Horizon, Host: Ted Simons

September 30, 2013


Host: Ted Simons

Health Insurance Marketplace Navigators


  • Over $5 million in federal grants have been awarded to community organizations in Arizona to help people enroll in the Health Insurance Marketplace. The Arizona Alliance for Community Health Centers has received over $2 million of that money. Tara McCollum Plese, Senior Director for External Affairs for the Alliance, will talk about her agency's role as a Marketplace Navigator.
Guests:
  • Tara McCollum Plese - Senior Director for External Affairs, Arizona Alliance for Community Health Centers
Category: Medical/Health   |   Keywords: health, insurance,

View Transcript
Ted Simons: Over $5 million in federal grants have been awarded to community organizations in Arizona to help those looking to enroll in the health insurance marketplace. Much of that money is going to the Arizona Alliance for Community Health Centers. Joining us now is the organization’s senior director for external affairs, Tara McCollum Plese. Good to see you again. Thanks for joining us.

Tara McCollum Plese: Thank you.

Ted Simons: Community organizations helping people enroll. How?

Tara McCollum Plese: Well most of the community organizations that are collaborating with us on this effort have done eligibility and enrollment for years and years. These are people that have had a lot of expertise in this, primarily signing people up for Medicaid and for kids care. This really isn't a lot different. They know the process extremely well so they will be looking for those folks who are eligible for Medicaid and then those that are eligible for the marketplace, they'll move them onto a navigator who will be able to help navigate them through that online eligibility system.

Ted Simons: There's a difference between the first contact and a navigator?

Tara McCollum Plese: Well, the assister can talk to them about where to go to find the marketplace and basically tell them some basic information that they might want to have when they go through that marketplace online but they don't actually do the assisting for the marketplace.

Ted Simons: That's where the navigators and the brokers as well?

Tara McCollum Plese: That's where the navigators come in and here's the distinction. The navigators can help them through that online process and explain to them what they need to be looking for in a health plan according to their income, their family size, their ZIP code. There are a number of factors that they can remind them. And if they have a chronic disease like diabetes and they need special medical attention or special medical equipment or prescriptions, then they're going to be looking for that on that marketplace when choosing a plan, but neither the navigator nor the assister can choose a plan for them because that would be conflict of interest. That would be a broker. If they can't make a decision, then a broker can step in and help them decide between all those health plan choices.

Ted Simons: Navigators, especially brokers, how certified, how much are they overseeing, what's kind of regulations going on here?

Tara McCollum Plese: Well, all the assisters and all the navigators have to be trained. They have to go through extensive training and then take a test to be certified. And once they get that official certification, they'll actually have the document, then they're ready to go to help people.

Ted Simons: What questions are you hearing now? We're just right here at the doorstep of opening this thing up. What questions do you hear most?

Tara McCollum Plese: I think the question we hear the most is does everybody have to go to the marketplace? No. Not everybody has to go to the marketplace. If you already have health insurance, then you more than likely don't have to go to the marketplace. If you have Medicare, Tricare, are on Access, any number of other healthcare coverages, you probably would not want to go to the marketplace.

Ted Simons: And I didn't ask David this but I guess I should have. If you go to healthcare.gov, and you say I've got -- will they tell you to go away? You don't need to be here?

Tara McCollum Plese: They won't tell you to go away. But you won't get any of the tax credits or the subsidies that you could get if you're not being covered presently. So if your employer is already giving you healthcare benefits and your premiums, they're what you have to pay aside from what the employer pays, is more than 9.5% of your income, well then you can go into the marketplace. And you may be eligible for some subsidies and tax credits. Otherwise, if you're really not paying that large of a percentage for your portion of the health plan, then you are probably not eligible for the marketplace.

Ted Simons: Okay, yeah. I just wanted -- go away, leave us alone, we've got other people to deal with here. The challenges now in enrolling and helping people enroll. The language challenges, cultural challenges, just the ability to understand what to do and where to go. What are you expecting?

Tara McCollum Plese: Well, I can speak for our community health centers, which do have a lot of translation services in many, many languages, not just Spanish. But even on healthcare.gov, when you call the number for healthcare.gov, you can request to do the application in the specific language. And I believe I heard that they have over 105 different languages on healthcare.gov.

Ted Simons: Okay. So that kind of information is out there. What about those who are worried? I'm giving a lot of personal information on a website to people that I don't know, even the navigator helping me, I don't know this person. Fraud, the concern over fraud. Is it out there? Is it realistic?

Tara McCollum Plese: I think fraud is realistic because there are going to be a lot of predators out there who are going to look for people that they can offer assistance to do the marketplace but the only place that you can sign up is on healthcare.gov. No other place. So people need to be aware of that. There is also a fraud line if you go to healthcare.gov and if somebody is trying to scam you, you can go to healthcare.gov and report that.

Ted Simons: Interesting.

Tara McCollum Plese: Yes, there is a place to report the fraud and abuse. Now, as far as privacy concerns with our navigators and our assisters, part of that training process and their certification requires them to sign a confidentiality rule. And yes, most of these people are well vetted. There are background checks. Because many of these people are already employees either in our health centers or in those community organizations. These aren't just generally people we've pulled oft street and said now you're an assister. They've gone through an extensive process in order to do this and they've signed off on a privacy agreement.

Ted Simons: We've got a lot of time left. I just need to know from the community health center's point of view, are you ready? I think everyone thinks it's going to be a stampede here come tomorrow but that's not necessarily the case, is it?

Tara McCollum Plese: Well, I'm hoping that's not the case but we are ready. We are prepared. We have our navigators and our assisters in place. But I think that we're going to have -- it could be one or two scenarios. I'm hearing that a lot of people think October 1st is the only day to enroll and it isn't. If you enroll and I think you heard this from David, any team twine October 1st and December 15th, after that January 1st deadline, you will be enrolled in a health plan. And if you still have through March 31st to enroll, anyway.

Ted Simons: So do it between now and December or it will be done --

Tara McCollum Plese: My piece of advice would be to wait until mid- or late October. Let people kind of work out the bugs and then go on.

Ted Simons: We'll check back with you in a few weeks, maybe a month or two and see if any bugs are rearing their heads. Thank you so much for joining us.

Tara McCollum Plese: You’re so welcome.

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