Here & Now

Noon Wednesday: Need Help Enrolling On The Marketplace?

Marisa Wojcik:

Welcome to Noon Wednesday. I’m Marisa Wojcik, a multimedia journalist with Here & Now on PBS Wisconsin. And it’s that time of year again, it’s open enrollment for health insurance on the federal market exchange, and it’s also referred to as The Marketplace. So helping us to understand a little bit more about this is Adam VanSpankeren Adam VanSpankeren, he’s part of Covering Wisconsin, and they provide free assistance to people navigating the enrollment on The Marketplace. And thank you so much for being here.

Adam VanSpankeren:

Absolutely, thank you for having me. I like the way that you said it’s that time of year again, so we’re thinking Marketplace always.

Marisa Wojcik:

Right, right, it has nothing to do with the seasons changing whatsoever.

Adam VanSpankeren:

It gets cold, that’s Marketplace time.

Marisa Wojcik:

That’s marketplace time. Yeah, it’s like a feeling that you feel in your bones, right? So open enrollment, it started on November 1st, it ends on December 15th.

Adam VanSpankeren:

Correct.

Marisa Wojcik:

So, we’re a couple weeks in. What have you been hearing about the process so far from your navigators?

Adam VanSpankeren:

Sure, so right now the process looks like it has in previous years. So somebody can go to healthcare.gov or work with an Assister, like somebody from Covering Wisconsin, or a CAC, a Certified Application Counselor, throughout the state to apply online and enroll. So far it looks very much like it has. There’s been improvements to the website that have been made each year. And the plans are looking very competitive and strong again for next year. Many people in the state are seeing their premiums go down, and tax credits continue to be competitive. And that’s the thing that brings the premium down so somebody can afford their monthly payment for insurance.

Marisa Wojcik:

Has there anything that’s come up that has been new to even you guys?

Adam VanSpankeren:

I wouldn’t say new to us, per se, which is a good thing. That means people have gotten used to kind of the song-and-dance of doing the insurance. And all the plans, we’ve had a couple other plans come in to different areas of the state where they hadn’t been present before. I think we have like 16 different insurance carriers available on the Marketplace throughout the state. With most counties have at least three options, which is really nice that people, and that’s not just three plans to pick from, that’s three companies with many plans to pick from. So that’s a lot of options, dozens of options, for people in most parts of the state.

Marisa Wojcik:

Historically has it been more rural areas potentially that have less options? What does that dispersion look like and why is it different for different counties?

Adam VanSpankeren:

Sure, that’s true that rural areas tend to have the fewer insurers operating in those areas just because of the availability of the health services in those areas. There tend to be fewer clinics, fewer hospitals, things like that. But the insurance companies do a pretty good job setting up their networks and making sure that they’re working with providers and facilities that people can get to in those areas.

Marisa Wojcik:

So who is someone that is going to be going on to the Marketplace to look for insurance, and who isn’t eligible?

Adam VanSpankeren:

Sure, that’s a perfect question actually. Anyone can go on the Marketplace. But the thing is if you don’t have another offer of what’s affordable insurance. So in terms of affordable insurance, it’s a little bit of a math problem. But if your employer offers you insurance, for example, and it’s less than 10% of your monthly income to pay for that insurance, then they want you taking that insurance. But anyone else who doesn’t have an offer of insurance and is making some income, self-employed people, people who are working for smaller employers who just don’t have an offer of insurance, the Marketplace is there for them. Likewise, people who might be working, make too much for BadgerCare Plus, the Marketplace is there for them as well.

Marisa Wojcik:

So I went onto the Google machine, and I typed in Wisconsin Marketplace health insurance, and I got a lot of options from a lot of sites that were like Wisconsinhealthinsurance.com. So it’s just a lot of really kind of generic stuff, but it looked legit. Are any one of those sites going to be a place that I could go to look?

