Newly-Insured Face Hurdles as They Navigate Health Insurance Benefits
Posted by Professor Marianne Artusio
Sunday’s New York Times brings the discouraging news that many people, newly-insured under the Affordable Care Act, are having difficulty figuring out how to use this new benefit. Although eight million people have now enrolled, government and communities now must assist them to be smart consumers of health services and to use their medical coverage wisely. Many, insured for the first time, are perplexed by the complications of co-pays, premiums, and the task of choosing a primary care doctor. It is such a new world for many who are thankful to have insurance, but uncertain how to use it. Just as medical providers are struggling to adjust to the changes wrought by the Affordable Care Act, enrollees are grappling with such mysteries as the differences between coverage for urgent care clinics, emergency rooms and retail clinics. Even the task of understanding the information on an insurance card can be baffling. Fortunately, the Centers for Medicare and Medicaid Services (CMS) has rolled out an extensive program and easy-to-understand materials to help community groups teach “health insurance literacy.” These efforts are vitally important if the promise of expanded coverage is to be realized. It would be tragic if unfamiliarity with the ordinary processes of handling health insurance defeated newly-insured enrollees, jettisoning them into the ranks of the uninsured again. The problem is particularly acute among enrollees with limited English language proficiency and older enrollees. CMS is producing printed materials and videos in Spanish and many other languages.
However, the confusion for older enrollees may warrant even greater efforts. Many, who are nearing the Medicare eligibility age of 65, are not computer-literate. When they signed up for health insurance initially, they were not able to study the available plans offered on the online marketplace. Relying on friends, family or community services, many did not fully understand the choices available or their responsibilities and must now contend with new and bewildering obligations. For example, the schedule for making premium payments may be confusing; an enrollee who does not pay the premium will eventually find the policy has been cancelled with no chance to reenroll until the next enrollment period. I spoke with Rebecca Cashman, who was featured in the Times article and whom I have known since she was born. She is the program coordinator for Resources for Human Development, a non-profit agency in Philadelphia, offering educational programs and assistance for new enrollees and she has spent her career working for better health outcomes for at-risk populations. “People who are not familiar with computers find the need to engage with technology daunting,” she said. “Setting up an email account for their coverage can be unsettling. They will need more in-person explanations and help to understand their coverage.”
The recession ended the working lives of many older adults, many of whom never had health insurance. Surely, their health needs cannot wait until they qualify for Medicare. Preserving the health of those on the brink of their senior years requires fully utilizing all health care coverage, so “health insurance literacy” programs should be presented to senior centers and caregiver programs too. Medical providers and insurers have a role here too, participating in educational programs and operating telephone information lines, staffed with patient, unflappable and knowledgeable employees.
Click here to read the New York Times article.
Click here to read the Centers for Medicare and Medicaid Services “From Coverage to Care” materials.