Helping Your Patients Make the Most of Their New Health Insurance Coverage / HealthChoice

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hello everyone and welcome to the latest in Maine Quality Counts wants to learn webinar series my name is Paul Santa menna at main Quality Counts and obviously kicking things off with an introduction this afternoon and you have joined the webinar entitled helping your patients make the most of their new health insurance coverage little background on main Quality Counts for those of you who aren't familiar with us we're a member-driven and supported nonprofit organization here in Maine and

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we work to improve health care and health for everyone in the state and specifically we bring together the people who give get and pay for health care and provide tools and leadership that we all need to make sure all Mainers receive care that's truly patient-centered we are driven by a spirit of collaboration we work with over 70 partner organizations both in the healthcare world and in government

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also in the community basically working to all of us working together to achieve shared quality improvement and ultimately health outcome goals we have about 140 members members are both individuals and organizations and if you are not yet a member of Maine Quality Counts we invite you to consider becoming one there are benefits of membership like special networking events a couple times a year some web

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webinars for members with national experts we've got one coming up I'll talk about in a minute discounted registration to the QC 2016 conference our next big conference coming up in in about a year but put it on your calendar now it fills up so please consider becoming a member obviously your dues support us and our work and in fact these very webinars that we can provide to you at no cost and obviously there's benefit to you too so go to our website

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main quality count or get the join button at the top and you can fill out the forms and be your way the member only webinar that's coming up that I just mentioned is this coming Thursday at noon and it's with Lauren Taylor who is the co-author of relatively new book on what she and her co-author called the American healthcare paradox why as you all know we spend more than other developed countries and

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get worse results in many cases there should be an interesting discussion Lauren will be joined by Lisa letourneau our executive director to engage in a spirited discussion with folks with members who are joining on the call as well as I mentioned we do maintain a website main Quality Counts org and post frequently on social media including Facebook and Twitter and LinkedIn and

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also we have many many videos on youtube if you go to youtube and search for main quality counts for our channel you can check out all of those much of that content on YouTube is a video from webinars like this one so you can go there and look at all of our past many of our past webinars and even review this one if you like also on iTunes we maintain a podcast the main Quality

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Counts podcast and that also is webinars and also some of the really good keynote speeches from various events that we hold and other content so go to iTunes search for main Quality Counts and subscribe to our podcast so technical notes for this afternoon your phone line is muted to minimize background noise but we do want you to join in the

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conversation and the best way to do that is to use the chat function at the lower left hand corner of your screen there at any time during the presentation today you can feel free to chat in we'll be monitoring that and if a question sort of fits into the flow will answer that question as we go along if not we'll answer questions at the end there'll be a few minutes for Q&A at the end and also be prepared for some surveys so stay awake and look for

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surveys that respond to those and that will be an added benefit of this particular webinar this webinar is being recorded and will be available as i said as video and as audio and you will receive a link to the slides and the recordings later this afternoon and you can also look at any other webinar from our website and at the other sites that i mentioned so moving on to the

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presentation today we have two presenters from consumers for affordable healthcare emily brontë with the executive director and mary schnecken berger who is the education and outreach manager so with that emily and mary i think it is your turn to take over and bring us through great thanks so much Paul and thank you to everybody for joining us today on your lunch break my name is Emily braszczok i'm here with mary schnecken burger and over the next

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15 minutes or so we're going to be talking with you about the challenges that families today are facing and navigating and using their health coverage so just to give you a sense of where we're headed today I'm going to give a brief overview of consumers for affordable health care we're going to talk about why this topic matters go over some basics for some common types of coverage focusing on the marketplace the ACA marketplace in Maine care and

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then we're going to kind of sum up what we've learned talk about how health providers and people involved in Maine health care system can help and we'll save some time at the end for questions but please feel free as we go to type questions and we'll try to keep track of those as well so consumers for affordable health care is a nonprofit that's been around for 27 years and our mission is to advocate for the right to quality affordable health care for everybody in Maine we do that in a number of ways we help consumers

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with health coverage issues through our consumer assistance helpline we also provide a lot of information online we also help consumers who are having problems with their coverage like denied claims and with coverage disputes and we provide workshops presentations training for professionals like you so you have all of the right information and resources to assist your patients and clients and in addition to this work we also are involved with legislation and