Adam VanSpankeren:

Right, so that’s really dangerous is the thing for people keep in mind. You want to go to healthcare.gov. If you’re looking for the Marketplace and for plans that are covered by the ACA, and you’re getting tax credits to help with the premiums, you want to go to healthcare.gov. Or you want to be reaching out to an Assister, like somebody from Covering Wisconsin, or a CAC, or an agent or a broker that is licensed through the office of the Commissioner of Insurance in your area. ‘Cause you can Google healthcare, health insurance Wisconsin, and you’re going to get all these dot coms, Obamacare.com, or Trump care, whatever it is. You’re going to see a ton of different things that do as you said look legitimate. There are a lot of red flags to watch for. Again, if you’re not on healthcare.gov, that’s the biggest red flag. But a lot of times they’ll collect your information and then the phone calls start. And you’ll get bombarded with really aggressive marketing and things like that, and that’s always a bad sign. That means you might not be working with the best actor or a plan that meets all the ACA requirements like pre-existing conditions and things like that. So you want to be really careful when you’re looking online.

Marisa Wojcik:

Have people been falling into kind of some scams?

Adam VanSpankeren:

It happens. So there’s two things. Right now especially, like you said, with that being the time of year, so that also means it’s scam season because people looking for insurance are especially vulnerable to what look to be affordable insurance options. Like, oh, this one seems too good to be true. That’s the thing to keep in mind. If it sounds too good to be true, it probably is. And then, in terms of scams, there are definitely direct scams. Like they’re just trying to take your money. And then there’s another thing to keep in mind is what you might think of as junk insurance plans. You might’ve heard that. Insurance plans that aren’t ACA compliant, they tend to be short term policies. But as of a couple years ago, short term can mean 364 days. So they might say we have a plan for you for the next year and it looks like you have a year of coverage, but unless you’re reading the fine print, that might not be an ACA-compliant plan. That might only cover certain accidents or certain conditions. It might not cover your pre-existing conditions, your medications, things like that. So those market at the same time as the Marketplace, which is really concerning.

Marisa Wojcik:

But people, it’s legal now for people to pursue those options if they really want to, but it’s just they need to understand the consequences, or they need to understand what they’re signing up for. And it’s not always clear?

Adam VanSpankeren:

Right, that’s 100% right. Is that with the rule change and the policies change around short-term plans, yes, it’s legal. They are legal products. But it oftentimes is confusing for people because they’re looking for Marketplace coverage. They want health insurance, the things that people are used to hearing. It covers my pre-existing conditions, things like that. All of the rules that the Affordable Care Act put into place don’t necessarily apply to these short-term plans and things like that. And they might, to the average person, health insurance, for everybody let’s say, health insurance is incredibly complex and complicated and it’s hard to think about. It’s very difficult to distinguish between one thing and another, so we try to get the right messaging out that you should either be working with an Assister like a navigator like myself, or an agent or a broker. Or if you’re doing it on your own, only go to healthcare.gov.

Marisa Wojcik:

Okay, and so, if someone is maybe concerned about how much it’s going to cost them, let’s say they’re looking on the insurance Marketplace and they’re seeing the cost difference between two different plans, how will they know exactly what tax credits they’re eligible for, or what subsidies are possible? Is that something that doesn’t come until they do their taxes? Is that a reason why people maybe do kind of go towards the short-term plans, because it seems like a cheaper option on the forefront?

Adam VanSpankeren:

So, yeah, at first glance, if you’re just looking at prices or if you did the plan preview tool without doing the application, you might not be seeing the savings. So if you first look at insurance and see the full price of insurance without any kind of tax credit factored in, tax credit, subsidy, the same thing, then it’s going to be really intimidating, and you might veer away, oh, insurance is too expensive. But it’s worth doing an application because once you put in your income information and your household information, then you’re going to see right away the tax credit you’re eligible for. So as soon as you see the plans, you’re going to see the plans with the tax credit factored in.

Marisa Wojcik:

Okay.

Adam VanSpankeren:

So the premium might’ve been $500, you qualify for a $450 tax credit. You’re going to see premiums starting at that $50 range and going up from there.

Marisa Wojcik:

And so, your program is called Covering Wisconsin.

Adam VanSpankeren:

Correct. (laughs)

Marisa Wojcik:

That’s a lot of ground to cover.

Adam VanSpankeren:

Sure.

Marisa Wojcik:

If someone is wanting to call you guys, are they going to have to wait for a really long time for help?

