Preparing for health insurance enrollment

Questions answered at next week’s event

By Jason Starr

Observer staff

There is a tightened window this year for Vermont residents to make changes to, or enroll in, health insurance plans under the federal Affordable Care Act.

The Williston Observer — along with BlueCross BlueShield of Vermont, MVP Health Care and the Vermont Department of Health Access — is presenting a free seminar next Thursday, Sept. 28, to help area residents make their best health insurance choices for the upcoming year.

“Health Insurance 101” begins at 6 p.m. at the Dorothy Alling Memorial Library. Sean Sheehan, state deputy director of Health Access, Eligibility and Enrollment, will speak and take questions during the two-hour event. Representatives from BlueCross BlueShield of Vermont and MVP Health Care will also be on hand to answer questions.

Sheehan has worked for the department for five years and is a veteran of public education events on health care. He is prepared to answer questions about people’s individual circumstances, explain the different health insurance options and their costs and point people to “plan comparison tools.”

He is also eager to explain strategies for people to get the most value out of their insurance plans.

Questions from Vermonters in the lead up to open enrollment often focus on understanding health insurance terminology, evaluating income-based state and federal subsidies and assessing the effect of changes to individual circumstances, Sheehan said.

“It’s easy to say ‘what plan does everyone else have? Put me in that one.’ In actuality, everyone’s health care needs are different,” Sheehan said.

Insulation from federal cuts

Open enrollment runs from Nov. 1 to Dec. 15. It is the only time of year Vermont residents can enroll in or make changes to their health insurance plans for the upcoming year, barring a “qualifying event” like a change in employment or marital status. People currently enrolled in an insurance plan will be automatically re-enrolled in the same plan for 2018 if no action is taken during open enrollment.

The federal government, under a new administration for the first time since the Affordable Care Act was passed in 2010, reduced the enrollment period to six weeks this year from the 12 weeks that were provided the past two years. During the early years of the Affordable Care Act, open enrollment stretched from October through March.

According to Sheehan, the federal government also decreased funding for advertising and human resources in support of the open enrollment period this year. Those cuts have a greater impact on states where the uninsured rate is higher, Sheehan said, where there is a greater need to recruit first-time enrollees in health insurance to support the system as a whole. A majority of states also rely on the federal online health insurance exchange to comply with the Affordable Care Act. Those states are more affected by federal cuts than Vermont, which has built its own online exchange, Vermont Health Connect.

During a 2015 check, Vermont’s uninsured rate was the second lowest in the nation at 2.7 percent, according to Sheehan. He said while the Department of Health Access has lost federal grant funding for health care “navigators,” the state’s provider networks and social services organizations have more than picked up the slack in public education.

Familiar plans

Both BlueCross BlueShield of Vermont and MVP Health Care  offer the same six standard plans under the Affordable Care Act. Each company also offers four non-standard plans. Bare bones “catastrophic” plans are available to people under the age of 30.

There is one new standard plan both companies will offer in 2018, according to Sheehan, a higher-deductible plan without an out-of-pocket cap for prescription drugs. It’s a lower cost plan suited for someone without major prescription drug needs.

Sheehan won’t be able to recommend which plan is right for people during next Thursday’s event.

“We give people tools to make an informed decision,” he said.

Vermont health connected

The state health insurance exchange, Vermont Health Connect, has recovered from the technical problems it faced since its launch in 2013, according to Sheehan. Up through the spring of 2016, the website was unable to reliably process change requests like qualifying events or address changes.

A backlog of change requests had built up, leaving consumers who had requested changes unsure what their health insurance status was.

Sheehan said the website is now reliably processing change requests in 10 business days.

“We still have room for improvement, but overall the system is working much better,” he said. “It is in a good place and operationally ready to support this coming enrollment period.

“As far as being a long-term solution, that is still an open question,” he added, referring to potential changes to state and federal health care policy.

“There are a lot of big policy questions,” Sheehan said, “but what’s in your control is choosing a plan for 2018.”