Don't Chip Away CHIP

Leaders, from Illinois and across the country, are calling on Congress to continue funding the Children’s Health Insurance Program by highlighting its success in reducing the number of uninsured children and warning that these children may lose coverage or receive less age-appropriate care.  The Children’s Health Insurance Program, or CHIP for short, offers developmentally appropriate healthcare for low-and-moderate-income children from families earning wages above the Medicaid threshold.  In Illinois, the program covers 219,000 children and pregnant women as of June 30, 2014.

The healthcare reform law funded CHIP until October 2015, but states need quick federal action as they plan their budgets for the coming year. Unfortunately, Congress may forgo CHIP funding, because children could potentially obtain health insurance through the health insurance marketplace. However, the health benefits in a marketplace plan may not equal those offered through CHIP, and families may not be able to afford the premiums and co-payments.

CHIP’s Benefits are Better

The essential health benefits in the marketplace’s qualified health plans can differ from CHIP’s; marketplace plans can either enact more stringent benefit limits or not cover important pediatric services. For example, a Government Accountability Office study of CHIP programs in five states including Illinois found that marketplace plans were more likely to limit pediatric services and that CHIP offered more generous ceilings for certain services.

Of special significance for children, marketplace plans are not required to cover pediatric dental services if a stand-alone dental plan is available. This means families might be forced to purchase a dental plan in addition to a general health plan for their children—increasing monthly premiums. Since the individual mandate would not apply to dental coverage, families may forgo pediatric dental coverage altogether.

Children in the Illinois CHIP program, All Kids, benefit from Early and Periodic Screening, Diagnosis, and Treatment services. EPSDT can identify medical conditions at an earlier and more treatable point in time and link children with necessary care. The benchmark plan for the state does not offer a comparable set of services. 

Higher Costs and Family Glitches

CHIP health plans, including Illinois’ All Kids, have better cost sharing arrangements than marketplace plans. Monthly premiums in All Kids range from $0-40, while the marketplace’s lowest cost bronze plan in Chicago had a heftier premium of $76 per month.

A report by the nonpartisan Medicaid and CHIP Access Payment Commission found similar patterns across the nation. According to the report, the actuarial value, or the costs covered by a health insurance plan, is generally lower in marketplace plans.

Parents and children forced out of CHIP plans would also encounter higher healthcare prices due to the ACA’s family glitch. The healthcare law bases affordable workplace insurance—and a family’s eligibility for marketplace financial assistance—on the cost of insuring individuals, not families. Parents are placed in the bind of being unable to afford their employer’s family plan, because that option involves much higher costs, but cannot qualify for tax credits or subsidies.

Stick with CHIP

Advocacy groups and leaders from both political parties have called CHIP a success. Since its creation in 1997, the program has increased the number of children with health insurance: 8 million children were enrolled in 2012 alone. The program has contributed to the marked decrease in the percentage of uninsured children, which has fallen from 13.9% to 7.1% over the past 17 years. Because of CHIP’s proven track record and uncertainty surrounding healthcare options in a post-CHIP era, Congress needs to continue funding this important program.

Bryce Marable, MSW
Policy Analyst
Health & Disability Advocates

Why Narrow Networks are a Big Deal: A Discussion of Network Adequacy

A network is defined as the healthcare facilities, professionals, and suppliers that an insurance carrier has contracted with to include in a given health plan. Network adequacy is the extent to which a health plan has a satisfactory number of primary and specialty healthcare professionals that consumers can access in a timely manner.

The terms network and network adequacy are pretty technical words, so the average consumer may not know their definition, but a percentage of the population is even unaware of how to apply these terms to the process of purchasing a health insurance plan. According to a Commonwealth Fund survey of marketplace shoppers, 25% said they did not know the quality of the network for their health insurance plan. The survey results indicate that consumers may lack an awareness of how network adequacy impacts them on a personal level.

Consumer Problems with Network Adequacy

Consumer awareness is important, because network adequacy can have a tremendous influence on a patient's quality of care. For example, plans can include a hospital in their network, yet exclude doctors or specialists working at that hospital. As a result, patients may unknowingly receive care from an out-of-network doctor and be left with an exorbitant bill. This practice, in which consumers must pay the costs beyond the allowable amount determined by the health insurance company, is called balance billing. Sometimes the lists of healthcare professionals in a network are not even accurate, which may lead consumers to enroll in a plan that does not have their desired provider. Also, hospitals serving special populations, such as children, have reported difficulty being included in networks – preventing families from getting needed care at a reasonable cost.

