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Navigating Healthcare.gov: One Woman’s Story

Healthcare.gov
Missourian's can sign up for health insurance through healthcare.gov/Photo Credit: Scott Harvey

DORI MEYER: This plan does have a lower out-of-pocket maximum for the year.

PAMELA LANGHOFF: Yeah, but by the time you pay $600 there – it’ll be more than $600 there [total premiums for the year], it’s gonna be about the same.

Inside the second floor Community Room of the Springfield Midtown Carnegie Branch Library, 62-year-old Pamela Langhoff compares health insurance plans through Missouri’s federally-run online marketplace, or exchange. It’s her third meeting with Dori Meyer, a licensed insurance navigator through the healthcare firm Primaris.  

LANGHOFF: I don’t understand the co-insurance.

MEYER: The co-insurance is what percent the insurance company pays and what percent you pay. Like this would reflect a 90/10 – you would pay ten percent, they would pay 90 percent.

LANGHOFF: Okay.

Langhoff; a resident of Willard, was one of the many enrollees victimized by the rollout of the previously glitch-prone healthcare.gov website. But on this day, she’s able to complete the process. Aside from a couple of unfortunate accidents on the roadways, Langhoff said she simply needed a plan that would reflect her good health.

“I just wanted a safety net if I get hurt with the horses or if I get hit on the freeways again; something like that,” Langhoff said.

She’s given her electronic signature to the Coventry Health and Life Silver Plan, which is through Mercy. Because of her income – Langhoff is currently unemployed – the plan’s $535.06 premium is waived, paid for through a government subsidy. Her deductible is also free of charge; with a $1,500 maximum out-of-pocket expense, plus a free co-pay if she uses a general practitioner.

“I looked at the other plans as well. My parents went to Cox [Health], and they were really very happy with Cox, and I’ve been taking them to the doctor ever since I came back here their Medicare. And I liked Cox, but the lowest plan was going to be $55 a month and again, like I said, I just wanted a safety net.”

“We can, at this point, help people understand the plans. We can show them premiums, we can show them their subsidies – basically tell them where they stand – and explain the law, so I think we are providing a pretty valuable service and we’ve counseled more than 700 Missourians at this time” says Milarsky.

That’s Jeremy Milarsky, the navigator program manager with Primaris, who adds that navigators do not charge for their services. As of late November, there were roughly 60 licensed navigators in the state.

To earn the opportunity to help the state’s citizens sign up for coverage, Primaris applied for a grant through the federal government. Their application cited that Missouri had the highest percentage increase of uninsured people during the first decade of the 21st Century. Milarsky says those that are uninsured face a higher risk of bankruptcy, a higher risk of mortality, and are much less likely to seek preventative care.

“Most of our medical costs in the United States are due to people with chronic conditions, not managing those conditions, conditions balloon up and they end up getting treated in the ER. And a lot of that is uncompensated care.”

With most of the site’s glitches now fixed, healthcare.gov is enrolling more people quicker and easier following numerous technical fixes and a renewed push by the Obama Administration. But the website is enrolling fewer than Affordable Care Act advocates had hoped since the marketplaces opened Oct. 1. In Missouri, one of 36 states who are served by the federally-run exchange website, just 751 people signed up for coverage in the first month. The latest figures show that through November, Show-Me State enrollees topped 4,100.

Milarsky says many Missourians use a navigator to help them determine what their cost will be, and then return home to discuss the options with their family before choosing whether to enroll.

He adds that when Medicare Part D was unveiled in 2005-2006, the online service also experienced numerous glitches up front, and that few people initially signed up for the Massachusetts version of healthcare reform, instead doing so closer to the deadline.

MEYER: And if you want to enroll in that plan just click “confirm.”

As for Pamela Langhoff, you could say she’s one of the easier cases; a healthy individual who returned three separate times to get signed up for a policy, perhaps more motivated because her premium was waived. But officials say more healthy enrollees through the exchanges is vital in generating affordable policies. Langhoff, who has been without insurance the past ten years, said had her premiums not been zeroed out and the costs too high, she would have just paid the penalty for not having insurance. It will be interesting to see if healthy individuals that don’t qualify for certain subsidies will be as inclined to enroll.