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updated: 10/14/2013 6:13 AM

VNA Health Care helps residents navigate new requirements

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  • VNA Health Care is one of the primary outlets for Fox Valley residents to find assistance in navigating the new health insurance marketplace.

       VNA Health Care is one of the primary outlets for Fox Valley residents to find assistance in navigating the new health insurance marketplace.
    James Fuller | Staff Photographer

 
 

Fox Valley residents appeared to put a timid toe into the new pool of insurance coverage options offered during the first week of the exchanges created by President Barack Obama's new health care law.

VNA Health Care hosts one of the larger contingents of "navigators" in the Fox Valley. The organization has about 25 trained, background-checked navigators who are assisting local residents in determining their medical coverage options now that the exchanges are open for business. VNA hopes to eventually have 50 navigators in the field assisting residents.

Interviews with some of the current navigators show local residents have been somewhat slow to come to the exchanges, but the pace is building as more information becomes available.

Nadia Daley is one of the VNA's navigators. She helped about 10 individuals and families in the first week of the exchanges.

"When people come in, most say, 'I heard I can get insurance, and I really, really want insurance. So, I'm here for you to help me get insurance,'" Daley said. "That's their main concern, especially if they have somebody ill their family or have a pre-existing condition. Basically, the door to insurance has been opened, and everyone is just pushing to get in."

Urian Diaz Franco, another navigator, said he's assisted mostly young families find coverage during the first week of the exchanges. Most of the VNA locations are either in Elgin or Aurora. An estimated 50 percent to 70 percent of the clientele helped by Franco and Daley have been Hispanic. Franco said he's seen a lot of interest by students as well.

"I'm a recent graduate of the University of Illinois, and they required us to have insurance there," Franco said. "But they also provided insurance to us. I've realized this first week that not all schools do that. So some are being put at a disadvantage."

The new health care law allows children to remain on their parents' insurance until age 26. But that's helpful to students only when their parents actually have insurance themselves. Franco said students who aren't covered by parents are finding solutions mainly through expanded Medicaid eligibility. VNA officials all agreed the best option for people on Medicaid, or newly eligible for Medicaid, is to stick with that program.

"The Medicaid benefit, what's wonderful about it is you don't have to worry about paying premiums every month," said Cheryl O'Donoghue, vice president and chief communications officer for VNA. "You will get coverage and all the essential insurance benefits the same as people who are paying for it through their work or through the exchanges. And you are usually paying a very small fee (less than $10) at the time the service is provided."

VNA officials said they are also spending a fair amount of time informing local residents the new insurance exchanges are not offering government insurance. Only the expanded Medicaid and Medicare benefits are government insurance. The exchanges offer an open marketplace where private insurance companies bid their services to prospective customers. The rates fluctuate depending on where people live, but having a pre-existing condition no longer disqualifies people from private insurance, nor can that be a factor in the price. Navigators said residents testing out the system should favor the getcoveredillinois.gov website, over healthcare.gov. The Illinois website will allow residents to learn if they qualify for Medicaid and is experiencing much less website traffic delays than the federal portal.

VNA officials said they expect the level of interest by local residents to increase as they hear from friends and relatives who test the exchanges and Medicaid eligibility. They may lead to a surge of applications both late this year as local residents hope to gain coverage by Jan. 1 or before the March 2014 open enrollment cutoff. The next open enrollment period after that won't be until October 2014.

Here are common questions -- and answers -- officials say residents are asking:

Q: I'm a senior on Medicare. What do I need to do to maintain coverage?

A: Nothing. You don't need to do anything with the new insurance exchanges to maintain coverage. You will still have the same benefits you currently receive. In addition, Medicare now covers preventive services and a free, annual wellness checkup. You also don't have to do anything to qualify for new discounts on prescription drugs. If you qualify, you automatically get the discount.

Q: I'm a legal, permanent resident. Can I get insurance coverage through the exchanges?

A: Yes. You can buy insurance in the new marketplace with your document numbers taking the place of a Social Security number. Undocumented immigrants are not eligible, nor will they have to pay a penalty for not having insurance.

Q: What if I don't want to buy insurance, and I don't want to pay the fine?

A: You may not have to. The new law exempts people from paying a fine if the cheapest insurance coverage open to them costs more than 8 percent of their adjusted gross income or if their income is low enough that they are not required to file income taxes. The fine this year is $95 or 1 percent of your income, whichever is more. In 2015, the fine increases to $325 or 2 percent of your income.

Find information about VNA Health Care enrollment information sessions at vnahealth.com.

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