Blog Archive

Monday, January 20, 2014

Welcome to the Jungle, I mean, Marketplace

This past week I attended a useful and interesting meeting, NHF’s Social Worker Insurance Marketplace Workshop (funded by Baxter Healthcare and Pfizer Inc; thanks guys!). Together with about 80 social workers from HTCs around the country, and some chapter leaders, we listened to various consultants and government representatives speak primarily about the “Marketplace,” the website of the Affordable Care Act that allows people to choose a healthcare plan.

We’ve all heard about the difficulties in dealing with this website——such as the crash, and various other glitches. The good news is that many of these glitches have been fixed; and now it’s time to get our bleeding disorder community on board. Healthcare insurance is mandatory now; all US citizens (with notable exceptions) must have insurance. The website is created to help people find the lowest cost insurance that also provides all their essential healthcare needs.

Crafty Posters were created to help us visualize; good idea,
we needed the help!
There is plenty of assistance in navigating the website. We actually tried the website live, and it was pretty interesting, and yes, we even got stuck once or twice! For us, we were stuck trying to find out if our HTC hematologist was in-network.

Each website will have on-line or Internet guides, to help you live. They are called various names: Assisters, navigators, certified application counselors, in-person assistance, marketplace call center, agents and brokers. Most people are used to calling them “Navigators.” (I can’t help but think of “Engineers,” a la Ridley Scott’s Prometheus)

Navigators, Engineers: whatever you
call them, they are here to help
Jim Romano, from Patient Services Inc (PSI), gave a presentation about how PSI has been chosen to train qualified applicants to become  Certified Application Counselors (CAC), to help people navigate the Marketplace. This is truly a great coup for PSI, and I can’t think of any other group better qualified to train. PSI will train CACs in different states, and pay their fees (yes, you have to pay for the pleasure to become a CAC to help people navigate their state Marketplace! One point from an audience member who underwent the training: the training wasn’t very hemophilia-focused, and needs to be more focused.

Jim noted that there were still some difficulties to overcome in each state. Ed Kuebler, a social worker from Texas, slyly asked, is the difficulty level in some states… political? This garnered many laughs! Ya think?

There are many marketplaces, as each state as their own. All the marketplaces have different funding sources, based on what type of marketplace it is:

FFM: Federally facilitated marketplace
SPM: State partnered marketplace. The federal government has some role in this.
SBM: State based marketplace and the fed has no role in it.

How many people have enrolled since the site was unveiled in October?
                  By Dec 28: 6 million Americans gained coverage through Marketplace and Medicaid
2.2 million of those enrolled in private plans
80% received help in paying for premiums
53 million visits to and state marketplace websites
11 million calls to the federal and state call centers

Different healthcare plans are designated by “metal.” The more precious the metal, the higher priced the plan, but also the more coverage. Enrollment by Metal?
                  60% are choosing Silver plans
20% Bronze
13% gold
7% Platinum
1% catastrophic plans

Ed Kuebler thinks we need more help than
navigators (kidding--a gift from a friend)
There are still consumer problems using the Marketplace:
                  An inability to complete application on line
                  Applications get “stuck” (freeze) or lost
                  Info is not transmitted after the plan is submitted
                  If not sure you’re insured, call insurance company (not the website) to check
                  If you don’t pay 1st month premium by certain date, you will not get insurance!

Don’t despair! I found it actually fun to hop on Colorado’s state Marketplace and select a plan.

Another useful website is, which has FAQs, tip sheets, paper application, and materials in Spanish. And, which does premium estimate, on line application. When you log on, you will see this banner!
Michelle Rice (L), Mary Garvey (R) of NHF; Tiara of PSI (C):
all great speakers and resources!

Enroll by February 15 for coverage starting March 1

So contact your social worker for help if you are not yet enrolled; don’t miss the deadline!

Next week I will cover more of the NHF Social Worker Insurance Marketplace workshop.

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