Being aware of the options in health care reform

With the implementation of the Affordable Care Act, or Obamacare, California’s healthcare system is undergoing some of the biggest changes since Medicare was introduced in 1964.  While this is an exciting development that promises to improve the overall quality of health for all Californians, it is sure to bring some challenges for people as they begin to purchase new types of health insurance coverage in new marketplaces.


The California Health Benefit Exchange developed Covered California to be a one-stop marketplace for Californians looking to secure more affordable health insurance. Through the Covered California website, due to launch this fall, Californians will be able to determine their eligibility for, and enroll in, various affordable health insurance programs, including plans subsidized by the government.


Given the complexity of the new health insurance exchange and the fact that many of its users will be uninsured, first-time consumers with little to no familiarity with the available care, Californians for Patient Care developed a consumer-friendly guide: “Healthcare Coverage in 2014: Five Things Californians Should Know.” This guide empowers consumers to know their options and the resources available to make the right healthcare decisions for them and their family.


However, it’s also important that the exchange board and policymakers understand and anticipate the needs of consumers. This will help ease the transition to this new healthcare marketplace. As the exchange programs are developed, we urge Covered California and others to strongly consider the following points to protect, inform and enable consumers:


Implement a user-friendly website. Consumers should be able to easily navigate the Covered California website. People using Covered California’s website will have different levels of skill and confidence in using computers and the Internet. Covered California must be mindful of these differences and make its website as easy-to-use as possible.

Simplify the cost explanations. Consumers should be able to easily determine what differentiates each of the plans for which they are eligible, including cost, benefits and provider networks. Covered California should clearly explain the different coverage and cost options, including premium costs and additional shared costs that consumers may be responsible to pay. Consumers should also be made aware of the costs insurers must pay.


Define risks and penalties. Consumers will need to receive clear information that details the risks and penalties if they choose not to secure health insurance, through Covered California or elsewhere, by January 1, 2014. It also is important for consumers to understand the consequences if they default on their premium payments. Failure to pay insurance premiums may result in the loss of health insurance for a period of time. If options exist that allow consumers to resume premium payments, those options and processes must be thoroughly explained.


Make personal assistance available.  Consumers should be able to receive answers to their questions about Covered California, or the insurance plans offered through the website, from live people, in their native languages, at no extra charge. It is estimated that two million previously uninsured Californians will secure health insurance from Covered California. Because of their uninsured status, they may not be familiar with the current insurance market and at times may require immediate answers regarding coverage.


Seek prompt resolution of complaints and other issues. Consumers need to know to whom they direct complaints – if any – about their experience using Covered California. Some people may find the enrollment process frustrating or confusing. An unsatisfactory user experience will compound that frustration; consumers should be able to immediately seek resolution to problems they experience. Further, consumers should be able to obtain information about how to resolve a problem with, or file a complaint against, the insurance plan purchased through Covered California.


Lastly, to ensure the greatest possible patient/consumer satisfaction, the Covered California website must provide understandable explanations about how to manage their insurance policy after enrollment. Consumers need to know how to renew their policies through Covered California, how to switch to another plan once enrolled and how they will be notified of changes in their benefits packages after enrollment.


With changes happening daily in healthcare reform, it is important for all Californians to be fully aware of their options and the resources available to them so that they may make the best healthcare decisions for themselves, and their families.

Ed’s Note: Carmella Gutierrez is president of Californians for Patient Care, a nonprofit organization dedicated to protecting the interests of patients and ensuring all Californians have fair and equitable access to high quality healthcare. 


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