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advocacy to make sure that the consumers perspective and voice is considered in our laws and the way that our health system runs so with that let's jump right in to our presentation today so families today have a couple major pathways to get health insurance coverage so we have main care or Medicaid we have chip which is actually part of the main care program many

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families are now getting private insurance through the ACA marketplace or healthcare gov in these last few years and many people most people actually who have coverage are insured through their employer and so these are some of the major ways that people get insurance today and you'll notice we didn't include Medicare here we're not going to focus on Medicare today although that is obviously a major way to get coverage for people who are older have

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disabilities today we're primarily going to focus on main care including chip and also on the private insurance coverage that's available through the marketplace with these programs families are having to navigate you know applications eligibility as well as how the actual coverage works so when you're a consumer and you're trying to figure out what kind of coverage you qualify for it is complicated so we've provided this slide

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not because we want you to parse through each different area of this handout but just to show how complicated it is you can see that four different categories of people whether you're a senior apparents a young adult to child and depending on the number of people in your family there are different income guidelines there are different rules to each program and so it's extremely complicated at times for people to figure out what kind of coverage they

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may be able to get and complicating matters even further is the fact that different family members may qualify for different things so in your family your kids might qualify for a main care or chip for example but you know some adults in the family may have coverage at work other adults may be able to get a plan through a marketplace maybe you have an older family member who has Medicare and you might also have some

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family members who are in one of the gaps you still don't have any coverage options at all and so families are having to juggle all these different programs and understand different kinds of coverage rather than being covered through one plan so why is this an important topic for us to talk about today well if people don't understand their coverage and we know that most people don't health coverage is extremely complicated the terms are difficult a lot of people don't understand their plans and how they work

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and if people don't understand their coverage that may impact how they access the healthcare system and whether they're compliant with their medications in their care also you know as I said on the last slide more and more families are juggling multiple of coverage and that can be a big burden on them and as health professionals you all can help so patients are more likely to want or need to learn about their coverage when they're actually accessing the health care system and there's also

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a lot of research that shows that people trust their health professionals when it comes to learning about their their health coverage and how it works even more than they trust their health insurance company so you are a trusted source of information that people will be looking to so I just want to give a short example is a real example from a family that we met through our help line that shows why this matters so we helped a self-employed couple get signed up for insurance for the first time I'm is the

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first time they'd have private insurance and most of their adult lives a couple months later one of them got injured on the job I believe he injured his foot or his leg but he was afraid to go to the emergency room because he thought that he would have to have his entire deductible in his pocket ready to pay or he wouldn't be able to get service and so he didn't go to the emergency room he didn't go to the doctor's office he waited and by the time he actually

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access care he was in danger of meeting his leg to be amputated because he had waited because he was afraid of how much that would cost him so clearly it has a big impact on how Pete spacious actually access their care alright so now that we understand how important it is let's just learn a little bit about the marketplace which is the the plans that are available through the Affordable Care Act now i'm also going to add we're

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not going to go into the nitty-gritty with either the marketplace or main care today if you are really interest in learning more about those programs we have some other resources we can point you to we'd be happy to answer questions so I'm just going to give at this point a very basic summary so the marketplace these were created for it through the Affordable Care Act's a law that was passed in 2010 and as part of that each state has an exchange or what we now call a marketplace so each state has a

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marketplace in some states the state built and runs their own marketplace and other states the federal government runs that marketplace for the state and that's the case in Maine we have the federal government running our marketplace which is why we use healthcare.gov the goal of the ACA was three parts to increase affordability to increase quality and increase access to coverage so let's kind of look at through how that those goals played out

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with an example family so here let's meet our marketplace family so katie is a self-employed psychotherapist Erin works up in animation studio awesome animations they have a little girl lucy before the ACA kate had an individual policy and erin was covered at a bigger company but now he's out awesome animations which doesn't offer coverage because they are pretty small group

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their federal poverty level based on their income in their household size is about three hundred and seventy-five percent and their households right now is three they have three people in their household so what would they be eligible for when it comes to marketplace plans most people actually are eligible to purchase plans on the marketplace the big question is who is eligible to get the financial health that makes those plans more affordable so some people if

