By Erika Webb
It's the elephant in the waiting room: the Affordable Care Act.
For the past two months, Volusia County libraries and the Health Planning Council of Northeast Florida have partnered to demystify and prune away obstacles on the path to the new Health Insurance Marketplace.
In October, more than 300 residents attended the workshops conducted by the Health Planning Council's certified navigators in libraries throughout the county, according to a Volusia County Community Information news release.
Navigator Program Director Joyce Case said attendees are learning the whole process is not as daunting as they expected.
"A lot of it is fear of the unknown," Ms. Case said in a phone interview. "When we show them the (insurance) plans they go, 'Oh, these are private insurance companies.' They go, 'Oh, I thought this was Obamacare.'"
"The plans in Volusia (include) Signa, Coventry, Florida Blue and Florida Health Plans. People are surprised there's not a plan out there called Obamacare," she added, laughing. "They say, 'I didn't realize it was going to be Blue Cross.'"
And, she explained, there is an a la carte menu.
"There are different plans for family members," she said. "For example, the Gold Plan for a spouse with more medical issues. I told a guy it's just like shopping at Best Buy. There's the more expensive Apple iPad for the son in college and the less expensive laptop for the daughter in high school."
But before applicants even get to the choosing point, there is a process.
The good news, Ms. Case said, is the website, healthcare.gov, is "getting so much better."
"Last week at New Smyrna Beach I clicked on the website and I sort of jumped because it came up so quick," she said.
In order to obtain coverage by Jan. 1, applicants must sign up by Dec. 15, but those required to participate have until March 31 to enroll, Ms. Case explained.
The keys to success are patience and systematic use of the website.
Frustration comes from trying to get through the entire process at once.
"Everybody thought, 'I can do this at one sitting,'" she said.
Her advice is for applicants to go to the website and set up an account first. Then fill out the application. Look at the plans offered and then call preferred health care providers to determine whether or not each is in the chosen plan.
"Then (applicants should) talk about it with their spouse," she said.
She cautioned against being stymied by "sticker shock."
"Let's say the premium is $3,000 a year. The tax subsidy, based on income, pays about $1,500 of that," she explained. "You would then be on the hook for $1,500 divided by 12 months. All the sudden that premium that was unreasonable ... all of a sudden (they realize) 'Oh, I'm only gonna have to pay...'"
Ms. Case didn't do the math, but in that case scenario the insured would pay $125 monthly.
Navigators take workshop attendees to the website, healthcare.gov so they can see what to expect.
"One thing I think it's important to note is when you Google healthcare.gov the first thing that comes up isn't the official website," Ms. Case said. "We show them the first two (sites) aren't. We show them what is."
On the "new and improved website," it is possible for applicants to click view and type in their zip codes to view the different plans available in their regions.
"The same companies are offering different things in different counties," Ms. Case said. "What's available in Flagler is not necessarily available in Volusia."
In the workshops, navigators also explain the ACA premise of buying in bulk to achieve a lower unit price.
"I don't have children but my plan is going to pay for pediatric care, oral and vision care for kids," she said. "That's the only way it's gonna work. We're all going to pay for all kinds of stuff in our plans, like maternity health care, mental health ... We may never need substance abuse treatment, but we're paying for everybody to have it to reduce the unit cost."
Using the example of establishing an account on Amazon's website, Ms. Case said healthcare.gov requires each applicant to accept an emailed receipt once his or her application has been submitted.
The good news?
"When you submit, it actually accepts now. It comes on and says 'thank you;' they email you back the result of your tax subsidy and then you can go look at plans," she said. "Before, it would never go from the circle or the hour glass. Now we're actually getting applications approved."
Initial reports for health insurance enrollments under the plan totaled 106,185, according to the Department of Health and Human Services.
Of that, 25 percent came from healthcare.gov and the federal exchange that serves 36 states, according to Jaime Dupree's Washington Insider blog. The rest are from states with their own exchanges.
The highest numbers on the government exchange came from Florida -- seventh overall -- at 3,571, followed by Texas with 2,991, Mr. Dupree reported.
The first premium payment has to be made online at healthcare.gov, Ms. Case explained.
People are asking why the payment is due by Dec. 15 when they won't be covered until Jan. 1.
"They don't realize insurance is pre-paid," she said.
Ms. Case said most people have not been asking about individual mandates.
"The ones that ask are the ones that are concerned they may not be able to afford the premiums even with the tax subsidy," she said, explaining some may qualify for an exemption if unable to afford the premium.
Income levels determine type of plan and subsidy qualification, but they are levels with leeway, she said.
"People are surprised to learn that 400 percent of the federal poverty level for a family of four is almost $95,000 a year you can earn and still qualify for a subsidy," she added.
There is one aspect of the workshops that seems to be the proverbial light bulb.
An online tutorial demonstrates the process: creating the account, submitting the subsidy application, receiving the government's subsidy approval, picking a plan from the provider network, selecting the plan and, finally, remitting payment.
"Once we show the tutorial about the website they go, 'Oh! I could probably do this on my own,'" Ms. Case said, adding encouragingly, "Yeah, you probably could."
She said the workshops will continue through the end of March.