In Oregon, 'assistors' there to help

Oregon has 1,300 people trained to help with health insurance applications

By Lily Raff McCaulou / The Bulletin / @LilyMcCaulou

Published Oct 6, 2013 at 05:00AM

As part of her job, Laurel Case has spent the past 31⁄2 years helping low-income families enroll their children in Healthy Kids, a state-run health insurance program. Until this week, after she got the youngsters signed up, she braced for another set of questions: “What can we do for the rest of the family?” “What about my 20-something child who doesn't have coverage?” “What about my husband, who needs to see a doctor, too?” It was a constant source of frustration for Case — not to mention for the families.

Beginning this week, Case has some new answers to those old questions. Oct. 1 marked the start of the open enrollment period for the Affordable Care Act, and the launch of a new online marketplace where people can shop for health insurance.

Sometimes called Obamacare, the 2010 law requires that almost all Americans have health insurance and that all states have “navigators” available to help guide people shopping for coverage. Case is one of these navigators.

That term isn't used much here, however.

“We heard from (the public) that it was confusing because it's used in so many other areas of health care,” said Amy Fauver, a spokeswoman for Cover Oregon, the state's new marketplace.

Instead, Oregon has invented its own lexicon. Throughout the state, roughly 1,300 people, including Case, have been dubbed “application assistors.” The 100 or so organizations that employ them — Case, for example, works for Healthy Beginnings, a nonprofit in Bend — are considered “community partners.” There are seven community partners in Central Oregon, according to Cover Oregon.

Assistors such as Case have undergone a four-hour training session that was run by Cover Oregon. Community Partners such as Healthy Beginnings have signed contracts with Cover Oregon.

In the new exchange, individuals may visit a website (www.coveroregon.com) or call a toll-free number (1-855-COVER-OR) to compare the prices and benefits of different insurance plans.

People can also find out if they qualify for tax credits and other subsidies to help them afford health insurance.

So far, Cover Oregon's online portal has been off to a slow start. Sometime in the next month, officials expect that the Cover Oregon website will be fully operational so that people can directly enroll in an insurance plan online, according to Fauver. For now, everyone must speak with a live person to sign up.

The website currently allows people to search by county or language spoken to find a community partner with trained assistors on staff.

In addition, the site refers visitors to over 2,000 “certified insurance agents” throughout the state. These are insurance brokers, licensed by the state, who have completed eight hours of training to navigate the Cover Oregon system and sell any insurance policy in its database.

While assistors such as Case are trained to answer any factual questions about a person's insurance options, a certified agent is allowed to go one step further and advise the person about which plan seems best. Assistors are not allowed to offer advice.

Art Uecker, an insurance broker who owns the La Pine Insurance Center, said even though people will soon be able to buy insurance directly from the online marketplace, there is a benefit to working with a real person.

“At no cost to them, people can ... have a certified agent to guide them through the process,” he said. Shopping for health insurance “can be daunting and confusing and it's not always intuitive.”

For-profit agents such as Uecker earn a commission on each insurance policy that they sell. This commission is paid for by the insurance providers, not the policy holders.

In other words, nobody involved in Cover Oregon or its community partners will charge fees to help people research or sign up for health insurance. All of the people who are trained by Cover Oregon have passed background checks, according to Fauver. To report a suspected scam, call 1-855-COVER-OR.

Galen Blyth, who works for JAD Benefit Solutions in Bend, said the Affordable Care Act is likely to send a lot of new business to insurance brokers such as himself. Most Americans face tax penalties if they don't sign up for coverage by mid-March.

The state's version of Medicaid, the Oregon Health Plan, is also expanding next year. That means more low-income adults will be eligible for coverage.

The Affordable Care Act prohibits insurance companies from denying coverage to patients with pre-existing conditions, so people who have been unable to buy insurance can sign up for coverage now. Plans that are purchased through Cover Oregon will go into effect as early as January 1.

“Cover Oregon is actually trying to steer people toward insurance agents, who can help them understand all of their options,” Blyth said.

Blyth urges people who are shopping for insurance to be patient, while Cover Oregon works out its kinks.

Fauver, the spokeswoman for Cover Oregon, said there has been so much media coverage of the Oct. 1 launch of the exchange, some people have confused that date with some sort of deadline.

“There is nothing magical about October 1,” Fauver said. “It's just the beginning of a six-month open enrollment period ... people shouldn't feel that there's a rush.”

Case, who is an outreach specialist at the nonprofit Healthy Beginnings, in Bend, said she has long worked to get children in Central Oregon signed up for health insurance. So it was a logical step, she added, to undergo training this summer to help get their families signed up for coverage, too.

So far, she has just answered questions for people who have called or stopped in this week.

“Most people have questions that they want answered and then they want to consider all of their options before making a choice,” Case said.

Important dates

Later this month: Online open enrollment for Cover Oregon is expected to begin.

Dec. 15: Deadline to enroll to get coverage by Jan. 1.

Jan. 1, 2014: Coverage begins for those enrolled by Dec. 15.

March 31: Enrollment ends.