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your income is between one hundred and four hundred percent of federal poverty you can get help with the cost of your premium if your income is between 100 and 200 and fifty percent of federal poverty you can get help with your out-of-pocket costs through a cost-sharing reduction whether you qualify for financial health depends on your income how big your household size is that used to calculate the federal poverty level your citizenship or immigration status and also whether you have any other kind of

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coverage available to you so our Kate and Aaron eligible for the marketplace they are they can buy a plan and because their income is under four hundred percent of federal poverty they're able to get tax credits that make their premium more affordable every month because they are over two hundred fifty percent of federal poverty they are not eligible for cost-sharing so on the marketplace the amount of health that you get is on a sliding scale that means

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people with lower income and more household members get more help in people who make more money get left help so where you fall on that scale will determine how much your premium is and how much help you get with cost-sharing marketplace plans have varied levels of cost-sharing and so in general in the marketplace you can find plans that are bronze silver and gold in other states there are also platinum plans but we don't have platinum plans here in Maine because our insurance companies have

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chosen not to offer them those levels are based on actuarial value or on average how much you pay for your health care and how much your plan pays for your health care so for bronze plans for example the plan is paying for on average about sixty percent of your health costs and you are paying forty percent those plans typically have a lower monthly premium that you pay more out of pocket when you actually get care and young adults and people with

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hardships can also get catastrophic plans those are plans with even higher out-of-pocket costs and that don't have any financial help available to purchase them and some people who apply to the marketplace may also find that they or a family member actually qualifies for Medicaid or main care so with that we're going to move to our first question and I'm going to give you some thinking music in about thirty 30 seconds for you

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to answer why you think consumers find insurance difficult great so you guys did great clearly you realize that there are many reasons that consumers find it difficult to navigate their health insurance you know it involves some sophisticated mask to understand out-of-pocket costs deductibles copays co-insurance some of the costs are unknown it can be very difficult if not impossible to know how much a service is going to be and how your insurance will cover it before you

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actually get that service and there's also a lot of really complicated specialized terms that people need to need to get comfortable with to really understand their plan things like you know premium co-insurance explanation benefits so so good job alright we're going to move on and just to talk a little bit more about the marketplace so you can apply a number of ways people can apply to the marketplace online at

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healthcare.gov you can also apply by phone or many people have applied with in person helped through navigators Certified Application counselors or brokers all of whom can sit down with you and help you understand your options and sign up for a plan and get any financial healthy you might qualify for and we'll talk a little bit more about how to access that help later in the presentation there are deadlines for when you need to apply for most people the most people must sign up during open

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enrollment for this year that open enrollment period starts on November first it goes until January 31st of 2016 and most people need to sign up by December 15th in order to get a plan that would start on january first so in order to be covered for the entire year of 2016 now some people if you have certain life events happen to you you can actually apply outside of open enrollment

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during a special enrollment period and here you can see a list of many of the more common examples of Special Enrollment Period triggering event so if you move to a new area you get married you lose the coverage that you had to work etc I'll just note that getting divorced is listed on this slide it actually is only a special enrollment period if it causes loss of coverage or change independent status on its own without getting into the nitty-gritty it

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doesn't trigger a special warm-up period on its own so back to our marketplace family Kate and erin so now that they've understood what they qualify for they were enrolled in a marketplace plan they signed up during the first open enrollment period within a sister so with a navigator or application counselor they found that a sister through enroll 207 com which is a great website that you should book mark if you haven't already and then during the second open enrollment period for their

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2015 plan they r Ian roll themselves using healthcare gov now that they're familiar with the system so here's your next pop quiz how many essential health benefits must be available in marketplace plans and again I'm going to give you some some thinking music great well many of you are right on target others you know this might be some new information for you so what we'll just move on to the answer

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essential benefits are those services that marketplace plans have to cover so there are ten essential health benefits that's 10 categories of benefits that every plan on the marketplace and most plans outside of the marketplace in fact have to include now to be considered health insurance and it's these are all things that you would assume would be covered under health insurance but before the Affordable Care Act unfortunately many of them were not so includes things like hospital stays

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prescription drugs mental health services maternity and newborn care etc so our marketplace family back to them Erin and Kate signed up for a plan and they liked the benefits especially because when they would started being covered through this plan they decide to add to their family and have another child so with that I'm going to pass things over to Mary who is going to talk more about another way many families get coverage which is through main care good

