive assistance is available, however, may vary widely by state. “Particularly because a lot of states have taken an oppositional approach [to the ACA], there are a lot of questions about where consumers should go with questions,” says Sabrina Corlette, a research professor who directs Georgetown University’s Center on Health Insurance Reforms. “A lot of it is unsettled right now.”
Maryanne Rice called Community Health Advocates, New York’s Consumer Assistance Program, when she got hit with a $50 copayment for a bone density scan she had in January to check for osteoporosis. Under the ACA, preventive screenings recommended by the U.S. Preventive Services Task Force are covered without any out-of-pocket cost to the patient.
Rice, who lives in Canastota, N.Y., was just a few months shy of her 65th birthday when she had the test, which is recommended for women age 65 or older. Her CAP advocate argued successfully on her behalf that she should receive the preventive screening without shouldering any of the cost.
“I was so upset about the copay business and the fact that I had no one to turn to until I found Community Health Advocates,” she says.
Funding for the national CAP program remains in question. After an initial $30 million appropriation, the federal Department of Health and Human Services awarded nearly $20 million in August 2012. It’s unclear where additional money will come from to keep the New York and other CAP programs running, says Elisabeth Benjamin, vice president for health initiatives at the Community Service Society of New York, of which CHA is a program.
“Our job is to be squarely on the consumer’s side,” she says. “These are the worker bees of the ACA.”