Network Reforms Proposed

These issues may soon change. The National Association of Insurance Commissioners (NAIC) recently released a new draft model law for states, which has proposed some significant reforms. To begin with, hospitals would need to develop a process for alerting patients in cases where they may be seeking treatment from an out-of-network provider who happened to be working at an in-network hospital. In addition, insurance carriers would be required to update changes to their provider networks on a monthly basis and must make this information available online and in print form.

NAIC's draft model law also created the general recommendation for states to create sufficiency standards accounting for elements such as the amount of specialty services available, geographic accessibility, the number of providers, the wait time for receiving care, and the hours of operation for participating providers. NAIC gives states latitude in how they apply their sufficiency standards. However, NAIC does note that some states have chosen to adopt quantitative standards that set minimum numbers for providers for maximum travel times and maximum waiting times, among other metrics.

Changing Consumer Experiences for the Better

The reforms requiring insurance companies and healthcare providers to communicate accurate and timely information on healthcare networks are a much needed help for consumers who lack basic knowledge of their options (which may be due to the fact that they hate shopping for health insurance). Mandating more open lines of communication would simplify the process of finding and using health insurance. With readily available information, consumers would know what providers and hospitals are a part of their plan. Importantly, state actors are recognizing the significance of empowering consumers with knowledge, as the Illinois Department of Insurance recently released fact sheets on networks and out-of-network benefits.

Beyond improving communication with consumers, NAIC’s draft language on sufficiency standards would support consumers who have purchased a plan in having the ability to access the healthcare providers they need to stay healthy – without traveling great distances or waiting long periods of time. Advocacy needs to be done at the state level to guarantee that the sufficiency standards in place are in line with the intentions of NAIC’s draft model law and create quantitative metrics to determine a network’s strength.


Bryce Marable, MSW
Policy Analyst
Health & Disability Advocates

Learn. Connect. Share. PTSD Treatment can help.

June was PTSD Awareness Month. And although spotlighting it throughout the month of June brings a lot of great information to the public, it is important to remember that PTSD is something that many individuals struggle with throughout the year.

Take the Fourth of July as an example: This great American holiday is only four days past the end of PTSD Awareness Month, but many people are not aware of the impact this holiday has on combat veterans with PTSD. For many of them, these exuberant displays of sound and light trigger combat flashbacks that last long after the last sparkler has fizzed out for the night.

This year, there has been more publicity around the effect that fireworks can have on returned vets. And there has been a growing campaign to increase PTSD awareness by placing signs in front lawns that read: "Combat Veteran Lives Here, Please Be Courteous with Your Fireworks." The experience of combat veterans on the Fourth of July is a prime example of the type of awareness that needs to continue beyond the month of June, and that is an awareness that centers on respect for those who suffered trauma in the past, and who continue to feel the effects to this day.

That being said, it’s hard to know how to be courteous of those with PSTD when you don’t have a very firm grasp on what PTSD is. Although it is most commonly associated with combat veterans – and vets as a population experience PTSD at a much higher rate – it also occurs in those who have lived through other violent experiences. The National Center for PTSD defines it as "a mental health problem that can occur after someone goes through a traumatic event like war, assault, an accident or disaster."

Understanding that PTSD is not limited only to combat veterans is an important step in learning how to be mindful of things that may trigger flashbacks or any other cognitive or bodily symptoms. Things that might seem part of the norm – like fireworks on the Fourth of July – can actually cause a painful reliving of a traumatic moment.

The way each person experiences their PTSD is different, and the only way to be able to really get a grasp on what these individuals experience is through talking with them. However, it is understandably difficult for many to recount their stories, so it is important to be patient and supportive. Reach out if you see that your friend or family member with PTSD wants to talk and be sure to listen to their story.

If you or a loved one struggles with PTSD, or if you just want to learn more about how you can help support someone with PTSD, the Department of Veterans Affairs' websie has a comprehensive section devoted to the condition, the National Center for PTSD (ptsd.va.gov). The section has resources for everything from treatment options like exposure therapy to a section specifically geared toward friends and family members.

Also, let people know that treatment is covered! The Affordable Care Act requires qualified health plans to include mental health services as an essential health benefit. The ACA also outlaws discrimination based on pre-existing conditions, so individuals with PTSD or other mental health symptoms need not be worried that they will be denied coverage or that their coverage will be cancelled.

