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Open enrollment for some local health insurance options is closing soon. D.C. residents can enroll through the District’s Health Benefit Exchange Authority until January 31, 2021. Maryland residents can enroll through Maryland Health Connection until March 15, 2021, after Governor Larry Hogan issued an enrollment period extension.
Virginia does not have the same state-run programs and instead operates on the federally run exchange through healthcare.gov. Although that open enrollment already ended, there are still other health care options for Virginians, such as federally qualified community health centers, like Neighborhood Health.
We discuss these and other health care options available to Washington-area residents. And we talk about the importance of health care access and how to make the best coverage decisions for you and your family.
Produced by Inés Rénique
- Jessica Sanchez Navigator, Prince George's County Health Connect
- Mila Kofman Executive Director, DC Health Benefit Exchange Authority
- Dr. Basim Khan Executive Director and Primary Care Physician, Neighborhood Health
KOJO NNAMDISome enrollment periods for public health insurance options are closing soon here in our area. And amid the pandemic, access to healthcare has become all the more vital. But navigating the options can get complicated. So joining us now to help with that and explain local coverage options is Jessica Sanchez, a navigator for Prince George's County Health Connect, helping connect people with insurance options. Jessica Sanchez, thank you for joining us.
JESSICA SANCHEZHi. Good afternoon. Thank you, Kojo, for extending the invitation for PGC Health Connect to be a part of today's conversation.
JESSICA SANCHEZJessica, tell us about your work as a navigator. What does that entail?
JESSICA SANCHEZRight. Yes. So, I am a navigator for PGC Health Connect. So, we work with residents of Prince George's County in Maryland to help apply for insurance. And we like to review the different options available to consumers, because I know it can get a little complicated when trying to understand what we are eligible for, when trying to understand what we can afford. So, as a navigator, me and my colleagues, we kind of walk everyone who calls in through the process of determining that.
NNAMDIWhat are health insurance options through Maryland's Health Connection program -- its public option -- and who qualifies?
SANCHEZYeah, so it's a great question. So, Maryland Health Connection is the state's official marketplace to purchase health insurance, and dental insurance, as well. And it is one application. Luckily, it kind of reduces the stress of trying to figure out what you qualify for.
SANCHEZThrough that one application, we'd be able to see -- taking under consideration the size of your household and the income of the household and also looking into legal status of individuals, we will be able to determine if you are eligible for Medicaid, which is the state's medical assistance program. We'd be able to determine if you qualify for a paid plan with financial aid. And sometimes, unfortunately, individuals may not qualify for Medicaid or financial aid, but they are still eligible to apply for a private plan.
NNAMDIYou're talking with Marylanders every day. How has the pandemic changed these conversations? Are more locals looking to enroll in insurance because of the current health crisis?
SANCHEZYes. So, with everything that's been going on, given the circumstance, I understand that everyone feels a bit vulnerable to the pandemic. So, we have seen an increase in people who may not have considered health insurance in the past because it may have been seen, you know, as an additional cost of living. So, we do see an increase in the number of people who are calling and in saying, you know, I want to get signed up for health insurance. Never gone through this process before, and they want to see what it's all about.
SANCHEZSo, we have seen an increase in the number of calls, but we've also seen kind of a shift in the types of calls that we're getting. So, unfortunately, we have heard repeatedly the narrative of individuals who have lost their jobs. And, unfortunately, they've also lost coverage through their employer. And/or they may now be underinsured. So, they are going from full time to part time so they may not be eligible for those employer-sponsored coverages. So, now they're kind of looking into the resources that are available to them as Marylanders.
SANCHEZSo, they've been calling in, and we've been guiding individuals through the process. People who were previously not eligible for the state-funded Medicaid program now are eligible due to the loss of, you know, a big amount of income that we've seen all throughout the state. And I know that, you know, other states have also seen it, as well.
NNAMDISo, the pandemic is kind of changing the kind of questions you get. Joining us now is Mila Kofman, the executive director of the DC Health Benefit Exchange Authority. Mila Kofman, thank you for joining us.
