Pennsylvania's Health Insurance Exchange Navigators

What are Navigators?

The Affordable Care Act is funding certain groups nationwide to act as navigators to help guide Americans through the health insurance exchanges. They are to provide "fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions about [qualified health plans], and helping qualified individuals make informed decisions during the health plan selection process." To qualify for this funding these navigators must be affiliated with a community organization and must undergo extensive training. They must not be affiliated with the health insurance industry. Navigators will provide additional assistance to people who are disable, do not speak English, or who are not familiar with health insurance.

Who are the Navigators in Pennsylvania?

Five different organizations received federal grants to be navigators in Pennsylvania.

Resources for Human Development
RHD is based in Philadelphia and will work with consumers in Philadelphia, Montgomery, Bucks, Chester,  Delaware, Allegheny, Lancaster, York, Berks, and Lehigh counties, which have the highest rates of uninsured people.

Pennsylvania Association of Community Health Centers
PACHC will provide enrollment assistance to the underserved, typically rural, areas throughout Pennsylvania.

Pennsylvania Mental Health Consumers' Association
PMHCA is working together with the Mental Health Association in PA and Mental Health America Westmoreland County to provide enrollment assistance to people who use or need behavioral health services in their insurance plans.

Cardon Healthcare Network, LLC DBA Cardon Outreach
Cardon Healthcare Network operates in 33 states providing assistance to Medicaid enrollees. They are experienced in working with people who are financially stressed. They will provide individual consumers with assistance in finding a health insurance plan they can afford.

Mental Health America
The Mental Health America Navigator Initiative will work with underserved people who are uninsured or underinsured and who have behavioral health disorders. The National Office is the lead agency. the Mental Health Association of Southeastern Pennsylvania will work in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.

Nursing Home Report Card

Families for Better Care, a non-profit citizens advocacy group working to improve conditions in our nation's nursing homes and long term care facilities, has published a state-by-state report card for nursing homes. Pennsylvania earned an overall C grade and placed 26th in the rankings. Data was collected from the Kaiser Family Foundation, CMS's Nursing Home Compare, and complaint data from the Office of State Long-term Care Ombudsmen. Scores are averaged for the entire state; individual nursing homes are not listed. For more information on what information was included in the grades and how other states were ranked go to the groups website.

What Preventive and Wellness Services Are Covered by Plans in the Marketplace?

Preventive and wellness services are one of the "essential health benefits" that all health plans in the Marketplace must cover without charging a copayment or coinsurance, even if you haven't met your deductible. There are lists of preventive health services for adults and women, and a separate list for children. The list can be found at HealthCare.gov.

Deciding Between the Bronze, Silver, Gold, and Platinum Insurance Plans?

One of the decisions you'll have to make in the insurance Marketplace is whether to buy a Bronze, Silver, Gold, or Platinum plan. The plan names have nothing to do with the quality of the plan and everything to do with the amount of money you will have to pay out-of-pocket when you need healthcare. An out-of-pocket charge is the portion of the bill you pay to your doctor, the hospital, pharmacy, etc.that is not covered by your insurance plan. The Bronze plan will cost you less for the premiums, but you will pay more in out-of-pocket charges if you need care.

Another thing to know about the different types of plans is that they must offer the same set of "essential health benefits." These are the minimum requirements for all health plans in the Marketplace. The "essential health benefits" include:

• Ambulatory/outpatient services (care you get without being admitted to a hospital)
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment (counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices that help gain or recover mental and physical skills when you are injured, disabled, or have a chronic condition)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

Get Your Flu Shot for 2013-2014

According to the CDC, "manufacturers have begun shipping flu vaccines for the 2013-2014 U.S. season. Between 135 million and 139 million doses of vaccine are being produced. While some vaccine will be available in August, ample supplies should be available by September and October. Everyone 6 months of age and older should get their yearly flu vaccine, ideally by October."

More information on the 2013-2014 season can be found at the CDC website.

Healthy Roads Media has produced a few short videos on the flu for this upcoming season. They include inactivated vaccine,  the live (intranasal) vaccine, and reactions to the vaccine. There is even a mobile site. For more videos on additional types of vaccines go to the Healthy Roads webpage on immunization.

Where Can I Find Information About Health Insurance?

With October 1 fast approaching, consumers need to begin gathering information on their options for health care. There are several resources that can help you with this. HealthCare.gov is the federal government's main site for information about health insurance and the new law. Also, the Institute of Medicine created a resource center to help guide consumers in answering four questions:

• What are my choices for health insurance?
• How do I get it?
• How do I use it?
• How much will it cost me?

In addition to these slide presentations, there is a video and a printable consumer's guide.

The National Network of Libraries of Medicine Middle Atlantic Region has put together a page of consumer resources about the Affordable Care Act for people living in Delaware, New Jersey, New York, and Pennsylvania. Finally, the National Library of Medicine has a health insurance page where you can get information and links that may answer specific questions you may have. You can also sign up for e-mail updates.

Get Ready for the Health Insurance Marketplace

October 1 is the first day for open enrollment in the Health Insurance Marketplace. The enrollment period ends on March 31, 2014. If you live in Pennsylvania, your access to the Marketplace will be at HealthCare.gov. (Spanish language speakers, click on Cuidadodesalud.gov.) Coverage starts as soon as January 1, 2014.

 HealthCare.gov has all the information you will need to enroll. You can learn about different types of coverage, explore options, and compare plans. To start you'll need some basic information about your household income, your budget for purchasing a health plan, and any health benefits through your employer. Make sure you understand how coverage works and make a list of any questions you may have. You can get ready now by clicking here. 

You can also call for help. The following phone numbers are now open.

Individuals: 1-800-318-2596 (TTY 1-855-889-4325)
Customer service representatives-24/7 (English and Spanish/Language line for 150 additional languages)

Small business owners (SHOP program): 1-800-706-7893 (TTY1-800-706-7915)
Monday-Friday, 9:00 a.m. to 5:00 p.m. EST