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afternoon everybody we are going to look at the basics of main care and then eventually we'll get into doing some comparing and contrasting between main care and the marketplace so the Affordable Care Act intended that there'd be no gap between Medicaid or main care and entry into the market place without with subsidies but because Maine has not expanded Medicaid we do unfortunately have a gap so these fpl numbers that you see on the slide those are the

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poverty level limits for parents at 105 percent and children at two hundred and fourteen percent these are the current cut-offs in Maine they both include a standard five percent ACA disregard the cut-offs could be different from state to state but the five percent disregarded standards across the country this is a little slide that we've developed to give people an idea of what we call the universe of mean care and

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you can see that Medicaid is funded jointly by the federal government and states in Maine we call our Medicaid program main-care other states may have special names for their Medicaid programs as well in Maine Maine care is administered by D HHS and it is a needs-based program and so here is another quiz for you so take a few seconds to fill out your answers it looks like this is a very smart group

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again the answer was all of the above and so similarly to the problem with the marketplace people the public in general is very confused about these programs what their cover what covers what they would have covered you know what services would be covered or even if they have coverage at all and so now we are going to introduce you to a main

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carry this is laura and Karl there are both self-employed musicians and they have a five-year-old child named Harry so are they eligible for main care let's look at the rules first so who is eligible this is confusing too because there are over ten categories and every one of them has its own income bar some non Stanley categories may have asset bars as well in addition you do have to be a resident of the state of Maine and

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you must be here legally at least five years or a citizen unless you are a child or pregnant so those are the criteria and so our Lauren Karl eligible well Laura and Carl can apply in the parent category because they maintain a household for a child and so yes they currently meet that income bar because their income was less than one hundred and five percent and Harry also meets the income bar for children in addition they are residents of Maine and they're

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all three citizens so there are different ways to apply for Maine care like there are different ways to apply for the marketplace people can use paper applications although that is not as popular anymore there is my main connection which is an online portal that's great if you have access to the Internet many people still don't every main care office now has a kiosk with an online portal and additionally if you

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apply to the marketplace and are deemed to be eligible for main care instead the marketplace does directly send your application to make care or 2d HHS so Laura and Karl did apply for main care in 2013 originally they had enrolled in the marketplace but then they did their taxes after the new year and in February of 2014 they showed a lower income which made them then eligible for main care so

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they had to switch over they enrolled online at my main connection it did take a couple months to hear back now during those couple months Laura actually required emergency surgery in the middle of the night her bills were in limbo for a while but eventually they were paid by main care so we're going to look at coverage now and a lot of I've answered the help line here at cake for a long time and people often ask is coverage

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good when you have mean care and that depends on who you are for children the coverage is very comprehensive for parents it's pretty good too but it does actually vary from category to category it's not the same coverage just like the income cutoff is different for each category so is the coverage so we're going to move into the portion of the webinar where we're going to look at differences and similarities between main care and the marketplace and we

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have created a handout for you that's very user-friendly that we're going to be sending you by email or that quality council send you which will summarize these similarities and differences for you to use as a reference so we're going to look at networks first main care networks are very black and white either a provider is in or not if a main care member visits a provider who is not a main care provider but the provider does until the member that the service won't be covered that member

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can't be built for that service so there is a built-in protection however when somebody is a new main care member they really do need to ask any providers that they've been seeing whether they take me care or not because if they don't take maker they the member will need to switch so contracting main care networks to marketplace networks you can see marketplace networks are very tricky because each marketplace insurance company has its own network and some

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insurance companies even have different networks in different parts of the state and so you guys probably know this but the general public especially people who are newly insured may not realize that services that are received out of network without prior authorization will be more costly so Aaron remember the marketplace family Aaron needed lake surgery luckily his marketplace plan had broad networks it was easy to choose a

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doctor he liked well maybe not that easy it actually took them all summer to you to choose but he was fortunate enough to have choices and on the other hand Laura needed emergency surgery all main hospitals do take me and care but many doctors don't however lucky for her main-care covers emergencies regardless of network so just to explain about chip chip is funded by a separate law and in some states is considered to be a fully

