The Obamacare rollout (continued): Even the savvy need a little help

The website is working much better, but most Americans need guidance to sift through the many coverage choices.

The race was on this past week as hundreds of thousands of people flooded the government’s health insurance website in an effort to sign up for coverage that could kick in as early as New Year’s Day.

Those who have made it through the application process and potential website hurdles now face another possibly daunting decision: which of the many plan options should they choose? Bronze, Silver, Gold? High deductible, low deductible?

Luckily for Bryan Kennedy, a busy business owner, he’s had two advocates to walk him through and help him reach his goal of a new and cheaper policy.

The season for signing up 

The weather is unseasonably warm in downtown Media over the weekend. A mix of bell ringing and chatter echo through a central walkway near a main road.

“Thank you! You have a Merry Christmas,” George Leverich salutes to those leaving money in his Salvation Army bucket.

Feet away, inside Seven Stones Cafe, sits Caroline Picher. She has been highly sought after this holiday season. With her laptop open near the front of the cozy shop, Picher, a certified health care navigator, helps a father help his son sign up for health insurance.

The frustration

Dan Kennedy thought a better insurance option might be out there for his son, Bryan, a small business owner who doesn’t have major health concerns, but whose coverage costs about $500 a month.

“It hurts,” says Bryan Kennedy. 

Yes, dad chips in.

The new options offered through the marketplaces are a mainstay of the federal health law, and are geared toward people who don’t have health insurance at all or buy it on their own. Those making between 100 and 400 percent of the federal poverty level are eligible for subsidies.

So while Kennedy’s son worked around the clock running a sober living residence, dad took advantage of his extra time in retirement to research and weigh plans. Fortunately for Bryan, his dad is also not a typical consumer. He’s the former president of Riddle Memorial Hospital.

“I was more in tune with what was going on,” says Dan Kennedy. “Bryan and I talked and decided it was an appropriate venture to look at what the options were.”

But like thousands of other consumers, he too faced problems trying to sign his son up for coverage on his own.

“I was so frustrated,” says Kennedy. “I got dropped off the system so many times. It’s difficult to get through it.”

So he turned to Picher’s group, Resources for Human Development, listed on the federal website as one of a handful of area agencies offering free, in-person assistance. He and Picher spoke several times over the phone, troubleshooting possible errors in the application, and ultimately scheduling an in person meeting in Media, a spot convenient to both of them.

Weighing the options

Navigators like Picher are not affiliated with insurers. They undergo a 20 hour training, and while they can break down plan details and translate insurance concepts that might otherwise be confusing to the average consumer, they can’t recommend plans, thus differentiating their role from that of a broker.

Bryan’s dad did for him a lot of what a navigator or even broker might do for someone without such support. Familiar with how insurance works, he had already compared benefits to make sure they “had the right plan to match up with Bryan’s needs.”

How does one do that?

“You weigh all the factors,” says Kennedy. “You decide on what premium you want to pay through the year and what level of deductible you can sustain. If you don’t go to the doctor, it all means nothing. If you go to the doctor or ER or have lab work, you’ll pay a portion up to the level of the deductible.”

While faced with many options, each plan has a comparable benefits summary. The levels of cost-sharing and deductibles are also divided into four types of plans: bronze, silver, gold and platinum. A catastrophic option, which covers a bare minimum, is also available.

The two also reviewed which doctor networks and drug benefits were covered under each plan.

The final selection 

Having done the research, the selection was easy once the Kennedys and Picher make it to the enrollment page in the online application.

They decide on a silver-tiered plan, costing $144 after income-based subsidies, with a $750 deductible. The plan, equivalent to Bryan’s current one, costs about $4,000 less annually.

“I’m lucky I have a parent who has such vast knowledge in that field of insurance to be able to turn to for insight and help.” Bryan says. He turns to his dad and thanks him.

Picher, meanwhile, explains that with this plan, they’ll have until Jan. 10 to pay the first premium, though coverage will be retroactive, kicking in Jan. 1. She hands them a customer service number for the insurer they selected and says they should be getting an invoice in the mail soon.

Enrollment complete, Dan Kennedy turns to Picher and shakes her hand. “Thanks for navigating it,” he says. “I see where the name comes from.”

The process took about an hour.

Addressing the need for navigators 

Outside Seven Stones, George Leverich continues ringing away, thanking those who stopped by to drop donations in his Salvation Army bucket. Formerly homeless in New York, Leverich now works at a warehouse in Philadelphia, one that doesn’t offer health insurance.

He, too, has tried signing up for health insurance through the new marketplace.

“I thought, what if I get sick? I don’t want to go to public assistance,” says Leverich. “So I’m gonna have to do something.”

Leverich says he spent a good two hours online, trying to sign up earlier this year. Questions stumped him. The website froze up.

“You really need somebody to sit you down,” he says. “I’m not gonna lie to you, I’m going to give up.”

Did Leverich know about Picher, situated just feet away, who’s job is to help people through the process?

Silence. Bells stop ringing.

“Is there? For real?”

He says he’ll try and contact a navigator. Perhaps a sign of slim outreach resources in states like Pennsylvania, which are turning to federal officials to run their marketplaces, Leverich isn’t the only one unfamiliar with such assistance.

But while he may be too late to join Bryan Kennedy in the pool of people gaining new coverage on New Year’s day, he’ll still have plenty of chances to sign up by the final open enrollment deadline of March 31. 

Picher, the navigator, says she’d be happy to help him.