A report from the Kaiser Family Foundation examines the need for comprehensive assistance programs to help consumers to select appropriate health insurance when mandated coverage begins in 2014.
Coverage options will come from expanded Medicaid eligibility in many states and subsidized private coverage through state health insurance exchanges that are supposed to be operational by October 2013. “The job of consumer assistance will not be limited to a single task,” the report asserts. “Rather, as consumers seek to get and keep health coverage, they may face a series of challenges that assisters will need to address.”
A recent poll from the foundation found two thirds of uninsured respondents and a majority of overall respondents have too little information to know how the Affordable Care Act will affect them. “A necessary first task for consumer assistance will be to inform the public about individuals’ responsibility to enroll in qualified coverage, new coverage options and subsidies, and where to go for more help.”
State insurance exchanges are required to employ “navigators” to help consumers determine their eligibility for specific benefit plans and select the most appropriate plan. Washington State officials, the Kaiser report notes, estimate up to a quarter of individuals and families enrolling in new coverage for 2014 will need consumer assistance. Many consumers also will need assistance in making mid-year changes to their benefits plan as income fluctuates, employment changes or family status changes, such as a new baby or change in immigration status, occur.
Consumers with existing health coverage often are just as confused about their benefit plans as those who will get coverage through Medicaid or the exchanges. More than a quarter of privately insured consumers that Kaiser Family Foundation surveyed in 2009 reported their plan would not pay for care they thought was covered.
The Kaiser report, “Consumer Assistance in Health Reform,” is available here.
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