Adam VanSpankeren:

Not typically. We have an awesome team in our office, both our offices, Madison, Milwaukee, as well as volunteers answering phones to help connect people directly to a navigator. And it is actually very easy to get to one of our navigators directly if you have specific questions, or maybe it’s someone you’ve worked with in the past or you were recommended by a colleague or a friend. So we are very responsive all the year, but especially this time of year. So it is easy to get a hold of us. And then, for other parts of the state, we have sub contracts in the Northeast with partnership from the Health Center, and in the northwestern part of the state, Northwest CEP is an organization we subcontract with that also has navigators. That covers a big, big part of the rural area of the state, as well as multiple sub-contracts in the Milwaukee area as well. So there’s a lot of help available for people who are daunted by this process and want some assistance.

Marisa Wojcik:

Sure, do we know how many people in Wisconsin just forgo health insurance? And why is that happening?

Adam VanSpankeren:

It’s hard to say. I was looking for numbers on this the other week actually. And the ones I was seeing were a couple of years old, so we had the uninsurance rate in Wisconsin down to like 5% and it started to creep back up. One reason for that is part of the Affordable Care Act was the penalty for not having insurance. That got a lot of people into the Marketplace, and they stopped enforcing that going into last year. And so, now there isn’t this individual mandate if you remember that what it was called, that people have insurance, so people who feel young and healthy and just don’t want to think about it at all, might not be getting insurance and that might be a factor. And I think another big part of it is just the confusion and the misinformation. And the process, it feels overwhelming. It doesn’t have to be. But when you’re talking about the intersection of health and finances, it’s really something people would rather not be thinking about. So I think those factors contribute to people not getting insurance. But they don’t have to. There is assistance out there. There are people like navigators who can explain the plans to you and help you pick one that’s right for you and your family. And we do have a pretty robust network of assistants in the state.

Marisa Wojcik:

And Covering Wisconsin, you’re not a private organization, or you’re not a non-profit, so why are people going to you? You get federal funding, right?

Adam VanSpankeren:

Right, so Covering Wisconsin we’re actually right now affiliated with the University of Wisconsin. We’re not a 501(c)(3), but we’re essentially a non-profit. We have that same status. So the Federal Navigator Grant I think is the most important thing. By having the Federal Navigator Grant, we have the Navigator title, but what that means is that we are beholden to certain requirements. We’re completely objective, we’re completely impartial. We don’t charge for any of our services. And nor do navigators get commission from any health insurance plan. So it’s not our job to talk anyone into anything. It’s our job to educate and help somebody feel good about what they’re picking.

Marisa Wojcik:

And you’re not pushing politics onto people?

Adam VanSpankeren:

Never, no not even allowed to. It doesn’t have to come up in a conversation at all. Health insurance is a very, it’s a personal conversation and it’s different for every household, every family. And that’s what we focus on is health. What are your health needs? What are your medications? We want to make sure your doctors are covered, and that’s not political at all.

Marisa Wojcik:

Remind us again, where should people go? What’s the deadline? And what do you think it’s kind of most important for people to remember as we have about a month left in this process?

Adam VanSpankeren:

Sure, so the deadline is December 15th. So no matter what, take action before December 15th. And if you’re looking for assistance, you can call 2-1-1. That’s the number you can call anywhere in the state. It’s run with United Way and we work really closely training them to make sure that the people who answer the phone at 2-1-1 can connect people to assistants like navigators in their area. And you can go to our website, Covering Wisconsin, to find an appointment. All of our schedules are on there. But yeah, 2-1-1, Covering Wisconsin. And I think the most important thing if people remember is that they take action before December 15th. That even if say they’re enrolled in the Marketplace right now, that they’re not doing nothing, ’cause they’re going to get letters from their insurance companies saying this is your premium for next year. But you really want to go online and check everything out, make sure your information is correct. And if you’re not insured right now, and if you thought insurance was too expensive last year or anything like that, it’s worth taking another look because the plans and prices change every year. The tax credits change every year. And you just don’t do nothing as I would say. Just reach out, there’s help available. And definitely, so call 2-1-1. And if you’re going to try it on your own, only go to healthcare.gov. Just keep that in the back your head. But Covering Wisconsin is definitely available as well as all of our partners throughout the state.

Marisa Wojcik:

All right, Adam, thank you so much for being here.

Adam VanSpankeren:

Thank you so much, Marisa, I appreciate it.

Marisa Wojcik:

For more from Here & Now and PBS Wisconsin, you can visit pbswisconsin.org. And thank you so much for joining us on Noon Wednesday.