Choosing health insurance is hard. Choosing ACA health insurance can be really tough as the choice environment can be chaotic.
It is not equally hard for all people. It is easier for people who have the social status, education, resources and experience that enables familiarity with complexity and perhaps the benefit of the doubt from street level bureaucrats. It is far harder for folks who routinely are stumped, intentionally or unintentionally, by complexity. Sometimes people who face complex interactions and enrollment processes for services that they are eligible for just walk away.
One way that these enrollment frictions can be reduced is with trained navigators who bring expertise on reducing complexity and confusion. The federal government under the Obama Administration aggressively funded navigators at both a state and local level through two different funding mechanisms. The Trump Administration dramatically reduced total navigator funding while the Biden Administration has re-upped funding for navigators at a high level.
My colleagues Dr. Rebecca Myerson and Honglin Li, both of the University of Wisconsin, leverage the two different funding streams and then the huge Trump Administration funding cuts to assess if navigators are causally helpful in a new article in the American Journal of Health Economics:
Cuts to the navigator program significantly decreased marketplace coverage and total coverage among lower-income adults, and significantly decreased total coverage among adults under age 45, Hispanic adults, and adults who speak a language other than English at home. We found no significant impact of the cuts on Medicaid enrollment (95 percent CI: −1.9 percentage points to 0.5 percentage points); most uninsured people in the states we studied lived in locations that had not implemented Medicaid eligibility expansions. These findings suggest that before the funding cuts, navigators were helping underserved consumers obtain coverage.
People need help with insurance. Navigator programs are pretty effective in helping marginalized people get coverage as they likely reduce complexity, information and compliance costs.
Professor Bigfoot
¡Ay caramba!
I hate even thinking about this stuff; but I just crossed the 65 barrier and now I HAVE to.
I’ve been assuming that the jillions of Medicare Advantage ads, mailers and suchlike were all meant to drive people to specific companies plans- that they’re there to sell, not help.
How does one access one of these “navigators?”
(and does that even apply for those of us in the Medicare thicket?)
[ed: first? me? gtfo ;)]
Scout211
@Professor Bigfoot: You can find a listing of Medicare advisors/navigators by state and the contact information here.
Click the “SHIP locator” button and you can find the contact information for your state.
Here in California it is called HICAP and each county has an office.
H.E.Wolf
It’s good to learn that the Biden administration has resuscitated the navigator program.
I recall that the Obama administration recruited a number of navigators who were from the same marginalized populations – adding to their effectiveness, notably in the Deep South.
(Very similar to what Four Directions, Voces de la Frontera, and VAAC have been doing with their voter outreach efforts, in fact!)
p.a.
Some of the “being stumped by complexity” is not having the time to work through it; multiple jobs/kids/elder care/poor internet resources…
America, fuck yeah!
Lord Fartdaddy (Formerly, Mumphrey, Smedley Darlington Mingobat, et al.)
This is off the topic, but related to health care, so I wanted to ask. Do you know anything about asbestos abatement? We found some in our house, and we need to get it taken care of, but the cost can run up fast. I already left a message with my state delegate asking whether there are any state or federal grants for this, but I thought it couldn’t hurt to run it by the experts here as well. I don’t expect you to have an answer off the top of your head, but if you could point me in the right way, that would be a huge help. Thank you.
Barbara
@Professor Bigfoot: Regarding the Medicare thicket — do NOT respond to the 1-800 number advertisements that are aggressively promoted through the use of stars from yesteryear.
If there is a local navigator, then that would be helpful. Local agents and brokers will be more helpful with comparative information about plans than the national “e-vendors” that advertise on tv, but they are still working for the plan, and may be subject to incentives that you do not understand, at least with regard to Medicare Advantage. Agents and brokers are probably more useful for Medicare Supplement insurance, which you would buy if you stay in the fee for service (traditional) Medicare option.
Medicare.gov plan finder will at least let you know which plans are available in your specific zip code.
In my experience, it helps to sort things out by focusing on whether there are specific doctors or hospitals you need or want to have access to. Don’t rely solely on the plan for that information — look at the website for the provider, and then confirm by calling whether they are going to be in the network as of January 1, 2023, when your enrollment would become effective.
Once you sort through the provider participation, try to assess your medical expenses, and do NOT assume that they will get lower over time. They don’t! Use the plan finder formulary tools if there are drugs you are currently taking. This is a huge issue, and some plans are really hard to deal with if the drug you take is not the drug they put in their favored tier. You can’t avoid this by staying in fee for service, because the drugs are only available through private plans, whether integrated with MA or standalone.
Once you do all that, and you aren’t really facing any significant medical expenses yet, you can go for the plan that gives you the benefit where you want it — cash (zero premium) or dental or eye coverage. Most beneficiaries value benefits that are close to cash as possible, e.g., an OTC budget, but that means they might actually have a plan that charges a lot more for service encounters. People prioritize “here and now” benefits and are basically inept when it comes time to look at anything longer term, especially if there is an uncertainty factor.
Barbara
@Lord Fartdaddy (Formerly, Mumphrey, Smedley Darlington Mingobat, et al.): Ugh. We had asbestos in our original kitchen tiles as well as in our siding. The contractor took care of it when we remodeled. My understanding is that the type of product can really make a difference in how hard abatement is. Asbestos that is well-sealed into the product (floor and siding tiles) and not friable and likely to blow around is easier to abate. Honestly, you might want to assess whether it’s really worth abating at this point.
Lord Fartdaddy (Formerly, Mumphrey, Smedley Darlington Mingobat, et al.)
@Barbara:
Yes, it’s kind of tempting to just leave it alone, but we desperately need to get rid of the awful, nasty carpeting we have, and put in some kind of flooring, and to do that, they’ll need to make enough of a mess that the tiles are likely to get scuffed up.
sab
@Barbara: Thanks. That is helpful, since I am rethinking my coverage again since it’s open enrollment season.
taumaturgo
Jay
@Lord Fartdaddy (Formerly, Mumphrey, Smedley Darlington Mingobat, et al.):
up here, it costs between $10-$15 per square foot for removal and disposal.
It’s the microfibres in airborne dust that are the health issue. Items like siding, floor tiles and shingles, are only an issue if you (or your Contractor) cut, grind or sand.
It’s a fairly common practice during renovations, that the floor tile is “buried” under any kind of “floating” floor surface like edge glued hardwood, engineered interlock wood or vynel, or sheet flooring. Even ceramic tile can be used if you Scheutler- Ditra to create a “floating” floor.