This year’s PTSD Awareness Month motto was aptly put and is something to keep in mind throughout the year: "Learn. Connect. Share. PTSD treatment can help." Connect by reaching out to someone around you. And finally, share your experiences and knowledge with others.


Julia Ortner
Intern
Health & Disability Advocates

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To learn more:

• Explosion of Kindness – yard sign campaign
• For Vets With PTSD, Fireworks Can Trigger Painful Memories – at CBS Minnesota
• National Center for PTSD – at the VA

On COBRA? New Announcement from HHS Could Save you Thousands of Dollars

In mid-April, I received a call from a 62-year-old woman named Alice who had been laid off from her job quite a while back. She was paying around $650 each month to maintain her COBRA coverage. Turns out she got my number from her brother, Carl, whom I had helped enroll into a Marketplace plan. He, too, was paying a lot of money each month for COBRA coverage after his employer had cut his hours in half, making him ineligible for employer-offered coverage. By enrolling into a subsidized Marketplace plan, Carl saved more than $400 a month in premium costs. He hoped I could also help his sister. Unfortunately, she called me just a few weeks after open enrollment had ended.

Normally, this would mean that she would have to wait until the next open enrollment period or until she exhausted her COBRA coverage before she could qualify for a Special Enrollment Period which would allow her to enroll into a much more affordable Marketplace plan. It seemed she had missed this window of opportunity – that is until HHS announced new Special Enrollment Periods for folks currently enrolled into COBRA coverage.

As I mentioned, normally a consumer has four options regarding COBRA coverage:

• Decline an initial offer of COBRA coverage
• Get a Special Enrollment Period and enroll in marketplace coverage
• Switch from COBRA coverage to marketplace coverage during open enrollment
• Wait until the exhaustion of COBRA coverage to get an Special Enrollment Period

Well, HHS recognized that folks just like Alice were confused about their options. So they decided to offer COBRA enrollees a Special Enrollment Period. If you or someone you know is on COBRA, he or she can qualify for a Special Enrollment Period to shop for a plan on the Marketplace until July 1 of this year.

Simply call the Marketplace call center at 1-800-318-2596 and tell them you are currently on COBRA and that you would like to explore your options in the Marketplace. Then fill out an application at healthcare.gov to see if you’re eligible for financial help. This could very well save you hundreds of dollars each month in premium costs. You have nothing to lose. I’ve already called Alice.

Jillian Phillipsr
Chicagoland Organizer
Campaign for Better Health Care

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For more info on qualifying events:
http://illinoishealthmatters.org/wp-content/uploads/2014/04/Special-Enrollment-Periods-Explained.pdf

Four Gifts the Affordable Care Act Has Given Americans by Its Fourth Birthday

On March 23, 2014, the Affordable Care Act (ACA) turned four. In its relatively short life, the ACA has already accomplished a great deal. To celebrate, here’s a list of the top four gifts that the ACA has given to the American people:

1. No More Pre-existing Condition Exclusions

Before the ACA was law, insurance companies routinely denied people health coverage due to“pre-existing conditions,” which could range from common chronic conditions such as asthma and arthritis to diseases such as cancer or mental illness. However, as of September 2010, children could no longer be denied coverage due to a pre-existing condition, and as of January 2014, adults are now enjoying that same right.

By way of example, on HelpHub, the Illinois site that provides technical assistance to enrollment specialists, we have heard many stories about people who are beginning to obtain insurance after being told for years that they are were “uninsurable.” Families USA estimates that 64.8 million non-elderly Americans—or 1 in 4 people—have been diagnosed with pre-existing conditions that could have led to denials of coverage in the past. That’s over 5.6 million people in Illinois alone who can no longer be turned down or charged more for health insurance.

Though over half of the public know about this “gift” from the ACA, according to a January 2014 Kaiser Family Foundation tracking poll, 53% of the uninsured remain unaware of this provision. We need to continue to publicize this incredible benefit of the law.

2. Financial Help to Obtain Insurance

Aside from pre-existing condition exclusions, another major barrier to accessing health insurance has been cost. Since employers have not been required to offer coverage, many low-wage workers never received an offer of coverage and were priced out of the individual insurance market.

Through the new Health Insurance Marketplaces, the ACA created three new ways to make health insurance more affordable. The first is premium tax credits, which can be taken by Marketplace consumers in advance to lower the amount of premium the individual or family must pay for their coverage. Consumers with incomes under $45,960 for a single individual and $94,200 for a family of four are eligible for these credits. The Department of Health and Human Services reports, for example, that nearly 5 in 10 uninsured single young adults eligible for the Marketplace could pay $50 or less per month after tax credits for coverage in 2014.

