Residents Struggling To Sign Up For NY Marketplace Health Plans

Nov. 24--It's time to sign up for health insurance. Easier said than done.

New York is still paying agencies to provide in-person "navigators" to help people sign up for a NY Marketplace plan. While anyone can go to the website on their own and sign up, it's so difficult that even young people comfortable with the internet have turned to navigators for help.

"I made the account but I didn't know what spot to go to. I couldn't tell where to go to do the application," said tattoo artist Pat Dingman of Queensbury. "It was business or employee. There was no self-employed."

That's one of the many sign-up roadblocks people hit. The website does not seem to take into account complicated scenarios that many of its customers have. The average buyer is working but has no health insurance through work, which means they are often self-employed or working at multiple part-time jobs over the course of a year.

They also generally don't know exactly how much money they'll earn in a year. That makes it hard to guess at one of the first questions -- household income. By the way, household income means gross adjusted income, although nothing on the website says that.

Those who want one of the plans have to act soon. To have insurance that goes into effect on Jan. 1, you must sign up by Dec. 15.

Navigating to a plan

There is help.

Locally, the Adirondack Health Institute is taking appointments to work one-on-one with residents from Clinton, Essex, Franklin, Hamilton, Saratoga, Warren and Washington counties.

"We would encourage consumers to meet with a navigator," Joyce Porter of AHI said.

The navigators are "enrollment experts," she said.

"Consumers should take advantage of this free service," she said. "Navigators can walk consumers through the differences between the different types of qualified health plans and the different plan offerings, all of which can be very confusing."

The plans are organized by metal levels -- bronze to platinum -- and companies offer both standard plans and "non-standard" plans that include extras like acupuncture or a $250 gym membership reward. More importantly, the plans cover different prescriptions at different cost levels.

Navigators can help determine the true cost of a plan for the individual.

They can also help determine whether the buyer qualifies for financial assistance, Porter said.

Or call it in

The state also has a call-in center for those who want to sign up by phone. That's what Dingman did.

"It was like 45 minutes," he said. "It was easy. They said, 'Here is the plan, here is the cost, we'll send you something in the mail.'"

After he answered the questions about his household income and employment status, he was offered a plan that would cost $20 a month, plus copays. He chose to add dental and vision for a total of $45 per month.

"I think this is the best insurance you can get for making an average salary, say $33,000 to $38,000," he said.

He has bought a plan through the marketplace for years. When he was an apprentice tattoo artist, with no income, he signed up for free insurance through the marketplace. That was easy, too, he said.

For those who make less than $24,980, the marketplace offers a different option: the Essential Plan. It is a state-subsidized plan for people who make too much to get Medicaid, but too little to afford a regular marketplace plan. For a family of four, the income maximum is $51,500.

Premiums are either free or $20 a month, depending on income. The Essential Plan covers all the same benefits as standard insurance plans, but applicants must apply through the marketplace.

Luckily, that includes applying through a navigator or over the phone. Dingman is not alone in having trouble signing up online.

No escape from the expense

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