With new federal deadline mandates looming for all citizens to seek health insurance under the Affordable Care Act (ACA), free services are available to help the general public make the transition.
Through a grant provided to Mountain Projects, a community action agency, certified healthcare navigators have been established for Western North Carolina. Cynthia Solesbee, who has lived in Franklin for 10 years, attended the monthly meeting of the Macon County Board of Commissioners to make the public aware of her services. “In the simplest terms, I help folks sign up for healthcare through the affordable healthcare website; or over the phone ? and we also do paper applications when the site goes down,” explained Solesbee. “I have been trained to be a Certified Navigator in order to help people establish eligibility and enroll in coverage through the Marketplace.”
According to Solesbee, there are an estimated 30,000 uninsured people in her service area in the seven counties of Western North Carolina.
For Macon County, the number of uninsured residents is 7,078, or 21 percent of the population. For Jackson County, the estimate was 7,479 uninsured or 19 percent of the population.
Solesbee and other healthcare navigators such as Rebecca Mathis, who is one of Solesbee's counterparts serving Jackson County, have centered their focus on providing free, impartial, and unbiased information regarding enrollment for insurance plans. “I help consumers find the most affordable coverage that meets their needs,” said Solesbee. “In addition, I provide education and community outreach. I will be giving presentations at the Macon County Public Library on Dec. 2, at 6 p.m.; Dec. 4, at 10 a.m.; and Dec. 7, at 10 a.m. I'll also be at the Highlands library Dec. 3, at 2 p.m.”
“I was hired by Mountain Projects, Inc. to serve as a Health Care Navigator. Mountain Projects was awarded a grant to implement a Navigator program in the seven westernmost counties of North Carolina: Clay, Cherokee, Haywood, Graham, Jackson, Swain, and Macon. There are two navigators assigned to Jackson County ? myself and Jane Harrison,” said Mathis. “I have been certified by the United States Department of Health and Human Services as a Marketplace Navigator. This means that I am certified to assist consumers in understanding new programs, taking advantage of consumer protections, and navigating the health insurance system to find the most affordable coverage that meets the consumer’s needs.”
Mathis explained that the navigators act as a bridge between the community, the new legislation, and individuals. “We meet with partnership agencies in the region to determine how best to coordinate our efforts. We have met with staff from the Jackson County Health Department, The Good Samaritan Clinic of Jackson County, and the Jackson County Department of Social Services,” said Mathis. “We serve as a resource for anyone in the community who has questions about the Affordable Care Act and the new online Marketplace. Community members call and email us with questions. We set up appointments with people to help them understand their new health insurance options made available through the Affordable Care Act. During these appointments, we educate consumers about the Affordable Care Act and explain how the online marketplace works. We help consumers apply through the online marketplace to find out if they are eligible to receive Advanced Premium Tax Credits (APTC). APTC can help lower the cost of monthly insurance premiums, making health insurance more affordable for many folks who have been unable to afford purchasing a plan in the past.”
Solesbee takes phone calls, emails and meetings with people seeking her assistance. “I meet people at Macon Program for Progress and the Senior Services building in Franklin,” she said. “I want to be able to make it as convenient as possible for working people, so my hours can vary depending on when people can meet with me.”
Mathis explained that while she has two set offices for meetings and consultations, being flexible and accessible is a key component in helping residents.
“Our team of Health Care Navigators is a mobile group, willing to work out of many different locations in order to connect with as many people as possible,” said Mathis. “I work out of two offices: one at the Mountain Projects office in downtown Sylva and the other at the Jackson County Department of Social Services. I schedule appointments and meet with people at both locations. I also go to The Good Samaritan Clinic of Jackson County each Tuesday evening in order to reach uninsured people who may be able to gain access to affordable health insurance through the Marketplace. The Good Samaritan Clinic serves uninsured people (between the ages of 18-65) who do not qualify for Medicaid and whose income is below 175 percent of the Federal Poverty Level. Jane Harrison, also serving as a Jackson County Navigator, works out of the Mountain Projects office in downtown Sylva and goes to the Jackson County Department of Public Health on a weekly basis. We also meet people at community outreach events and schedule follow-up appointments with them.”
Both Solesbee and Mathis said the number one question they are asked from residents is regarding the tax credits available. “In general, people want to know if they qualify for Advanced Premium Tax Credits and want to learn how they can lower the costs of their monthly health insurance premiums,” said Mathis. “They also want to learn how they can lower their out-of-pocket expenses. Overwhelmingly, everyone I have talked to is eager to find a way to save money while having a good health insurance plan for themselves and their families.”
Two presentations are scheduled in Jackson County at the Cashiers Community Library. The same material will be covered at each presentation. “We are offering two presentations in order to be available at convenient times for folks: Thursday evening, Dec. 5, 6 to 7:30 p.m.; and Saturday afternoon, Dec. 14, 2 to 4 p.m.,” said Mathis
“I want people to know that I can help them determine if they can receive financial assistance for paying their monthly health insurance premiums through the Premium Tax Credits,” said Solesbee. “This financial assistance is only available through the marketplace and it costs nothing to apply to see if you're eligible. My phone number is 828- 400-4177. Also, I am available to provide presentations to community civic groups or churches, just give me a call.”
In addition to the healthcare navigators, Blue Cross and Blue Shield of North Carolina insurance agents are able to help residents in becoming compliant with the ACA. “As fully licensed agents, we are able to advise our customers, help them with the subsidy process and enroll them in the insurance plan,” said Kevin Corbin, BCBS agent serving Macon County.
Only two companies complied with all the regulations to be able to offer insurance that is subsidy eligible. “The two companies are BCBS of NC and Coventry,” said Corbin. “In Macon County and most of the western counties, BCBS of NC is the only company subsidy eligible. I would strongly advise consumers to work with someone who is licensed with BCBS of NC. Knowledge of the process and insurance is very valuable.”
Corbin recognized that while the navigators are a useful resource for the community, seeking insurance through BCBS provides guidance throughout the entire process. “Navigators can give advice and help, but in most cases they are not licensed insurance agents with the experience to understand the coverages, are not licensed with BCBS of NC and cannot service the customer from the insurance standpoint after they sign up,” said Corbin. “That is key. You want to work with someone who can provide you continuing service with your insurance plan after you sign up. Whether it is with us or another agency, I would strongly suggest that everyone contact the insurance professional of their choice to help guide them through the process.”
Corbin said that after residents are able to review different insurance plans, an agent can assist in the application process. “Once a person reviews all the available plans with their insurance professional, they apply through the insurance company with the help of their agent,” said Corbin. “From there, the application for the subsidy is completed and if they qualify, an up front tax credit is applied directly to the insurance premium and the customer only pays the difference. Navigators can certainly help people understand the process and can help those who do not qualify for a subsidy to apply for Medicaid, etc.”
With problems with the ACA website, it has become difficult for residents to sign up on their own. Corbin explained that by going through an insurance agent directly, residents would not have to deal with the website. “Right now the subsidy process is not working well because the government website is not fully functional,” said Corbin. “What we are doing is helping our customers apply directly through BCBS of NC and we will help guide the customer though the subsidy process when the system is working better. We are there to help guide them through the whole process. It can be complicated but we do this every day and can help make the process easier. Our services are free because BCBS of NC pays us and the premium is the same if you use a licensed agent or try to do it yourself or with the help of a Navigator.”