The second form of financial help provided by the ACA is cost-sharing reductions. These reduce the out-of-pocket costs, such as deductibles, copays, and co-insurance, that health care consumers can expect. Cost sharing reductions are available to health insurance Marketplace consumers who make between 100% and 250% of the federal poverty level who purchase a Silver plan. Why does this matter? It means lower prices for doctors’ visits, prescription drugs, and other care that people need—which is particularly important for people who utilize a high amount of services.

Recent enrollment numbers indicate that people are signing up for these subsidies, too. As of February 2014, 85% of Healthcare.gov enrollees qualified for premium tax credits, while 67% consumers chose Silver plans, indicating that they may also qualify for cost sharing reductions.

3. Medicaid Expansion

The ACA mandated a Medicaid expansion to all qualified adults below 138% of the federal poverty level (about $15,800/year for a single individual); this mandate filled a huge coverage gap in Medicaid eligibility for low-income adults. In June 2012, however, the United States Supreme Court made this expansion optional, and currently just half the states and Washington, D.C., have expanded Medicaid. Illinois is one of those states; last July, Governor Quinn signed the Medicaid Expansion (SB 26) into law, and according to reports at the recent Illinois Health Reform Implementation Council meeting enrollment into Medicaid has already exceeded expectations.

The number of Illinois residents enrolled in ACA Adult Medicaid is now at 200,000. This includes all Supplemental Nutrition Assistance Program (SNAP) auto-enrollment and enrollment in CountyCare, the early expansion of Medicaid in Cook County, the largest county in Illinois )which includes Chicago and some of its collar suburbs). Of pending applications, the state expects another 150,000 will be eligible for ACA Adult Medicaid. Overall for 2014, it is anticipated that Illinois will enroll over 400,000 adults into the new Medicaid program. 

Together, the Premium Tax Credits, Cost Sharing Reductions and the ACA Medicaid Expansion provide low-income families with the gift of affordable health care. 

4. Essential Health Benefits

The ACA gift that people probably know the least about is the 10 Essential Health Benefits (EHB) that must be included in Medicaid and health plans in the individual and small group markets. Under EHB, not only must plans now include a range of free preventive services and screenings, but also prescription drugs, lab tests, dental and vision care for children, and mental health and substance use disorder services, among other critical services. The Essential Health Benefits package ensures comprehensive services are included in your policy so you aren’t left paying premiums for shoddy coverage.

These gifts have already started to make a huge difference to the American people. The uninsured rate is decreasing; and stories from around the country are streaming in about people who are able to see a doctor when they hadn’t for years, families who are able to afford their premiums every month, and individuals who finally have peace of mind because they have a good health insurance policy when they need it.

We can’t wait to see what the next four years of the ACA brings.

The Obamacare Lady: What made me want this job?

Last year, I accepted a position to be an In-Person Counselor with the State of Illinois. You may also have heard the terms Navigator or Assister used to describe this job. I help people with the Affordable Care Act. A few people have called me, “The Obamacare Lady.”  Yes, I help people understand “Obamacare” and help them determine what help they may qualify for in obtaining health insurance.

What made me want this job you ask? Well, I was drawn to this job for a number of reasons:

First, I like helping people. Prior to starting the training for this job, the only thing I knew about the Affordable Care Act was that it would help people like my Mother get cheaper healthcare. My Mom had a heart attack a few years ago and since then, her health insurance premiums went through the roof. And by roof, I mean they were more than a mortgage payment on a 3 bedroom house!! Yikes! That seemed crazy to me. So, I wanted to do this job to help people like my Mother and clients like Kathy. Kathy* is a small business owner and has a pre-existing condition. Her business has been quite profitable in the past, but since 2008, things have been rough. Due to the high costs of health insurance, especially with her pre-existing condition, she could not afford to pay her rent and eat if she purchased a health plan. So, she hasn’t had health insurance for years. She has been going without her medication and has just been hoping that her condition has not progressed. We met and completed an application together and found out that she is eligible for a tax credit and reduced out of pocket expenses.  She is thrilled to be able to purchase a health insurance plan for $ 150 a month. These stories are my every day.

Second, I’m all about saving money. I love to shop for the best price for everything. I wait for sales, clip coupons and save my money for a rainy day. I get a little thrill out of helping someone save hundreds of dollars on their health insurance. It’s fun for me.