MILA KOFMANThank you for having me.
NNAMDIFirst, tell us about the DC Health Benefit Exchange. This is the District's public plan, correct?
KOFMANYes. We are the Affordable Care Act online health insurance marketplace here in the District called DC Health Link. We cover about 100,000 people and more than 5,100 employers in the District. And that includes about 20,000 residents with individual health insurance coverage.
NNAMDIWhat are you hearing these past months as a result of the pandemic? How many people enrolled a year ago, versus today?
KOFMANWell, as a state-based marketplace, the advantage we have is when COVID-19 hit, we made a local policy decision to open up our system. Even though it was after last year's open enrollment, we opened it up and we said, any District (unintelligible) get insured can come in and get coverage. And just looking at our data, comparing April 5th of 2020 to 2019, we had an increase of 71 percent in residents enrolling in private health insurance coverage. Quite an increase.
NNAMDIWhat does the DC Health Benefit Exchange Authority offer?
KOFMANWe have 25 different health plans available to our residents. Fifteen of those actually have lower premiums, so cost less than last year. And about half of our plans have no deductibles for things like your visits to a primary care physician or mental health provider or a specialist. We also have all of our health plans covering COVID-19 diagnosis, testing and treatment at no cost to the patient. So, that means no deductibles, no coinsurance and no copayments for COVID-19 diagnoses, testing and treatment.
NNAMDIMila Kofman, as you said, the exchange offers insurance coverage to individuals and families, as well as small businesses. How can D.C. residents find out if they qualify, and what's the deadline to enroll?
KOFMANGo to DChealthlink.com. The deadline for residents to enroll is January 31st. If you want February 1st coverage, then you have to sign up by January 15th. Now, employers have all year to enroll. And small businesses and nonprofits can come in any time. We have 163 different plans for employers in the District. So, keep in mind that the deadline is for residents, and the deadline is January 31st. And just go to DChealthlink.com, and all you need is residency to be eligible.
NNAMDIJessica, is the process similar in Maryland, too, and what are the deadlines Maryland residents should be aware of?
SANCHEZYes. So, there's actually three ways for individuals to enroll. The first, we use the Maryland Health Connection phone number, where they actually offer assistance in over 200 languages. So, the number is 1-855-642-8572. For individuals that feel a little more comfortable with navigating the application on their own, there is an application online on Marylandhealthconnection.gov. Now, to step it up a bit, there's also a mobile app that is super user-friendly and can be downloaded on any smart phone.
NNAMDIGot to take a short break. When we come back, we'll continue this conversation. Kishan tweets: Thanks for starting with Jessica, a navigator working at the grassroots level to get people covered. Navigators do such important work. I'm Kojo Nnamdi.
NNAMDIWelcome back. We're discussing the public health plans and the enrollment period for some of them that may be ending soon. We're talking with Jessica Sanchez, a navigator for Prince George's County Health Connect, helping people connect with insurance options. And Mila Kofman, the executive director of the DC Health Benefit Exchange Authority. Mila, what if someone misses the enrollment deadline? How can they get covered?
KOFMANWell, you don't want to be without health insurance, especially now. If you missed an enrollment deadline, you may still qualify for Medicaid coverage. And again, just go to dchealthlink.com to see if you're eligible for Medicaid. Medicaid is the public insurance program that's available for District residents. Also, as a state-based marketplace, we adopted a special enrollment period for COVID-19. So, if you do miss our deadline during open enrollment, you'll have another bite at the apple. Essentially, you can still come in later and get enrolled. But, please, don't go even a day without health insurance coverage. You just don't know if you or your family members may get sick.
NNAMDIMila, how is public health insurance different from private health insurance?
KOFMANPublic health insurance, Medicaid, is completely free to you. So, you don't have premiums you pay, and you usually also don't have other out-of-pocket costs like deductibles, coinsurance and copayments. And private health insurance, we have available from different insurance companies. Usually, with private health insurance, you do have to pay a premium or a portion of the premium if you qualify for premium reductions.
