Complex Personal Issues Cloud Insurance Decisions
It's also unclear whether the plans offered on the exchange would better meet their children's needs than the employer coverage they currently have, say experts. The couple would have to compare coverage specifics and costs carefully.
There's another coverage wrinkle that could affect this family. Depending on their income and the state in which they live and their children’s health care needs, some or all family members could be eligible for any one of a number of Medicaid-related health insurance programs, says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
How one of the enrollment assisters will handle a family like this one is uncertain. Under federal guidelines, assisters will generally be required to undergo at least 20 hours of training, and some states require more. Brokers generally are required to have fewer hours of training about the exchanges.
Experts say many people who contact the exchanges will be dealing with disabilities or complex family situations, and assisters should be prepared to either help them or refer them to appropriate state programs or community-based organizations.
"I think most navigator training should be able to identify these people who need extra special help," says Elisabeth Benjamin, vice president of health initiatives at Community Service Society of New York, which will contract with 38 community-based organizations statewide to provide navigator services in New York.
Sometimes even though the questions are complicated, the answers may not be. In the case of the infant whose two parents are covered on their own parents' plans, for example, experts say the baby would be eligible for a child-only policy on the health insurance marketplace, and if the parents' income is less than 400 percent of the federal poverty level ($78,120 for a family of three in 2013), they could receive a premium tax credit.
Still, figuring out how to work through a multi-layered question to get to the simple answer will take practice.
"You almost have to be doing this stuff on a daily basis in order to learn it," says Corlette. "But [the assisters] will get up to speed, and they'll probably get up to speed really quickly."
Mon, Dec 19 2011