Third, I like to know the facts. This has been quite the topic of conversation. Almost everyone has an opinion. Over the years, it seems our news sources now always have a particular slant one direction or another. It is pretty difficult to find someone that will give you both sides to a problem or issue. So, my solution was to get boots on the ground and learn about the ACA myself and make my own decisions.

This job is not for the faint of heart. The reason that I have kept this job is that I am persistent and resilient. On a typical day, I get to see a formerly stressed, worried and confused individual walk out of my office with a little less weight on their shoulders, a little more money in their pocket and much more confident about their future. But getting there isn’t always easy. The rules to the Affordable Care Act are complex and each person’s situation is different, but that has been the fun part of being “The Obamacare Lady.” I meet so many interesting people and have a bird’s eye view of the diversity in our state. Illinoisans are beautiful, generous and hard-working.

Back in October, when the website wasn’t working very well, every person asked me if people were treating me okay. They were concerned that someone would take their anger and frustration out on me. Not a single person did. Then, people were concerned about all “those people” that might be taking advantage and defrauding the system. They wanted to make sure there were ways in place to catch the “cheaters.” After a while, all these questions made me laugh. No. Everyone I meet with is just like you. We want the same things. We want to provide things like health insurance for ourselves and our family. We are willing to sacrifice and work hard to do it. We want to obey the law. We want to be honest and tell our truth. We want to pay our own way and don’t want anything for free. Our politics and opinions on this Affordable Care Act are varied to be sure, but the similarities among us are so close. We are too hung up on headlines and sensationalism to see it.    

By Barb Silnes

In-Person Counselor

Why We Built HealthPlanRatings.org – and What Makes it Different

Here at Consumers' CHECKBOOK, what we’ve always focused on is helping consumers make their best choices. And we felt that right now, choosing insurance plans on the Marketplace is difficult and confusing for most consumers, and that Healthcare.gov doesn't give consumers the key information they need to choose the best plan.

So what we did was build a model for how to get consumers to their best health plan choices – and get them there quickly. We launched this Health Plan Comparison tool at www.HealthPlanRatings.org.

This tool actually compares every plan available in the Illinois Marketplace based on total estimated cost (not just premiums or deductibles), plan quality, doctor availability, and other key factors. But it's designed to take consumers with little or no knowledge of insurance through a few simple steps – which take about five minutes – to help them choose the best plan for them.

Although it is intended to be a model for the country, right now the Health Plan Comparison tool only includes plans in one state: Illinois. Our hope is that the Feds and states that are running the Marketplaces will learn from what we have done and make their Marketplaces work better for consumers for the next open enrollment period, this Fall. Meanwhile, we want to have as many Illinois consumers as possible use the tool right now.

Here are some examples of what we've done:

COST. This is the primary consideration for most consumers when purchasing health insurance. Right now, Healthcare.gov lets you compare plans, but it just gives you the premium and the amounts of deductibles, co-payments, coinsurance, etc., for various health care services and products. Since it is all but impossible to calculate the likely total cost for each plan based on this confusing mass of benefit information, consumers often choose based on premium alone, or some other unreliable shortcut. Instead, our model uses actuarial analysis of data from large health-care-usage databases to calculate an Estimated Average Total Cost (premiums plus out-of-pocket costs) for a family of the same size, ages, health statuses, and other characteristics. That gives you a single dollar amount for each plan, making it easy to compare plans.

RISK. The Marketplace gives a consumer little or no help assessing risks of having a "bad year," or what the cost of an event such as heart attack could be. We calculate the cost in bad years and the probability that a family like yours will have such a year, giving you an easy-to-understand, easy-to-compare measure of "Risk" with each plan.

DOCTORS. For many people, whether they will be able to keep their physician – or be able to have one they like – is a key consideration in choosing a plan. But it can be challenging finding out which plans have the doctors you care about available in their networks by going to each of the insurers' doctor directories one at a time. So we combined them into an "All-Plan Doctor Directory" and when you see the list of available plans, you see which of your preferred doctors are in each plan.

QUALITY. All plans are not alike in the quality of care or service their members get, and the Marketplace gives little or no information on the quality of each plan. But we actually provide quality ratings. For all the plans, we initially display a simple overall quality score, and you can personalize the score based on the aspects of plan quality that are most important to you.