NNAMDIJoining us now is Dr. Basim Khan, the executive director of Neighborhood Health, which is a federally-qualified health center with locations in Northern Virginia. Dr. Khan, thank you for joining us.
DR. BASIM KHANThank you, Kojo. It's great to be on the program.
NNAMDIVirginia does not have the same state-run programs that we've been describing in Maryland and the District, but there are still other local and federal programs that Virginians have access to. Can you tell us about those?
KHANCertainly. I mean, the first thing I want to mention is that in Virginia, as well, if anyone wants to sign up for health insurance and has recently lost their work or for some other reason, the place to go is coverva.org or covervirginia.org. There's a phone number that people can call, as well, to see if, you know, anyone qualifies for Medicaid.
KHANAnd even though our open enrollment period has ended, if there's a change -- you know, sort of a changing life event like, you know, someone's lost work, there's a change in income, you know, change in number of family members, then one can enroll for the private marketplace, as well. And it's a federal marketplace. So, like in many other states, there are options in Virginia even though the open enrollment period has ended.
KHANIn addition to that, in Virginia and in other states, as well, in D.C. and Maryland, there are other options for people who don't have health insurance. One option are federally-qualified health centers. I work at one in Northern Virginia called Neighborhood Health, where we serve people regardless of whether or not they have health insurance. So, we provide primary care, primary medical care, but also dental services, mental health, medication assistance, HIV services, counseling, case management.
KHANAnd a lot of these services are available to people who do not have health insurance and they make less than 200 percent of the federal poverty level. So, people who are low income, there are multiple federally-qualified health centers in Northern Virginia, in D.C. and Maryland. And the program overall serves about 11 -- about 30 million people across the country, about one in 11 Americans and about 250,000 in D.C., Maryland and Virginia, overall.
NNAMDIHere is Stephanie in Woodbridge, Virginia. Stephanie, you're on the air. Go ahead, please.
STEPHANIEHi. I just wanted to call in and say, first of all, thank you so much, Kojo, for everything that you do. This is just another example of a very important topic that you bring to the public's attention. I wanted to call to emphasize that, because just a little bit over a month ago we lost my sister. She had a very manageable health condition, asthma, but she lost her health insurance. And she, for some reason, did not avail herself the opportunity to go on a public market, like the ones that you've discussed today. So, she had an aggravation of her asthma, and then an asthma attack in the middle of the night that ended up costing her her life.
STEPHANIEAnd so, I just really want to take that moment and this personal experience to really encourage your listeners to go ahead and do this. You know, it might seem like a lot of paperwork or it might seem like something that you don't have time to do. But if our loss taught me nothing, it was how important health insurance is.
NNAMDIThank you very much for sharing your sister's story with us, Stephanie. And, obviously, you have our condolences, and thank you for calling. But, Dr. Khan, a lot of people think they don't qualify for certain programs and are then surprised that they actually do qualify. Why is that and what do you want people to know?
KHANWell, first of all, Stephanie, thank you for calling in, and our condolences. You know, as a physician I've seen stories -- cases like this over the last, you know, several years where people didn't have health insurance. They didn't know they qualified for a program. And then by the time they come and see us, their conditions have worsened. And, you know, usually the hospitals end up referring people to us after they've had a heart attack or a stroke or some other event.
KHANAnd, you know, I think there's a lot of work that needs to be done in terms of the healthcare system in our country, where, you know, these types of things don't happen, there isn't as much sharing as there is, whether it's a public solution or a private solution. But given where we are, you know, I completely agree with the point that there are options for people to take advantage of. And, you know, whether it's signing up for insurance, a lot of people don't know that they're eligible, whether it's taking advantage of a program like a federally-qualified health center, a free clinic. Even the hospitals have charity programs that are available to people sometimes up to 400 percent of the poverty level.
KHANSo, you know, people making even higher incomes than some of these other programs where, you know, care can be discounted or even free. And what I recommend is that when someone thinks they might not have access to something, that they really should ask and try to look into programs. But even when people receive bills, they should call the hospital, or they should call the healthcare provider and ask if there are any charity programs in place. Because often what we've seen is people don't know that such programs exist. And they end up paying more than they should. They end up facing a lot of stress, or even worse, they end up not seeking care.
