Racine Kenosha CAA Helps Low-Income Navigate the Complex World of Purchasing Health Insurance in the Marketplace

The Racine Kenosha Community Action Agency (CAA) has partnered with the Covering Wisconsin organization to provide healthcare navigator services to communities in its service area.

As part of the Affordable Care Act, healthcare navigators are supported by federal dollars to provide consumers, small businesses and their employees with unbiased help understanding options available through the marketplace and in completing eligibility and enrollment forms. While this important work is conducted throughout the year, the open enrollment periods provide the biggest challenge to meeting consumer needs.

Throughout the 2014-15 open enrollment period, CAA navigators noted an increasing need to help consumers organize and understand the materials they received as part of the enrollment process. Consumers often came to appointments with envelopes, loose papers and folded printouts of income history, legal notices and communications from various state and federal agencies. At the same time, the enrollment process requires consumers to establish accounts on the marketplace website with user names, passwords and security questions. Completed applications produce 16-page eligibility determination documents with important dates, application numbers and instructions for providing verification information. Finally, plan selection provides consumers with insurance premium, deductible, out-of-pocket maximum amounts and co-pay/coinsurance amounts. Even the most prepared consumer was inundated with information and documents which, upon returning home, probably seemed overwhelming.

Initially, navigators began handing out pocket folders with the navigator’s business card attached and suggested consumers keep all of the documents they have pertaining to their application in the folder for easy retrieval. As time went on and more consumers came in after attempting to enroll online themselves, it became apparent that user names and passwords were not being remembered or written down. This complicated the enrollment process and limited the consumer’s ability to access his/her own account independently. As a result, a form was included in the folder with information related to the individual’s selected marketplace user name and password, as well as the security questions and answers consumers used to set up their accounts.

Over time, the navigators increasingly noted that most consumers weren’t familiar with the terminology used in the plans they purchased nor did they understand many of the benefits available to them within their plans. Consequently, navigators decided to use the folders as a means of providing abbreviated but necessary information the consumers could refer to that would make them better able to manage their accounts and their use of healthcare benefits.

Today, all consumers who work with CAA’s navigators receive a folder at the conclusion of the appointment with the following information:
• An enrollment summary containing the marketplace contact information, user name, password and security questions used to set up the account;
• An insurance summary detailing tax credits received, name and plan number, contact information for the company offering the plan, premium, deductible and out-of-pocket limits, co-pay/coinsurance amounts for primary care, specialist visits, generic medication and preferred brand medication;
• A list of the source and amount of income reported by the consumer on their application;
• An “information needed” checklist which lists any verification documents that must be sent to the marketplace, along with the address and due date;
• “Now You Have Healthcare Coverage …” pamphlet, with important tips about reporting changes, paying premiums, the need to file taxes and watching for Form 1095-A;
• “What’s Free?” document explaining free preventive services available on the health insurance policy; and
• “Protect Your Privacy and Personal Information” which suggests guidelines for maintaining privacy of personal and financial information.

CAA makes all of these documents available in English and Spanish, the two most prevalent languages in the agency’s service area.

Finally, there is an excellent resource provided by Covering Wisconsin that addresses common coverage terms such as co-pay/co-insurance and deductibles, as well as material intended to help the consumer better understand how to use health insurance and how to better manage his/her own healthcare. A copy of this document is also included in the consumer’s packet and reviewed with the consumer, if needed.

With the third annual enrollment for the Affordable Care Act just concluding, these folders continue to evolve to meet the needs of the consumers with whom CAA works. The agency believes that consumers not only need healthcare coverage, but they also need to understand how to use it. To that end, CAA’s navigators will continue to identify more effective ways to support the coverage decisions consumers make.

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