We believe that the Health Plan Comparison tool will save many consumers thousands of dollars and connect them to good care and service. It was a lot of work creating this website. We launched it two weeks ago, and did a demo for about 200 Navigators at a meeting set up by Get Covered Illinois. We want to reach out and help as many consumers as possible before March 31. Please take a look at www.HealthPlanRatings.org. Here is a sample plan-comparison page:

One more thing. We have been asked why we, based in Washington, DC, chose Illinois for our model plan comparison tool. There are various reasons, including the fact that it is a large, diverse state, with major urban and rural populations; has a lot of creative, consumer-oriented leaders; and has a substantial number of plans in the Marketplace. And okay, I admit it: we have some personal connections: My mom and dad were both born and raised in Illinois (Lexington and Lincoln); I graduated from the University of Chicago Law School; the director of our health plan ratings work got a Masters in opera (very different from what he has done for many years for us) from University of Illinois and sang sometimes in Chicago before spending eight years singing opera in Europe; and we publish one of our regional versions of Consumers' CHECKBOOK magazine in Chicago, with ratings or service firms, from auto repair shops to plumbers to doctors and veterinarians, and thus have reason for frequent trips to do Chicago TV appearances talking about our findings.

We really hope that you will tell everyone who might still be looking for insurance, or helping others look for insurance, in the Illinois Marketplace about this tool. And of course, we welcome any feedback. You can email me at rkrughoff@checkbook.org

– By Robert Krughoff, President, Consumers' CHECKBOOK

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CBO on ACA: Devil is in the Details

On Tuesday, while driving between meetings, my favorite talk radio host shared shocking details from a new report – Obamacare, or the Affordable Care Act, is going to result in a loss of 2 million jobs in the United States over the next 10 years. Well, I thought, it's going to be a long day.

Later I learned that this reporter was sharing details from the latest Budget and Economic Outlook Report from the Congressional Budget Office. The CBO is an independent agency tasked with providing fiscal analysis for Congress with the intent of informing the budget-making process. Periodically, they release these reports which provide a 10 year forecast demonstrating the economic impact of many policies. Since 2010, they have included analysis on the impact of the ACA.

Needless to say, I was anxious to dig into this nearly 200 page behemoth and figure out what was going on. What I read in this report turned out to be great news. The report does not say that the economy will lose 2 million jobs. It says that, by making it easier to access affordable, high quality health insurance, more than 2 million people can make the choice to leave their job and pursue their passions, spend time with their families, start businesses, or find better jobs.

For those of us that have been following and championing the ACA, this isn't actually new information. Last year, the Robert Wood Johnson Foundation released a report, entitled The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment, which estimated that we could see as many as 1.5 million entrepreneurial spirits leave their jobs to become their own boss in 2014 alone!

Both reports highlight the same important fact: Because of the promise made by the ACA, that we can all access good health care, people will have the freedom to do what they want without fear of medical emergency and financial ruin.

My father, sister, and brother-in-law are all self-employed. Even my grandmother owned a small craft shop for the better part of my 26 years. While they were all brave (and maybe a little stubborn) enough to pursue these passions before the ACA, it has not been without sacrifice. After my self-employed and uninsured father had emergency eye surgery in 1992, my family filed bankruptcy as a result of unpaid medical bills. If the ACA had been around then, things would have been much easier for us and my dad certainly would have avoided a lot of sleepless nights worrying about keeping his business or providing for my sister and I.

I was shocked when I heard that radio report, but – as always – the devil was in the details. Except the devil isn't really a devil at all. The bottom line is that the ACA presents a new opportunity: an opportunity for people like my dad, to become their own boss; for someone who has put in their years and saved their pennies to retire early; or for a new parent to work part time so they can spend more time watching their child learn and grow. The CBO report means that what happened in my family, and millions like us, doesn't have to happen anymore – and that is why I will continue to be a proud champion of the ACA.

– By Kathy Waligora

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Kathy Waligora is the Manager of Health Reform Initiatives at EverThrive Illinois (formerly the Illinois Maternal and Child Health Coalition).

See the 2013 ACA Self-Employment Infographic in PDF.

Consumer Information for January 1, 2014

As the start of coverage for Qualified Health Plans in the Marketplace approaches, the Centers for Medicare and Medicaid Services (CMS) anticipates that some of the newly insured individuals will have questions about how to access healthcare services. CMS has posted information on Marketplace.cms.gov to address questions that consumers may have with the January 1 start of coverage through their selected health plan.

