File photo by Sue Misao

File photo by Sue Misao

By Ann McCreary

When Methow Valley residents begin enrolling in health insurance plans under the Affordable Care Act this fall, they can turn to Room One in Twisp for help understanding the new insurance enrollment process.

Room One has qualified to provide “In-Person Assisters” who are trained to help individuals, families and small businesses navigate the new approach to insurance coverage that is still being finalized by the state.

“The goal of the in-person assistance network is to help uninsured folks get coverage,” said Elana Mainer, Room One executive director. “I think it’s so important to have a local organization leading the outreach effort, especially in a rural community.”

Room One is part of a statewide network of In-Person Assisters, created in accordance with the Affordable Care Act. Washington established a “Health Benefit Exchange” in 2011 to carry out the federal Affordable Health Care Act, and the exchange will allow residents to sign up beginning Oct. 1 for health coverage that takes effect on Jan. 1, 2014.

The state has created the “Washington Healthplanfinder” website to facilitate enrollment. The Healthplanfinder is described on its website as a “customer-friendly, online marketplace where individuals and families can find, compare and enroll in a health plan that fits their needs and their budget.”

Mainer said Room One will have two staff members trained to provide specific services, including helping uninsured people determine which health insurance options best fit their needs; identifying people who are eligible for reduced premiums; helping people complete applications; and supporting people with disabilities, language barriers or other special needs.

The Room One staffers will provide support to people who come to the office in Twisp, as well as by phone and electronic communications.

While Room One staff is looking forward to playing a role in the new process, Mainer said many details about the Health Benefit Exchange and the online Healthplanfinder are still unknown.

“The exchange itself isn’t open until Oct. 1. As In-Person Assisters, we can’t look through the exchange until then,” Mainer said.

However, Mainer said she’s optimistic that the process will be relatively simple and understandable. Washington, she said, is ahead of most other states in establishing a state-run health insurance exchange.

“I imagine it will be easy to use. I’m making the assumption it’s going to be good. Washington is a model for the rest of the United States. Some of the states are just setting up an exchange. Idaho just got started last month,” Mainer said.

 

Training required

Room One’s In-Person Assisters will be required to complete 30 hours of training, Mainer said. The training is being arranged throughout the state by lead organizations, which are receiving about $6 million in funds from the Health Benefit Exchange to create and oversee a network of partners, like Room One, to serve local residents. The lead organization overseeing Room One is Community Choice in Wenatchee.

Mainer said all staff members at Room One are “doing the best we can to be informed. All of us have done webinars and visited the website.” Lori Valentine and Erin Flahive, client services specialists at Room One, will take the more in-depth training.

According to estimates by state health care officials, as many as 400,000 Washington residents could obtain health insurance through the Washington Healthplanfinder.

Mainer said a toll-free customer support number will be available through Washington Healthplanfinder beginning Sept. 1, and people who want personal help will be referred to the nearest In-Person Assisters.

As the valley’s primary social services provider, Room One often works with people who don’t have insurance, or don’t have enough insurance, Mainer said.

“Most folks, if they get insured through the Health Benefit Exchange, will have access to better insurance than they have now. There’s a huge disparity between people who have great insurance and people who are underinsured,” she said.

Insurance plans offered through the exchange are required by the Affordable Care Act to provide essential benefits, such as regular check-ups, maternity care, prescriptions and preventive care like cancer screenings and immunizations. No one will be denied coverage because they are sick or have pre-existing conditions.

Most plans are not allowed to have annual benefit limits and none are allowed to have lifetime benefit limits.

According to information provided by the Health Benefit Exchange, the Healthplanfinder website will allow people to compare different health plans being offered through the exchange, learn about tax credits or financial help to pay for copays and premiums, and receive support online, by phone or in person.

Depending on how much a person earns, they may qualify for free health coverage or for financial help, according to the Health Benefit Exchange website. Individuals who have insurance through their employer will be able to remain on that plan.

Penalties for not enrolling in an insurance plan will begin next year. As explained on the Health Benefit Exchange website, individuals who do not have health insurance will have to pay a fine of $95 in 2014, which increases to $325 in 2015 and $695 or 2.5 percent of household income in 2016. For families, the penalty will be $2,085 or up to 2.5 percent of household income.

The Health Benefit Exchange website is www.wahealthplanfinder.org.