I-Team: Answers to your Health Connector questions

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Millions of people in the United States do not have access to health care. The cost of medicine and medical care continues to rise, as does the cost of health insurance. Trying to wade through the information to make the best decision for you and your family can be confusing and frustrating.  

The 22News I-Team has received many calls and emails from people with questions and concerns about health insurance, whether it be Mass Health or private pay. We posed some of our viewers’ questions and concerns to the Massachusetts Health Connector.  This is what we found out.

1. Some people say that when they sign up for a health plan, many doctors do not accept the plans and they have to find new doctors that do. Some doctors are not taking new patients or there are months long waits to see the doctor. Some of these people have chronic illnesses that need specialists and prescriptions refills and are frantic.
“The Health Connector provides access to more than 50 plans from eight carriers across the state, but not all plans are available in each region. In Springfield, for example, there are 39 plans from all seven carriers available.
Each carrier has a network of providers that provide services to patients. We understand that having the right doctor is an important part of a member’s coverage, and we consistently remind the public and our members to shop and ensure their preferred doctor or facility is in the network of the plans they are considering.
The Health Connector’s website includes a search tool that lets users see what plans their doctors or providers participate in. This ensures a member can verify their doctor is in the plan they want to choose.
We also strongly encourage applicants and members to consider seeking out face-to-face assistance when picking a plan, whether it is from our walk-in center in Springfield or from local Navigator agencies like Caring Health Center in Springfield, Hilltown Community Health Center in Huntington, or the Community Health Center of Franklin County. These trained experts can help people review their options and pick the plan that best meets their needs.
The Health Connector provides a wide range of information to members, including a provider search tool, a tool to compare plans and their offerings, and the statement of benefits and other information from carriers. You can view all the carriers’ plan information here.”

2. Some doctors who apply to accept the plans are told they have to wait until October 2018 to apply. 
“The participating doctors and facility in a network is based on a carrier’s contracts with those participating providers. The Health Connector does not play any role in those provider contracts between carriers and providers. We do ensure carriers have adequate network size, so that providers are available within a reasonable distance for members.”

3. What is the explanation for why the premiums and deductibles are so high?  
“Plans offered by the Health Connector are part of the Commonwealth’s merged market of individuals and small businesses seeking health insurance. Those plans are reviewed by the Division of Insurance.
According to data published by the federal Center for Medicare and Medicaid Services, the Health Connector has the lowest average premium cost in the country. The average premium for Health Connector plans is $385, which is nearly $30 lower than the next Exchange. The premium costs for Health Connector plans reflects that even though Massachusetts is a high medical cost state, having a strong, competitive Exchange can help reduce the impact of premium costs. Health Connector premiums are driven by carriers eager to participate in the Health Connector, and the availability of those plans extends to small businesses and individuals in the entire merged market.
It is important to note that the Health Connector’s ConnectorCare program provides state and federal subsidies to lower-income residents (who earn less than 300 percent of the federal poverty level). Plans in the ConnectorCare program include low monthly premiums (including $0 plans for the lowest income levels), low co-pays, and no deductibles, making health insurance more accessible to people who earn less money.
Health Connector plans also have some of the lowest deductibles in the country due to coverage standards enacted as part of the state’s requirement to carry health insurance. ConnectorCare plans offer coverage with no deductible to individuals with low- to middle-incomes, and most other plans have a deductible no higher than $2,000 for an individual or $4,000 for a family.”

4. Why do patients have to pay the deductible up front before getting prescriptions covered at a lower cost?
“This depends on the plan. Some plans include drug costs in the deductible, but many do not. The plan details for each plan outline the plan’s rules in regards to what is and isn’t subject to the deductible. Through links to plan details and other material available on the Health Connector website, applicants and members can review information, including premium amount, deductibles, co-pays and rules to ensure they are finding a plan that best meets their needs. Someone who needs a significant number of prescriptions will likely want to find a plan that does not include the deductible in drug payments, for example.”

5. Why are insurance companies allowed to “call the shots”…aren’t they regulated by the state or federal governments?
“The state Division of Insurance is the entity that regulates insurance companies in Massachusetts, including health insurance carriers. Through the state health care reform effort established in 2006, the Commonwealth put in place minimum creditable coverage standards that mandate plans include certain benefits for members. You can find out more about those minimum standards here. It’s important to note that the state individual mandate requiring adults to have health insurance is still in place after this year, even as the federal penalties disappear next year. The mandate requires residents have coverage that meets those minimum creditable coverage standards.”

6. Is the MassHealth program for no income or low income persons paid for by premiums paid to the Mass Health connector insurance plans? Where does the money for Mass Health insurance coverage come from?
“Private insurance premiums do not pay for MassHealth coverage. State and federal monies fund MassHealth programs (MassHealth is Massachusetts’ Medicaid program.) Learn more about the MassHealth budget here.

7.  Many people say they are forced to have health insurance they can’t afford to begin with and then don’t use it because they can’t afford the out of pocket deductibles. 
“The Health Connector and the Commonwealth remain concerned about the cost of health care. Through the ConnectorCare program, lower-income residents can access private plans that have low premiums and co-pays, and no deductibles. Because of the state’s commitment to providing access to affordable coverage to everyone, and the carrier competition in the ConnectorCare program, the Health Connector has the lowest average monthly premium of any Exchange in the country.”

8. Each person that calls me to complain is extremely frustrated and can’t seem to get answers when they call, or a different answer when they call….if anyone answers the phone. These are people who are paying directly for health insurance because it is not offered through their employers.
“The Health Connector has worked hard since 2015 to improve customer service, including making the call center more accessible to people who need help. In the last year, since May 2017, the average speed to answer has been under two minutes every month, including during the busiest times around Open Enrollment. We consistently work with our call center representatives to ensure they are providing accurate information to members, and retrain employees when we identify issues. The Health Connector also provides to members an Ombudsman program. Some cases can be quite difficult manage, even for the best call center representative. Our Ombudsman staff can work directly with members to solve their problems.”

9. I have received several complaints about how people sign up and pay electronically through their bank accounts, only to go to the doctor or dentist and find out their coverage has been cancelled for non-payment, despite having bank statements that clearly show the amount has been deducted.  And again, the customer service people are no help.  Several members have ended up having to take a day off from work to go to a service center to get it taken care of.  Even the navigators are perplexed as to how this happens. How does that happen? 

“This is an area where we would need specific details on the member in order to review the member’s account and understand what happened.
 We understand that many people have questions when it comes to their health insurance, and we try to provide as much as help as possible, whether it is in-person assistance or over the phone. We are constantly tracking the nature of members’ calls and questions, and training and re-training call center representatives as necessary. The Ombudsman program is available to members who have significantly difficult obstacles to overcome, and that program provides direct, one-on-one service to members to resolve their issue.”

Learn more about health insurance coverage and how to apply with the Massachusetts Health Connector.

Copyright 2020 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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