Individuals who have insurance for the first time or have new plans beginning on January 1 are likely to have many questions related to coverage, premiums payments, co-payments, and other issues and may need to reach their individual insurance plan. Below is information for consumers on how to access their health plans as well as education factsheets explaining how health insurance works.

• What to know about seeing your doctor
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/seeing-your-doctor.pdf
• What to know about getting your prescription medications
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-your-prescription-medications.pdf
• Appealing your insurers' decision not to pay
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/appealing-your-insurers-decision-not-to-pay.PDF
• I signed up, but don't have health coverage. What should I do?
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/signed-up-but-no-coverage.pdf
• Getting emergency care
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/getting-emergency-care.pdf
• What you should know about early renewal of health coverage
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/early-renewal-of-coverage.pdf
• What you should know about provider networks
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/what-you-should-know-provider-networks.pdf
• Contacting your Health Plan’s Customer Service Phone Number (includes a link to a database containing the customer service phone numbers for all of the Qualified Health Plans) https://data.healthcare.gov/dataset/QHP-Customer-Service-Phone-Numbers/vryg-tdzf?)
  http://marketplace.cms.gov/getofficialresources/publications-and-articles/contact-health-plan.pdf

Payments of Premiums
The deadline to sign up for coverage to start January 1st was December 23rd.

We want to remind you that consumers need to pay their premium directly to the insurance company in order to have coverage by January 1, 2014. Consumers can pay when invoiced by the plan, call the issuer to make payment, or pay online if the plan accepts online payment. All consumers have until at least December 31 to pay for coverage effective January 1, although some insurance companies have extended this deadline. Consumers should check with their insurance company to find out when their first premium is due in order for coverage to be effective January 1. Consumers should also confirm with the issuer that their first month’s premium has been received and that enrollment is complete.

Please note that once a consumer selects a plan through the Marketplace, it may take the health plan 48-72 hours to receive and process the enrollment, so please encourage consumers to continue to periodically check back with their selected health plan. The insurance company will also send plan information and an insurance card to consumers who have completed enrollment including payment of the premium.

https://www.healthcare.gov/how-to-have-the-best-experience-with-healthcare-gov/#part=5

https://www.healthcare.gov/how-to-have-the-best-experience-with-healthcare-gov/#part=6 

(Reposted from the Champions for Coverage December 27, 2014 email)

As Federal Website Improves, GCI Promotes a “Culture of Coverage” Across Illinois

As the federal website continues to improve, Get Covered Illinois today kicked off its first statewide TV advertising campaign, designed to raise awareness of the new state of healthcare that becomes a reality in 2014, with the opportunity to purchase a health care plan through the Illinois Health Insurance Marketplace.

“Now that the federal website has improved, we are shifting from educating consumers to the next phase of encouraging enrollment. We are urging thousands of uninsured residents in Illinois to get covered in this new state of healthcare that we are entering in 2014,” Jennifer Koehler, Executive Director of Get Covered Illinois said. “If you visited GetCoveredIllinois.gov before but didn’t select a plan, come back and try again. With the upgrades to the federal website that were recently put in place, the enrollment system is working much more smoothly. Now is the time to select a plan and get covered.”

In addition to the TV ad launch, Get Covered Illinois is ramping up its outreach efforts for an enrollment push leading up to Dec. 23, the first of a series of key enrollment dates under the federal Affordable Care Act (ACA). Consumers must enroll in a health plan by Dec. 23, and have paid a premium by Dec. 31, in order to have coverage on Jan. 1 through the plans offered on the Illinois Health Insurance Marketplace, which is accessed through healthcare.gov. The full open enrollment period for the Marketplace runs through March 31, 2014.

The Get Covered Illinois advertising campaign is designed to educate those who need insurance on the essential benefits and financial assistance available through the Marketplace, and to drive enrollment for coverage starting as soon as Jan.1. The advertising includes TV, radio, digital and social media, with an emotional connection to reach broader, multicultural populations of Illinoisans to encourage them to take action.

The nearly $1-million TV ad buy includes the eight major-media markets in Illinois, and is targeted to reach Illinois’ uninsured population. The campaign features one 30-second ad that highlights the all-inclusive nature of the new state of healthcare across Illinois; and two 15-second spots: one that highlights the fact that insurers can no longer deny coverage because of pre-existing conditions, and one that features a mom-to-be.

The TV advertising builds on the radio and digital banner advertising that began on Nov. 18 and is similarly targeted at Illinois’ uninsured population.

