Helping Consumers Understand
How to Use Their Healthcare
Coverage
PRESENTED BY:
LEIGH GRAUMAN, LSW
PORTICO HEALTHNET
Topics for Today
 What we know about new enrollees
 What’s so important about accessing health care
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coverage?
Confirming coverage
Educating enrollees on how to use their healthcare
coverage
Resources
Q&A
MNsure Enrollment Numbers
Over 200,000 people enrolled in health insurance
through MNsure during 2014 Open Enrollment!
Total
200,174
Medical Assistance
108,675
MinnesotaCare
41,403
Qualified Health Plan
50,096
Source: MNsure press release 4/23/14
New Enrollees Want Access to Care
Source: Enroll America
Many New Enrollees Don’t Have Usual Source of
Care
Source: Health Reform Monitoring Survey: Urban Institute Health Policy Center
Knowledge Gaps in Health Literacy
Health literacy is the
degree to which
individuals have the
capacity to obtain,
process, and understand
basic health information
and services needed to
make appropriate
health decisions.
Source: Enroll America
What’s so Important? Primary Care
 Ability to get care when you
need it without having to
worry about cost
 Primary Doctor gets to
know you and your family
and your medical history
 Referrals to Specialists
 “Everyday” care
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Cold
Flu
Earache etc.
What’s so Important? Preventative Care
 Detect problems early
 Health care law makes
many preventative
services free!
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Screening mammograms
Flu shots
 Reduce number of work
days missed due to
illness
What’s so Important? Cost Savings
 Don’t have to worry about
getting stuck with a large
medical expense
 Insurance companies
negotiate rates with
providers which lowers
costs for enrollees
(generally 40% savings)
 If you go without Minimum
Essential Coverage you
may have to pay a penalty
when you file your 2014
Federal tax return
Source: CMS National Training Program
Confirming Coverage
 MNsure online eligibility determination is
preliminary- important to confirm coverage
 How to confirm depends on program
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Assistor Resource Center (for certified Navigators)
DHS Member Helpdesk
MNsure Contact Center
Health Plans for QHP
Counties
 Permission to Share Information
 Help client collect important information
 PMI, Case Number, Effective Date
Choosing a Health Plan: Public Programs
 Completing Health Plan Enrollment Form
 Form must be returned within 30 days or client will be
enrolled in a default plan
 Amount of paperwork from health plans can be overwhelming
for clients
 Important to explain that MA and MNCare plans have basic
services that must be covered- coverage very similar from plan
to plan.
Choosing a Health Plan: Public Programs
 Do you have a regular
Doctor or clinic?
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Listing for each network’s
clinics on DHS edocs website
Can also call plan’s customer
service numbers
 Things to consider when
choosing plan:
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Is my clinic in network?
Is there a clinic close to my
home?
Language and cultural needs
Scheduling Appointments
 Offer to assist with
scheduling
appointment
 Use of Interpreters
 What to bring to
first appointment
Resources
 CMS Presentation on Health Literacy:
http://marketplace.cms.gov/training/gettraining.html
 HealthCare.Gov (Spanish and English)
https://www.healthcare.gov/using-your-newmarketplace-coverage/
 Other suggestions? Languages? Things you have
created or use?
Questions?
Sources
 Enroll America: The Affordable Care Act’s First Open Enrollment
Period: Why Did Some People Enroll and Not Others? conducted by
PerryUndem Research/Communication and funded by the Robert
Wood Johnson Foundation and The California
Endowment:http://www.enrollamerica.org/resources/publiceducation/why-did-some-people-enroll-and-not-others/
 Health Reform Monitoring Survey, Urban Institute Health Policy
Center: http://hrms.urban.org/briefs/Who-Are-the-NewlyInsured.html