Locals looking for advice as health care marketplace opens today

Nov. 01--If you're looking for help to enroll or renew health insurance through the Affordable Care Act marketplace, it might be more painful than a flu shot.

Today marks the first day of a six-week enrollment season where individuals can sign up for coverage. However, if you relied on an insurance broker in the past to help determine what combination of deductibles, co-payments, cost and coverage best fits your needs, you might have to look elsewhere.

Health insurance providers UPMC Health Plan and Highmark Blue Cross Blue Shield are no longer compensating insurance brokers for services, according to Carolyn Hall, a licensed agent with Byham's Insurance Services in Meadville.

In addition to the lack of reimbursement from insurance providers, the Pennsylvania Insurance Department will not allow brokers to charge a consulting fee for services, Hall said.

Many people have turned to insurance brokers to advise them how to select the best plan to fit their needs and their budget, according to Hall.

"At this time of year, I typically put in about 70 hours per week," Hall said. "People need help and we want to help them, but we can't work for free."

There is a bill in the state House of Representatives that could change that. The proposal would allow insurance brokers to charge a consulting fee for their services, Hall said.

"I don't think it's getting much attention," she said.

Republican state Rep. Brad Roae is a co-sponsor of House Bill 1605, which would allow insurance agents to collect a fee if they're not getting a commission from insurance providers.

The bill could use some additional co-sponsors, according to Roae, but he is hoping it will pass this fall.

"The way it is now, insurance agents can't get paid," said Roae, whose 6th District includes central Crawford County. "There are a lot of changes to insurance plans and people need help to figure that out."

He's hoping lawmakers will give it a look.

"Now that the budget stuff is behind us, it's important to get this bill passed," Roae said.

In the meantime, there is free advice available for those needing help.

Lisa Cox is a health insurance navigator who provides free advice and education to anyone looking for health insurance coverage. She is compensated through a grant provided by the Pennsylvania Association of Community Health Centers via the Meadville Community Health Center, which is subsidized by Meadville Medical Center.

The majority of people looking for coverage need help to select from the variety of plans that are available, Cox said.

"I help them find out if their medications are covered and if they can see the same doctor," Cox said. "Some people don't understand how deductibles work and they end up caught off guard sometimes by hospital bills."

Cox also clarified some misconceptions some people have about this enrollment period.

"Tax credits are still out there, despite what some people think," she said.

Some people have asked Cox if Meadville Medical Center has changed its list of accepted insurance providers.

"That is not the case," Cox said. "The hospital is still accepting the same insurance plans as they have in the past."

In addition to preparing for a potential deluge of telephone calls from health care shoppers, Cox also met with some community members planning an event to help inform and connect those in need with those who can navigate the health care system.

Members of Meadville's Thankful Thursday organization and All Citizens Together met with Cox to plan for a health care enrollment seminar from 5 to 7 p.m. Thursday at the Meadville Public Library, 848 N. Main St., in the third floor conference room. It is free to the public.

Cox hopes people will attend the seminar and/or contact her for assistance. The days of just taking whatever plan is provided are long gone, she said.

"People have to be smart consumers when it comes to health care now," she said.

While the open enrollment period ends Dec. 15, there are opportunities for special enrollment because of life-changing events, such as a marriage, throughout the year. The enrollment must take place within 60 days of the event, Hall said.

Lorri Drumm can be reached at 724-6370 or by email at [email protected].

How to get help

--The Afforable Care Act health insurance marketplace may be accessed at HealthCare.gov or by calling (800) 318-2596.

--Lisa Cox, a health insurance navigator who provides free advice and education to anyone looking for health insurance coverage, may be reached at 333-1758. People seeking help to enroll must call to make an appointment.

--Additional information about Thankful Thursday's health care enrollment seminar may be found at Facebook.com/ThankfulMeadville. Or, contact the group by sending a message on its Facebook page.

Key points for health care shopping

The following are key points for Pennsylvanians shopping for health coverage, according to the Pennsylvania Health Access Network.

--Sign up by Dec. 15. Open enrollment starts today, but you must take action by Dec. 15, no matter if this is your first time getting covered or if you are returning to shop and save. Beat the rush and sign up early.

--Coverage could be cheaper than you think. Last year, 8 in 10 people qualified for financial help to make their monthly premiums more affordable. In fact, most people found plans available between $50 to $100 per month. People will pay less for coverage this year than ever before. Eighty percent of people in Pennsylvania who look for plans at HealthCare.gov will be able to find plans for less than $75 each month.

--Shop and save. If you had coverage through HealthCare.gov for 2017, you should come back to update your information and compare your options for 2018. Every year, plans and prices change. You could save money by switching to a new plan that still meets your needs.

--Those who choose to go without health insurance may have to pay a penalty. There is a minimum penalty of $695 for not having health insurance.

--Free help is available. If you have questions about signing up or want to talk through your options, the Pennsylvania Health Access Network has free in-person assistance available. You can call or text the network's toll-free helpline at (877) 570-3642 or visit pahealthaccess.org/gethelp.

--For individuals making too much to qualify for financial assistance, there may be better options off marketplace. Visit pa.checkbookhealth.org to find out what other options are available.

--Tax credits protect people from rate increases. A 27-year-old earning $25,000 a year will get a monthly tax credit of $334 each month, an 82 percent increase, from $183 each month. This increase is because tax credits are set against the second lowest cost silver plan. Also, because of President Donald Trump's decision to stop making cost sharing reduction payments, the rates for these plans have increased, which means tax credits have too.

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