KHANThe same thing with medications. We've seen so many people spend so much on their medications, when all they need to do is talk to their doctor to switch them to a medicine that, you know, is equally effective but costs less, or take advantage of programs, you know, from the pharmaceutical companies where the costs can be brought down, or medications can even be free. I wish the system weren't like this. I wish it was more simple, but people just need to ask and try to, you know, figure out how they can take advantage of one of these multiple programs so that they get the care that they need.
NNAMDIHere is Nancy in Rockville, Maryland. Nancy, you're on the air. Go ahead, please.
NANCYDo you know of a navigator or advisory service for the menu of federal employee or federal retiree eligible insurance companies? I've been with Blue Cross Blue Shield forever and ever, both as a wife of an employee and as a retiree, and then as a survivor. (laugh) But I'm still with Blue Cross Blue Shield, and I may be moving overseas as a resident next year. And I wondered if there's an advisory service of the eligible companies which may be better for a person...
NNAMDI(overlapping) Well, you know, Nancy, every year around the month of November, we generally run a program, because that's when federal employees have to reenroll or renew their insurance. And that's when that usually comes up. But I don't know if any of our current guests can help you. Jessica Sanchez, know anything about federal employees?
SANCHEZFor federal employees, I do believe it would be separate, unfortunately.
NNAMDIMm-hmm. Mila Kofman, are you there? Same thing?
KOFMANYes. Can you hear me?
NNAMDIYes, we can.
KOFMANYes. Nancy, you should definitely connect with Office of Personal Management, OPM. That's the federal agency that handles federal programs. And they should be able to help you.
NNAMDIThank you very much for your call, Nancy. I want to move on to Vivian in Washington, D.C. Vivian, you're on the air. Go ahead, please.
VIVIANYes. Hello, thank you. So, I missed part of your question, but it was on healthcare, and I want to join in on the conversation. So, my family's Kenyan, and we moved here about ten years ago. Now, because my mother had to start from minimum wage, you know, building ourselves up, we kind of fell into the low socioeconomic class. And because of that, we couldn't get insurance, because she didn't have the money. And because we didn't have knowledge of how the system in the U.S. works, we never sought it out until we needed it.
VIVIANNow, growing up I went to college, I got it, and then I moved it off, because it was expensive (unintelligible). But now I'm 24, I'm recently 24. I turned 24 on December 31st , and I still don't have insurance, but I have a few thousand in medical bills, because I've had to go to the hospital for a few things. So, for example, I was a victim of female genital mutilation in Kenya, and I got the reconstruction surgery here. And because I didn't have insurance, that was a credit card or like a bill they send me.
VIVIANSo, all of this stuff, and then also not learning about it in school and only seeking it out once you go into the real world, or like once you need to go to the hospital or see a doctor, and then that's when you get educated about it. I feel like that pushed me very bad in respect to progressing with society and, you know, being on top of my things and transitioning into the adult life.
NNAMDIAnd you still have a lot of debt from medical bills, Vivian?
VIVIANSo, yes. For example, the first big medical thing I got was the FGM reconstruction surgery with Dr. Marci Bowers in California. And so, she did it for free, but you have to pay for the operating room. So, that and then I had a kidney stone, and then I was attacked one time. I had to go to, like, the hospital. So, all these would just keep piling up.
NNAMDINow, Vivian, do you now live in the District of Columbia?
VIVIANI do. I recently moved here for school.
NNAMDIMila Kofman, Vivian has already piled up these bills. Is there anything that the DC Benefit Health Exchange Authority can do for someone like Vivian?
KOFMANSo, Vivian, I'm glad you live in D.C. You have options. First of all, let's make sure you don't pile on additional bills to what you have now. Well, happy birthday, first of all. You have options. So, depending on your income, you can qualify for our Medicaid program, which is up to 200 percent of federal poverty level. So, it includes low and moderate income wage earners. If your income exceeds that, you can qualify for premium reductions through DChealthlink.com.