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separate program but it made for simplicity it is rolled within the main care umbrella chip is the only family man care category that has a premium and people members of chip which is only for children but parents of chip children do get a each month if they don't they they do have a grace period of a whole year but if by the end of the whole year they haven't paid up for the entire 11 past month they will their child will lose

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coverage they get a three-month coverage loss penalty and so it's important for chip families to keep track of those bills it is possible that the bill may not show up so they families do need to be aware of that so to contrast that marketplace premiums vary widely they depend on age County and smoking status this is because on average different ages are associated with higher or lower levels of health and also on average

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some counties are healthier than others and then again the final cost of the premium will depend on the amount of the subsidy if family is eligible for and as we mentioned earlier subsidies will be dependent on the income and household size which translates into the federal poverty level so we're going to look at cost-sharing now main-care has very little cross sharing main-care cost-sharing consists of co-pays and

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they are never more than three dollars and in addition as a further protection there are daily and monthly copain max's to protect some people that have many services and medications and in as well children and pregnant women are exempt from co-pays then on the other hand we go back to the marketplace plans and Emily mentioned earlier that there are different levels we have bronze silver

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and gold primarily in Maine and then if you take the silver plans people below two hundred fifty percent have and additional three different levels of cost-sharing so people whose incomes are very low can get ninety-four percent of their costs covered and you can see on the chart that there are those three ranges of that and once a family becomes eligible or chooses a silver plan and there are eligible for this cost sharing

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it actually makes the silver plans be almost a hundred percent identical and that is something that the public may not be aware of oftentimes they might pick the highest silica plan but if they have cost-sharing reductions they probably don't need to in most cases okay so here is a quick question for you how many levels of cost-sharing in marketplace plans are there all together take a few seconds

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so the way I would answer this question is there are catastrophic bronze silver gold or platinum that's five and then you can also take the silver and divide it out into three more levels so that would make eight that's the answer that I got but I think it's a complicated answer so no wonder the public is confused about this okay so cost-sharing

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is confusing there are a lot of levels but there's also a lot of pieces to it cost-sharing includes co-pays coinsurance and deductibles in marketplace plans and also also out-of-pocket maximum is considered part of cost-sharing too but it's kind of the protection it limits the amount of whoever have to pay in any one year and what happens if you forget to pay I'll

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remember back we talked about chip premiums that's the only regular family main care program that has a premium and you have a up to a really a 12 month grace period but with marketplace plans if you do have an advanced premium tax credit you have a three month grace period to pay up before the plan is terminated but here is something that messed a lot of people up that's only true if the first payment is made prior to the start date and that just in

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itself can be tricky so now we're going to discuss actual payment name so Kate and Erin do have cost sharing so remember Aaron had to have Lake surgery well they bought a gold plan and they have inducted below five hundred dollars and that means that their coinsurance or the part veo of other bills is twenty percent so the leg surgery just about ten thousand dollars in total including the physical therapy that he

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had to go to afterwards they had not paid anything into their deductible yet they would have paid that five hundred dollars they would also have been expected to pay about nineteen hundred dollars for their coinsurance and also laura has surgery remember but she didn't have any cost sharing there was you know because she doesn't think it was no deductible or coinsurance okay so

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now we're going to move on to really looking at ways that both programs are similar and you get to hear Emily's voice again thanks Mary alright so I'm going to wrap this up and get us into some time for discussion and questions so let's look at the similarities between main care and marketplace plans so both men care marketplace plans do you require prior authorization for some services meaning that you basically need to get a go-ahead before you get some kind of service or care main care

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providers must warn members if a service isn't going to be covered by their main care but if you have private health insurance including marketplace plans providers are not legally required to warn you if a service won't be covered and so sometimes people will go and get a service and then be surprised that they are paying much more than they expected because it turns out that service is over through their plan or maybe they get a surgery and find out that the anesthesiologist was not covered through their plan so it's very

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complicated for people to navigate and understand and because it's so complicated there do need to be some protections in place for both programs so if someone has care that is denied if they're denied coverage if service is not covered there is an appeal process for both main care and the marketplace it's a complicated well it's a fairly complicated process I'm not

