Navigating the health-insurance marketplace? Help's available
Open Enrollment can be 'terrifying,' but grants, subsidies allow for free advice
With all of the health insurance options available to consumers during the current Open Enrollment period, its understandable that folks might appreciate some guidance in finding the plan thats right for them.
Thats where experts like Victoria Bramley and Greg Osborne come in.
Bramley and Osborne are both local, veteran health insurance consultants who work for agencies that have been blessed by the government to help people who are confused, confounded and even frightened by the process of purchasing health insurance.
It is terrifying to people, and what can happen is that some people will just shut down, says Bramley, a planner and insurance consultant for The Insurance Store Inc., a Lake Oswego-based company that helps people choose from a wide array of available health care plans.
The Insurance Store is an authorized and certified entity that works alongside the Federally Facilitated Marketplace (FFM), encouraging clients to reach out for answers to help navigate the FFM system. Its one of many storefront operations around the state designed to help people who are shopping for a health care plan to narrow their options and guide them to a plan thats affordable.
Her role is not to sell anything, Bramley says, but rather to offer everything.
For us, its more about learning what a persons situation is and telling them whats available to them, she says. We get paid by a government entity or by a private carrier, not by the customer.
Often, Bramley directs customers to consumer tax credits that can save them hundreds of dollars a year in insurance costs. Of the approximately 107,000 Oregonians who enrolled through HealthCare.gov for 2015, for example, more than 77,000 received a premium tax credit averaging $199 per month.
By purchasing a plan, Bramley says, consumers can also avoid the non-enrollment fines required by the national Affordable Care Act.
It doesnt matter if you come from extreme poverty or extreme wealth, Bramley says. We just give an overview of what to expect in the FFM, so people are not afraid.
Osborne is an agent with Modern Insurance Marketing Inc. in Wilsonville, one of 24 individual agencies and community organizations authorized by the state Department of Consumer and Business Services to serve as drop-in enrollment centers. The role of the grant-funded program is to help people shop for and enroll in a health insurance plan thats right for them, Osborne says, and to help them access financial help to pay for it via HealthCare.gov.
In Clackamas County, nearly 8 percent or approximately 31,000 of our residents do not have health insurance coverage, Osborne says. A lot of people just dont really understand insurance, so it helps to have someone face-to-face you can talk to. Were here to help them through the process.
During last years Open Enrollment period, many consumers waited on the phone for long periods on hold, or faced myriad online obstacles in trying to get answers to questions about available health care plans. Osborne says the state responded by sponsoring agents in brick-and-mortar locations who can schedule appointments and take walk-up customers who are seeking answers to their health care questions.
Having an actual physical location was one of the criteria, he says. We can help people with the options in their local market. That helps narrow the focus for them, because were familiar with the hospitals and providers in their network.
Advisors also are available for seniors seeking answers about Medicare, and for business owners who are finding ways to make it easy for their employees to enroll. A complete list of the states agency and community partners is available at OregonHealthcare.gov or by calling the Oregon Health Insurance Marketplace at 1-855-268-3767.
Weve heard from Oregonians that free, in-person help can be extremely valuable in finding the right coverage, says Patrick Allen, director of the Department of Consumer and Business Services. We are pleased to be partnering with agents and community organizations around the state to offer this important assistance.
Bramley says she speaks to folks covering all demographics. One segment is seniors who tend to hide in the community instead of wading through all the confusing options. Another is young adults who have never had insurance and arent sure whether or not they need it.
Theyre saying, I cant afford it. Ive never paid for health insurance. Maybe I should just pay the penalty, because the penalty costs less, she says. Well, until you know what all your options are, how do you know?
Bramley says she welcomes those questions and is always ready to provide the answer that best suits individual situations.
Tell us your situation and well narrow down your options, she says. Theres no pressure. If we cant help you, well tell you where to go to get help.
For both Bramley and Osborne, Open Enrollment has meant longer hours in the office. But both say its an exciting time to be in the insurance business.
This is the one time of year when everybody has a chance to move to a different plan, Osborne says. Its changed our business model, but its really helped our business because more people are seeking insurance and its easier to get enrolled.
Im proud of what were doing, and Im passionate about it, she says. This is my community, and my reputation means everything to me. When you love what you do, its not work. The gratitude you get? Thats the reward.
The Insurance Store Inc.
252 A Street, Suite 2000, Lake Oswego
Modern Insurance Marketing Inc.
29174 S.W. Town Center Loop West, Suite 102, Wilsonville
4859 Meadows Road, Suite 155, Lake Oswego
Important dates for Open Enrollment
Nov. 1: Open Enrollment started the first day you could enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as Jan. 1, 2016.
Dec. 15: Last day to enroll in or change plans for new coverage that would start on Jan. 1, 2016.
Jan. 1, 2016: 2016 coverage starts for those who enrolled or changed plans by Dec. 15.
Jan. 15, 2016: Last day to enroll in or change plans for new coverage that would start on Feb. 1, 2016.
Jan. 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between Jan. 16 and Jan. 31 take effect March 1, 2016.
Note: If you dont enroll in a 2016 health insurance plan by Jan. 31, 2016, you cant enroll unless you qualify for a Special Enrollment Period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days.