An elbow-injuring fall in March proved nearly as painful financially as physically for Carolyn Gates, who was uninsured and ended up with an $8,000 bill for her emergency room visit.
She felt much better Wednesday after a visit to the S.C. Progressive Network’s Columbia office, where she worked with Navigator Tim Liszewski to sign up on the Health Insurance Marketplace under the Affordable Care Act. While Gates and her husband slowly pay off that emergency room debt, she’ll also be paying a $107-per-month health insurance premium next year.
“As far as I’m concerned, it was the best thing ever,” Gates said. “I told my Bible study about it, and three said they’re going to sign up.”
With the Dec. 23 deadline looming for signing up for coverage effective Jan. 1, and with the healthcare.gov website finally functioning smoothly, local Navigators expect a steady stream of insurance seekers such as Gates in the coming weeks. People who don’t have health insurance in 2014 face a tax penalty of $95 or 1 percent of their income, whichever is greater, in 2015.
The local Navigator agencies, who received federal grants to help people sign up, include the Cooperative Ministry, Greater Columbia Community Relations Council, the Progressive Network and the Benefit Bank of South Carolina. They are extending hours, adding weekends and branching out to locations throughout the region. In addition to supplying Navigators at local library branches, the agencies have an agreement to provide help at five Palmetto Health locations in the Midlands.
Palmetto Health reached out to the Navigator groups to help patients who show up at its facilities without insurance, said Rebecca Richardson, corporate director of access services. They’ve provided office space, and Navigators book appointments for 95 hours each week spread through the five locations.
“The more places people have to sign up, the better,” Liszewski said. “We want to be where people are, not have them have to come to where we are.”
People also can sign up on their own on healthcare.gov, or they can work with independent insurance agents certified for the ACA marketplace. The four companies offering policies on the marketplace – BlueCross BlueShield of S.C., BlueChoice HealthPlan, Consumers’ Choice Health Plan and CoventryOne – also sell policies directly to consumers. BlueCross, which has retail stores in Greenville and Charleston, is opening a new location in the Harbison area next week.
After a slow start in October because of the well-publicized problems with healthcare.gov, Liszewski directed about 10 people through the process in November. He said things started going more smoothly nearly four weeks ago for people like him who know how to get around in the system. He has multiple appointments each day this week.
Now, the slowdowns come when people signing up don’t have all of the personal identification or financial records they need, he said. One hurdle is specific to South Carolina. Many South Carolinians put a security freeze on their credit reports last year after the state’s Department of Revenue computer was hacked. They need to unfreeze their credit monitoring to apply for insurance.
Gates, 59, set up an appointment with Liszewski, arrived around 10:30 a.m. and walked out around 1 p.m. The process was slowed slightly while she consulted on the phone with her husband.
After Liszewski explained the three different levels of coverage – bronze, silver and gold – and provided other details on individual plans, Gates decided on a silver plan that would have low deductible and out-of-pocket expenses.
The plan would have cost in the range of $570 per month, but Gates qualified for tax credits that reduced the price to a manageable level. She checked, and all of the doctors she normally sees are on the plan’s provider network.
Next year, she can visit those doctors with a small co-pay, and an emergency room visit won’t be financially ruinous.
Liszewski, 54, hasn’t had insurance himself for 11 years, and he knew he needed to look into a policy even before the new law’s mandate for insurance in 2014. “I’m pretty sure I’ll blow a gasket sooner than later,” he said.
Because of his pay, he qualifies for a tax credit. He chose a silver-level plan, and his premium, after the tax credit, will be $27 a month.
And because he hasn’t been going to a doctor, he didn’t worry much about the plan’s physician network. He will start looking for a local doctor on the network early next year, the first step in the health maintenance effort he knows people in their 50s really need.
Liszewski said many of the people asking local Navigators for help have been in the gap left when state leaders turned down the expansion of Medicaid. They don’t earn enough (about $11,500) to qualify for tax credits on insurance policies, but they also don’t qualify for Medicaid. Those people won’t face fines for not having insurance, but Liszewski has encouraged them to go through the online registration process. That way they have proof next year that they shouldn’t have to pay the penalty for not having insurance.