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go into in detail today except for her to say that we can help so if you have somebody that you know how a patient or client yourself even you might need understanding what your rights are to a people is made by your insurance honey or maybe I main-care we can help with that and we also work really closely with our partners at main equal justice partners on main Cara peels there are different kinds of ella's of F denials

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and appeals it can include things like whether you're eligible for our program so sometimes people apply to the marketplace they're told they're not able even though they think they should be that's something that can be appealed it can also be for actual coverage for a service that you want to get in the future or something you've already provided so again it's a complicated thing for consumers to understand feel comfortable with but we can help another

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similarity with both the marketplace in Maine care is that you do need to report changes in your household or your income to either programs so if you get a raise or you lose some income or if you add or lose a family member that's a change that you need to report so you must report income or household size changes within 10 days to main care the marketplace also expects that you report changes to them people who are getting

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tax credits to the health insurance marketplace are expected to update their accounts as soon as possible that's going to affect how much assistance surveying they may get more assistance they may get less depending on what change happened if somebody experiences a change in their household size are their income and they don't report it they will have to reconcile this at tax time that's because your eligibility in the health insurance marketplace is

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based on your projected income for the year and then if your actual income ends up being different than what you would put in your marketplace application you have to kind of settle up with the IRS so if you got too much in tax credit to pay some back if you didn't get enough you will get additional money back which is great but the problem would have been even better if you were paying the right amount through the entire year so it's very important to keep the marketplace updated about changes speaking about

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that conciliation cross process there is a cap on how much most people would have to pay back to the marketplace even if they were getting the wrong amount of help throughout the year so for most people there there's a another to how much they would have to pay back so going back to our marketplace family Erin and Kate if they had a higher income for their household size then they had projected so they ended up making more money than they had thought

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they could owe money back to the IRS they would do that through the parent on tax return and for their family that the cabbie up to 2,500 dollars because they are a family and their income was between 300 and 400 percent of federal poverty now you'll notice their income landed them outside of that income range which actually made more than four hundred percent of federal poverty they would be subject to paying back the entire amount of tax credit that they

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received throughout the year again that's another reason why it's very important for people to update the marketplace as soon as a change happens because that could potentially be a big big expensive tax time that people weren't expecting so if it's talking about Erin and Kate again if their income with less they would get a larger refund at a time this is true you know since they had a child during one of

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their coverage years their household ends up being bigger that changes their federal poverty level and that would change the amount of credit as well now presumably they would have reported that so that their new child would be covered under their plan but that's also exchange that needs to be reported or else they wouldn't be getting assistance as they should have now a little wrinkle here with reporting changes through the marketplace if you are one of those families that is getting financial help with your out-of-pocket costs through cost

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reductions so remember that people whose incomes are below 250 find a federal poverty and their income changes and brings them out of that income bracket and then their premium deductible and car insurance could change quite a bit and the same if your income kind of changes within that Brett you can get a different level of cost sharing then you had been getting so maybe if your if your income had put you in the lower range you're making like a hundred fifty

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percent of federal poverty you have had a plan that had a two-hundred-dollar deductible and a very cheap premium if you got a raise and suddenly your income with two hundred percent you might see you both your deductible and your premium go up and again it's something that you want to report right away although those cost-sharing reductions are not something that you have to reconcile at tax time now another thing

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that must be considered is when you report changes in the marketplace sometimes if your income has gone down or you have some other change in your family this may make somebody in the household eligible for main-care and the way that these programs work is if you are eligible for Maine care you are no longer eligible for financial help that's available on marketplace so this actually happened with the main care family we've been talking about Carl and Laura they started out in the

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marketplace plan but when they realize their income in the next year what's going to be lower that moved them over to the main care category so not only do people have to navigate these very complicated grams that they need to navigate moving between each program potentially you know each year as income change of fluctuating because we know that many people in Maine have fluctuating income dependent on seasonal jobs and other changes all right well we are winding

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down towards the end now we'll be ready for questions just seconds but before that we wanted to give you just ten seconds to think for a minute and jot down the three most important differences between main care and the marketplace that you would want to make sure to share with your clients or patients all right well hopefully that

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gave you a chance to reflect and think of some of the things that stood out for you here are a couple that that really stand out for us as important for people to understand one is that you know unlike the marketplace where there's an open enrollment period you can enroll in Maine care any time people also need to understand that if they don't pay for their marketplace plan they are in danger of losing it people in both programs need to understand how networks work and where they can go to access

