‘Navigators’ help people through health insurance maze

Last modified: Friday, February 20, 2015

NORTHAMPTON — When Diana Soler sits down to help someone sign up for health insurance or test eligibility for MassHealth through the Massachusetts Health Connector website, she starts with the basics. Sometimes as basic as creating an email account.

Even for people who have Internet skills, signing up for health insurance can be confusing and time consuming, say Soler and others whose job it is to boost participation.

Among the local people who met with one of three certified application counselors at Casa Latina were Amherst residents Giancarlo and Victoria Garofalo, who sought help for the sign-up process after encountering discouraging roadblocks on their own.

Giancarlo Garofalo, 22, said since he and Victoria, 23, got married in September they have been trying to secure affordable health insurance. He is a full-time student, and she is seeking a job while awaiting work papers after moving here from Russia.

He said they tried to sign up on their own, but found the website confusing to navigate, and said they were “kicked off” more than once because they lacked proper documents. With help, they completed the application process Thursday.

“It was excellent, actually, it was the best experience I’ve had,” said Garofalo. He said he expects to learn results of his application in about three weeks.

Another applicant who sought help at Casa Latina was Margarita Albelo, 77, of Amherst, who had been denied MassHealth coverage 10 years ago when she first moved here. She learned about the Health Connector site, and the help offered by Casa Latina’s application counselors — also referred to as navigators — through a meeting at Casa Latina, and she’s glad she did.

“They told me I should try again because things have changed,” said Albelo, a retiree who lives on a Social Security income of a little over $1,800 a month. “I have been sick most of the time so I didn’t want to make any mistakes so I went there and they helped me with the application.”

Albelo is among the many people who don’t consider themselves either Internet savvy or especially tech-literate, so she appreciated the assistance. She said she hasn’t learned yet whether she will qualify for MassHealth, but the help she got in filling out the forms was invaluable. “They sat down and explained to me whatever needed to be done,” she said. “It was with them that I really got all the information that I didn’t know before.”

Soler is one of three certified application counselors at Casa Latina, a Northampton-based nonprofit where navigators are working under an $80,000 state grant aimed at reaching out to people in Hampshire and Franklin counties who need to enroll in health insurance.

The Massachusetts Health Connector awarded such grants to 15 organizations across the state last August. They are aimed at making sure that people who are uninsured, or who have to repeat the application process under new guidelines that came into effect last year with the federal Affordable Care Act, often referred to as Obamacare, get help with navigating the process.

The open enrollment period is from Nov. 15, 2014 to Feb. 15, 2015.

Casa Latina targeted 11,000 people with a door-to-door campaign, community events and outreach through the schools and gave individual assistance to those in need.

Taking time

“Many people find this process overwhelming, especially people for whom the computer is another world,” said Soler. After creating an email account, which for many people she works with is their first electronic communication, she will often sit with them for up to three hours to fill out online forms.

“I sit with them and call the insurance company to ask about the providers, I explain to them what an out of pocket deductible is,” said Soler. “There are all these terms that they have to know.”

Cameron Carey, the development director for the Community Health Center of Franklin County, which also sets up personal appointments to help people figure out how to apply for health insurance, said the process is daunting for anyone.

“We’ve had people from a very wide variety of socio economic scales coming and asking for assistance,” said Carey. “People with degrees, even cases with advanced degrees are having difficulty navigating the system.”

His center sets up 90-minute appointments for people seeking personal help. Carey said he understands why help is needed — it’s because the system is too complicated.

“The questions are not intuitive and the system is not working the way it should,” he said. Another problem is that the federally mandated system in place to verify people’s identification often slows the process down.

He noted that the Connector uses federal databases to verify information that applicants log. “If it can’t match the information with some sort of a federal registry it will stop you short and essentially freezes your application,” he said.

Carey said he isn’t surprised by difficulties people encounter as the federal health care system gets incorporated into the way the state of Massachusetts has been connecting citizens to insurers for almost a decade.

“Each time we go through a transition there is a period of confusion,” said Carey. “Back in 2006 when we transitioned to an online system it was very confusing and there were a lot of hiccups. We see a lot of this going on this time and arguably to a greater degree.”

Another thing that slows the process is the complexity of choices. “There might be several plans that are presented to someone and each plan features different benefits and costs,” he said. “There is a lot to consider in making the best choice for yourself.”

Counselors helping people navigate this system are prohibited from advocating for one plan over another. “They just present all of the information and allow the applicants to choose for themselves,” said Carey.

Jason Lefferts, director of communications at the Commonwealth Health Connector, said the system is improving. “We are doing a lot better this year compared to last year,” he said.

Asked about criticisms that the way the Health Connector website prompts people for information is not intuitive enough, Lefferts said, “health insurance is complicated no matter what the situation is.”

Gov. Charlie Baker addressed the issue in his inaugural speech, saying, “when thousands of families continue to be confused and let down by the Health Connector we’ve not paid attention to the details.”

Navigators aim to help

Lefferts said clearing up the confusion is one of the reasons the state has invested in training certified application counselors. There are 1,300 such people around the state, including in the 15 navigator organizations like Casa Latina that earned grants to reach out to people who might not otherwise sign up.

Casa Latina executive director Lillian Torres said that in addition to going into the community to raise awareness about the Health Connector, more than 100 people have come into the agency seeking help.

Meanwhile, the Feb. 15 deadline for open enrollment approaches and the need to apply becomes more urgent. “We are experiencing heavy volume, there are a lot of people with questions and a lot of people with difficulties,” said Carey.

Newlywed Garofalo said he’s happy to have the application process behind him. “When it finally comes through it will be a huge relief,” he said.

For more information go to the health connector website at www. betterhealthconnector.com.


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