KOFMANNow -- and this is generally for everyone. If you are undocumented and therefore cannot qualify for private or Medicaid coverage, we have the healthcare alliance program that covers D.C. residents who don't qualify for other programs. So, I would urge you to go to DChealthlink.com and figure out what you qualify for. If you want help, we have free help available to you. Just like Jessica in Maryland, we have our own Jessicas. (laugh) And all of their information is on our website, if you prefer to talk to someone by phone or a video visit.
KOFMANIf you connect with us after this program, we will do some basic research and help put you in touch with other local resources that may be available to you to help you with your current medical debt. So, please follow up with me afterwards.
NNAMDIVivian, thank you very much for your call, and so you can remember, Mila Kofman is with the DC Health Benefit Exchange Authority. And, Vivian, good luck to you. Jessica Sanchez, a lot of people struggle when it comes to choosing a plan. What are some basics you lay out to help people compare plans?
SANCHEZYes. So, the first things first, I kind of like to address the insurance jargon that kind of intimidates people when applying for health insurance. So, first, I do like to explain that there are different tiers of coverage, the first tier being the bronze tier, and it goes all the way up until the platinum level. And the way that we differentiate these plans is mainly we'll see the difference through the deductibles. And the deductibles are kind of like the contract price that you agree to paying out of pocket before the insurance kind of begins to kick in their major coverage.
SANCHEZSo, the lower that you're paying monthly kind of leads us to know that you're going to be paying more out of pocket, so higher deductibles and higher copays and coinsurances. And the more you pay monthly, the lower your out-of-pocket expenses typically are. So, we also work with big name companies, insurance companies that most people will recognize, such as Kaiser Permanente, Aetna, Blue Cross Blue Shield, insurance companies names that people recognize. And the prices will vary between these companies. So, we give consumers the opportunity to compare the cost to choose something that is budget-friendly to them, because we know that not everyone's budget is the same.
NNAMDIDr. Khan, if a potential patient shows up to one of your locations looking for health coverage, what options would that person be offered, and is everyone guaranteed coverage?
KHANSo, the first thing that we do when someone shows up, even though we serve patients who don't have health insurance, the first thing we do is to make sure that we check to see if they are eligible for any type of health insurance. And the reason for that is simple, because even though we serve people without health insurance, there are other services that they may need specialty care, which we don't offer ourselves. So, if they had health insurance, it is easier for them.
KHANAnd then, of course, there's a less cost-sharing. So, we check if they qualify for Medicaid, going through the same process that I talked about. We check to see if they qualify for any private insurance on the exchanges. And then if they don't qualify for any health insurance, we check their income -- like other federally-qualified health centers and similar programs -- to see if they make less than 200 percent of poverty. If they make less than 200 percent of poverty, then we put them on a discounted sliding scale, whereby they can get all the services that we offer for very discounted rates.
KHANAnd that's the same process that all FQACs across the country follow. And then with free clinics, while they don't take people with insurance, they follow a similar process, as well, so that patients can get services there. You know, one thing I'd like to add is there are ways to see what health center is in your area. It's on hrsa.gov, H-R-S-A dot G-O-V. And you can look up, you know, which health center is closest to you. And then there's also a website for free clinics, as well, where you can put in your zip code and see what clinics are close to you, and then are able to just give them a call.
NNAMDIWe got a listener who asks: If you lost your job recently, how do you prove that you qualify? Your most recent tax returns will show your previous income. Mila Kofman?
KOFMANSo, during open enrollment, you don't have to prove anything. You just come in, you just need to be a D.C. resident. If you live in Virginia, you do have to have proof of...
NNAMDIOh, we're still having trouble with Mila's line. But, Jessica Sanchez, can you give us a few -- well, can you answer the same question?
SANCHEZYes. So, in the event that a consumer is trying to apply and has lost their job, so they find themselves not having, you know, tangible proof of income, we do have affidavits that have been created to meet the circumstances, even though everyone has unique circumstances. So, if they currently have no income, there is an affidavit that they will sign off and attest to having zero income. And that will be suffice to fulfill that.