In addition to the statewide ad push, Get Covered Illinois and its more than 250 community partners are planning about 300 events to drive coverage around the state before Dec. 23. For planned enrollment events in your area, including those on Dec. 14, visit GetCoveredIllinois.gov and click on the events tab.

“We are encouraged that after two months of education and engagement by our more than 1,500 trained and certified Navigators assisting people to enroll across the state, there is steady feedback that residents are successfully buying Marketplace plans,” said Brian Gorman, Director of Outreach and Consumer Education for Get Covered Illinois. “We want to encourage people to sign up starting at our website, or work directly with a Navigator in your area, or call the help desk. All services are free.”

Get Covered Illinois is also further strengthening its Social Media presence to reach the uninsured through Facebook (www.facebook.com/coveredillinois) and Twitter (@CoveredIllinois). GCI recently launched a series of info graphics on social media that feature “30 Days, 30 Benefits.” The 30 pieces describe how the 10 Essential Health Benefits included in all Marketplace plans link directly to the real-life health needs people confront in their daily lives. GCI will also share testimonials of Illinois residents who have successfully enrolled in the Health Marketplace across social channels. These videos highlight what having health coverage will now mean for their lives.

The following is an operations, engagement and enrollment update from Get Covered Illinois >>

The U.S. Department of Health and Human Services (HHS) has released numbers for the first two months of enrollment under the ACA that indicate 67,936 applications on behalf of 124,252 individual people have been completed from Illinois and that 7,043 people have selected a private health care plan through the healthcare.gov website since Oct. 1.

Traffic on the Getcoveredillinois.gov website has remained steady, with 529,650 website visits since Oct. 1 and more than 245,800 users of the screening tool that leads users either to the federal website or the state’s new Medicaid eligibility site, ABE.illinois.gov (Application for Benefits Eligibility). The ABE site has received more than82,000 applications.

GCI encourages uninsured residents to:

• Visit the website where you can find out if you qualify for a subsidy and compare health plans side-by-side (there is also a Spanish-language version of the website).
• Sit with a specially trained Navigator at one of the hundreds of partner sites across the state; find a Navigator nearby through the website by entering a zip code. Bi-lingual Navigators are available.
• Call the help desk at 866-311-1119. Operators are available to help you each day from 8 a.m. to 8 p.m. Spanish-language assistance is available on the phone.

(Published on Friday, December 13 at Get Covered Illinois)

ACA Success Story in Southern Illinois

Laura Olmsted, a Certified Application Counselor (CAC), from Shawnee Health Services, had the great pleasure of helping Bill*, a 53 year old from Marion, Illinois, understand what the Affordable Care Act is all about.

Bill is a hardworking self-employed contractor -- making $23,000/year -- who works independent construction jobs, and has not been able to afford health insurance. However, health insurance is something that Bill desperately requires. In the past year and a half, he has suffered not one, but three heart attacks and a broken femur. Mounting medical bills are causing him incredible financial burden, and preventing him from accessing care that he needs.

Luckily, Bill recently met Laura, who helped him to complete an application on Healthcare.gov once he went through the Get Covered Illinois screener. Bill received great news: not only was he eligible for insurance, but he had options, ranging from the low end of paying nothing for a Bronze level or lower end Silver plan, to only $180 per month for a high-end Silver plan after the premium tax credit was factored in.

Laura’s client considered his choices and selected a Silver Multi-State plan through Blue Cross Blue Shield of Illinois where he pays only pocket change - $4.53 per month - for his premium. The plan has a $250 deductible and an out of pocket max of only $2,000 per year. Bill plans to pay for the premiums up front since the price was so affordable.

Should Bill have looked into buying health insurance prior to the enactment of Obamacare (the Affordable Care Act), he would have encountered a very different situation:

• No certified enrollment specialist would have helped him find and understand his health insurance options;
• Unless he was connected with an insurance broker, Bill would have had to shop for plans on his own, rather than being able to compare them all in one place;
• No tax credits or subsidies would be available to help him afford his premium;
• Bill may have been denied coverage based upon pre-existing conditions; and
• If Bill did find coverage, prior to Oct. 1 of this year, he likely would have found a plan with higher premiums and without the requisite 10 essential health benefits like the qualified health plan that he recently purchased.

Because of his new options through the Illinois Health Insurance Marketplace, Bill will now be able to receive the health care necessary to get well, and continue living a healthy, productive life in Illinois.
 
(*Bill is a fictional name to protect the client's anonymity)