Kokomo Tribune; Kokomo, Indiana

October 21, 2013

Navigator answers ACA questions

More education needed to reduce confusion.

By Lindsey Ziliak Kokomo Tribune
Kokomo Tribune

---- — Someone recently asked Nemramy D’Agostino if people could be thrown in jail for not having health insurance per the new rules of the Affordable Care Act.

The certified navigator chuckled as she told the story.

“No, you won’t be thrown in jail,” she told that person.

It was an illustration, though, of just how important community outreach is, she said. There are so many questions and misconceptions surrounding the ACA and the new health insurance marketplace, she said.

Her job is to answer those questions and debunk the myths.

D’Agostino tried to do just that during a League of Women Voters forum on the ACA Wednesday night.

She delivered an hour-long presentation showing people what to look for when shopping on the exchange.

She flashed informational slides through a projector as people in the crowd quickly jotted down notes. D’Agostino paused occasionally to answer questions.

She started with some basic information explaining the Affordable Care Act. The navigator quickly delved deeper into the exchange, though.

She explained the tax credits and cost-sharing reductions available to some families to help lower the cost of premiums, copays, coinsurance and deductibles. Eligibility for the tax credits and immediate reductions are based on income and family size, D’Agostino said.

But people who smoke are not eligible for the assistance regardless of how little they make or how big their families are, she explained.

The crowd wanted to know more about the five tiers of insurance plans available on the new marketplace.

They start at the bottom with a catastrophic plan that covers three primary care visits each year until a consumer meets the deductible. That plan is only available to people under the age of 30, D’Agostino said.

The plans go all the way up to the platinum plan. Under that plan, insurance pays 90 percent of medical costs, but premiums are higher. The bronze plans cover 60 percent of costs. The silver plans cover 70 percent, and the gold plans pay 80 percent.

As the amount the insurance company is responsible for goes down, so does the monthly premium.

Some people asked how the plans differed in their coverage. One woman asked: Could one plan turn you away for a surgery you need?

Those categories, D’Agostino explained, do not reflect the quality or amount of care the plan provides. All certified, qualified health plans on the marketplace have to provide essential health benefits that include emergency services, hospital care and surgeries, maternity and newborn care, outpatient care, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services and pediatric services.

The key then, especially when buying insurance outside the marketplace, is to make sure the plan is a certified, qualified health plan. People should ask about that, she said.

D’Agostino is spreading these messages throughout Howard County. She spoke to the Family Services Association and will talk with students and staff at Ivy Tech Community College Kokomo in November. She has answered countless questions over the phone and met people in person to help them solve their problems.

People usually feel much better after learning more about the exchange. D’Agostino said that’s understandable.

“It was confusing to me before I was trained,” she said. “Once we reduce the confusion, people feel more empowered to make informed decisions.”

D’Agostino said she believes that’s what the ACA is all about.

“The ACA empowers us to be responsible and pay in the kitty so we can help each other and keep costs low,” she said.

Lindsey Ziliak, Tribune education reporter, can be reached at 765-454-8585 or at lindsey.ziliak@kokomotribune.com.

Anyone with questions about the Affordable Care Act or new health insurance marketplace can call navigator Nemramy D'Agostino at 765-864-4160 ext. 4202. She can answer questions over the phone or schedule a meeting.