NNAMDIHere now is Lisa, in Tacoma Park. Lisa, you're on the air. Go ahead, please.
LISAHi. Thank you so much for taking my call. Can you hear me okay?
NNAMDIYes, we can.
LISAOkay, good. I lost my job due to COVID back in September. And first, I went with COBRA for a few months, but it was prohibitively expensive. So, then I went on the Maryland Health Exchange, which was great, and it turned out I was eligible for Medicaid. So, I'm still looking for a job, and I actually got a job offer yesterday, but the health insurance won't start until April 1st. So, I don't think that I can stay with Medicaid while I wait for the other health insurance, you know, the employer health insurance to start. So, I'm not sure what to do.
NNAMDIAny advice for her, Jessica Sanchez?
SANCHEZYes. That is an excellent question, just because your narrative is parallel to that of so many Marylanders. So, what happens is once a change like that occurs, you do have to call in to report the change that you are now employed. But we do understand that there may be that gap in the coverage period. So, we just update your information to make sure that we have your most up-to-date income. So, if it changed from zero to X quantity, we'll update that for you.
SANCHEZAnd I'd like to point out that even if you may not be eligible for Medicaid, there is still the option that you may qualify for a paid plan with financial aid. I'd like to point out that nine out of 10 Marylanders who apply through Maryland Health Connection actually qualified for financial aid. So, that financial aid helps lower the cost of your premium. And you're eligible for that up until your employer-sponsored coverage begins. And sometimes, even people with employer coverage are still eligible for coverage through the state of Maryland. You'll just need to provide us with your insurance information through your employer to see if you're eligible or not.
NNAMDIDr. Khan, at Neighborhood Health, you work to reach underserved communities. What do you do to gain people's trust?
KHANI think, in healthcare, trust can begin through long term relationships with people in a sense that you've been there to serve the community and you're going to continue to be there, and that patients can rely on you. And, you know, one thing I'll say is health professionals, in general, they go into healthcare because they want to help people. And all you need to do, in some ways, is let healthcare professionals do what they do in interacting with patients and showing patients that they care. And then you build trust over time.
KHANWe've been around for close to 25 years. Many of the other FQACs and free clinics have a long track record in our community. And when you've been there for such a long time and you serve them for such a long time, people in the community do come to trust you. And there is word of mouth, and they know that you're there and that they can rely on you. But it takes time, it takes effort.
KHANAnd that's one reason why, I think, primary care is something that's so important. You know, as our healthcare system is more fragmented and, you know, in retail stores, you know, different options they're opening, as well, you know, in some ways there isn't a substitute for a primary care physician, a nurse practitioner or primary care team that a patient can rely on. And even though someone might not need a primary care provider at this point in time, it's important that they have that relationship, in case they do get sick in the future and need important advice.
NNAMDIGot to interrupt because we're running out of time very quickly. And Mila Kofman is back with us. Mila, how does someone prove that they qualify if they've lost their job recently?
KOFMANDuring open enrollment, you don't have to prove anything. And if you're a D.C. resident, we have different ways that you can show you've lost your job, and we make it as easy as possible, including gestation option.
NNAMDIMila Kofman is the executive director of the DC Health Benefit Exchange Authority. Mila Kofman, thank you for joining us.
NNAMDIJessica Sanchez is a navigator for Prince George's County Health Connect. Jessica Sanchez, thank you for joining us.
NNAMDIAnd Dr. Basim Khan is the executive director of Neighborhood Health. Dr. Khan, thank you for joining us.
NNAMDIToday's segment on enrolling in local health plans was produced by Ines Renique, and our conversation about prospects for D.C. statehood was produced by Richard Cunningham. Tomorrow, tune in for NPR's special coverage of the impeachment proceedings in the House of Representatives. That coverage starts at 9:00 a.m. and will continue throughout the day. Until then, thank you for listening and stay safe. I'm Kojo Nnamdi.
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