Over the past year, experts from CHIR and Georgetown’s Center for Children and Families have been providing support to Navigators and assisters under a project funded by the Robert Wood Johnson Foundation. Our work includes back-office support to assisters in 6 states – Georgia, Florida, Ohio, Arizona, Arkansas and Michigan – and a Navigator Resource Guide, which includes close to 300 frequently asked questions (FAQs) reflecting a wide range of situations consumer may face as they navigate our changing health care system.
This week, CHIR is pleased to release an online version of the Guide, with searchable FAQs and easy-to-read background information on key health insurance and marketplace issues. Although the Navigator Resource Guide on Private Health Insurance and the Health Insurance Marketplaces is designed with the needs of Navigators in mind, the Guide is a hands-on, practical resource for anyone who needs to communicate with consumers about the Affordable Care Act. It’s organized into four sections, based on the types of circumstances in which consumers might present themselves to a Navigator: (1) People without coverage, (2) People with coverage, (3) Employers offering coverage, and (4) Post-enrollment problems with coverage. In each case, CHIR experts provide helpful background on the topic with accompanying FAQs, culled from common consumer situations. Examples of the questions answered in the Guide include:
- Are there exemptions to the individual mandate penalty? What are they?
- My son goes to college in another state, but we want to enroll him on our family plan. Can we do that?
- I own my own business and have no employees. What are my options?
- I have 47 employees and I’m trying to decide if I should hire more. What are the implications if I have more than 50 employees?
- I have an offer of coverage through my employer, but the premiums are too expensive. Can I get financial help to buy a marketplace plan?
- Does pregnancy trigger a special enrollment opportunity?
- I’m eligible for COBRA but haven’t elected it yet. Does that affect my eligibility for marketplace subsidies?
- I’m raising my grandchild and claim her as a dependent. Are we considered a household of two?
- What are health care sharing ministries? What are the risks and benefits of signing up for one?
- I was denied coverage for a service my doctor said I need. How can I appeal the decision?
We’ve highlighted some of the questions we’ve received from Navigators and assisters here on CHIRblog, including one on what to do when your drug is not covered by your plan and another on what to do when your provider is no longer in-network. The upcoming open enrollment period promises to generate many more questions – such as how to renew or change plans, obtain re-determinations of eligibility for premium tax credits and file for exemptions from the individual mandate. As more questions come in and new federal guidance comes out, we’ll update the Guide in real time so that Navigators and assisters can provide accurate, up-to-date advice to consumers.