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care especially for the marketplace where networks might be a little more limited or confusing to navigate it's also important for people to know that mistakes can happen in both programs and there are people who can help you if one of those mistakes has happened to you just a couple other things that we would highlight for you that you may all want to know is that I may encourage Nile is official only when it's in writing we also have seen a lot of people who sign

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up for marketplace plans and have trouble with their their premium automatic payment remember if you're not making your premium payment every month you are in danger of losing your coverage so you know if you said if you thank you set up an automatic payment and you don't that's the place that people can get really tripped up so just to wrap it up I just wanted to emphasize that this is something that as people who are you know within Maine's healthcare system you all can can help

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patients navigate this as I mentioned at the beginning patients are already thinking about their health care and their health coverage when they're interacting with the health system and so this is a good point where we can intervene and make sure that they that patients understand the coverage they have because if they don't understand their coverage they may not use it appropriately because they're afraid of how they'll be constant they'll be charged so be sure to ask your patients questions about if you know ask them if

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they have questions about their coverage if they understand their coverage if they have concerns about their coverage and if you're explaining concepts like deductibles or co-pays to them we would recommend using a method called axtell ask which is basically you ask them a question you explain the answer to them and then you you ask them to make sure that they to kind of explain it back to you it's kind of like the teach back method which many of you are familiar with and along those lines you know

49:02

whenever you have a chance to invite clients or patients to ask questions about their coverage that they may have it would be a good idea to do that understanding that the systems are so complicated for patients to navigate and the good news is you don't have to figure this out alone this doesn't have to be you know necessarily a new task that you all would have to take on there are paid their are people who can help the people that you are serving fixes

49:35

issues and so who can help you well we've mentioned our helpline a couple times this is something that we're ready to assist people with if they're having issues with their coverage the main Bureau of insurance is also a great resource for people who are having issues of private insurance with denials with other issues with their insurance company and as we've mentioned a couple times there are also people called navigators and certified Application counselors those are people working in nonprofit health

50:07

systems other sites across the state who provide free assistance to people free unbiased assistant signing up for coverage in the marketplace and brokers are also available to do that as well and so if you think that you know your patients and clients may need some help navigating their options or understanding how to use those options you could probably find a navigator or certified application counselor in your area who would be only too happy to come and drop off materials for you to do an

50:40

outreach event at your site and you can find them by going to enroll 207 com which is a great website that was developed by the main Health Access foundation help people find main specific resources and with that we do have some time for questions so I'm going to sit back and see if you guys have anything you want to ask or anything that we didn't answer and I

51:11

believe you can use the chat box if you'd like or you can also raise your hands and I think quality counts can unmute you in that case yes we can or you can unmute yourself by hitting the star and seven keys on your phone so while you're kind of gathering your thoughts about questions you may have I will say that if you want to learn more about any of these specific programs there are a number of great resources

52:03

that can help but one thing I would plug is that Mary together with some other people here at cake does a great one day workshop called main care where the mark marketplace main care and more that gives more details about both programs so if this is really you know what is your appetite for learning more about how this works for people in your community that is a great place to go so Emily looks like we might be able to wrap up a little bit early great all

52:55

right well thank you everybody for joining us oh wait we have to see the music credits oh I see there's a connection here to this music well thanks very much and it was very informative and particularly helpful to get connections to other resources other sources of information if people need to access access those later on so thanks

53:26

very much for your help and for your presentation taking the time to put it together and to present it today wanted to alert folks to the next couple of webinars in this lunch & Learn series we have guests from Maine's VA system on jun 2nd talking about that system which is the nation's largest integrated healthcare system and on jun 9 talking

53:57

about expert remind me what that stands for Emily you remember it's a substance abuse substance abuse screening tool and that'll be on jus and night so June second at noon and june nine sat noon two upcoming Lunch and Learn webinars if you haven't gotten an invitation yet you probably will in your emails so keep an eye out for that and for men quality counts we'll wrap it up thanks very much for joining us and everyone have a great afternoon

Helping Your Patients Make the Most of Their New Health Insurance Coverage

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SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE