Your Open Enrollment Questions

Tiffany Hanssen: It's The Brian Lehrer Show. Welcome back, everybody. I'm Tiffany Hanssen, filling in for Brian who is off today. It is open enrollment season for most people. This period of time, about a month or so, is their best shot to review their healthcare options, refine them, or enroll in a new plan. In recent years, a lot of Americans have enrolled in government plans. Last year, a record 16 million people signed up for the Affordable Care Act coverage through federal or state marketplaces.

This year, with a lot of people bumped off Medicaid, due to some COVID-era protections ending, that number is expected to be even higher. Joining us now to talk about some of the ins and outs of picking the right health insurance plan is Elisabeth Benjamin, vice president of Health Initiatives at the Community Service Society and co-founder of Health Care for All New York Campaign. Elisabeth, welcome back to WNYC.

Elisabeth Benjamin: Thank you. It's such a pleasure to be here.

Tiffany Hanssen: Elisabeth, I want to invite our listeners in because we know there are questions about open enrollment. That's a sure thing. 212-433-WNYC, 212-433-9692. You can text that number. Are you going from Medicaid to ACA plans? What do you need to know? What's on your mind when it comes to picking a new health insurance plan for yourself or your family? Are you afraid of getting stuck with the wrong plan? I know that does affect some people's decision-making process. 212-433-WNYC, 212-433-9692.

Elisabeth, I mentioned that 16.4 million people signing up for the ACA coverage because of more generous COVID-era subsidies. Congress extended those subsidies through 2025. We can get into some specifics on that, but I'm wondering if you can give us an overview of why the ACA or the Affordable Care Act and insurance that people can get through those marketplaces, state and federal marketplaces-- Why is that more popular than ever?

Elisabeth Benjamin: It's more popular than ever because Congress and President Biden enacted the American Rescue Plan, which enhanced the amount of subsidies people up to 400% of the federal poverty level could get and then expanded the income level to people all the way up to 600% of the federal poverty level. That meant that people with much higher incomes were able to get either deeper or more generous subsidies, and then people with even higher incomes could also get them. That's really exciting, and it really helps a lot of people be able to afford the cost of coverage.

Tiffany Hanssen: Some people have been disenrolled from Medicaid in the last several months because of the end of some pandemic-era protection. Briefly explain to us what's going on there.

Elisabeth Benjamin: Yes. During the COVID pandemic, the most important thing really was-- there were lots of important things, but one of the key things was that we really wanted to keep people with health insurance so that they could freely get treatment without worrying about going into medical debt or be able to get vaccines, get testing and all of that. One thing that the American health system uniquely does, unfortunately, is make everybody recertify for health insurance every year if you get publicly-sponsored coverage. In fact, we even do that through employer-sponsored insurance with our open enrollment.

There's this tradition of constantly every year having to get your act together and continue and make decisions about what kind of health plan you want and do that. That's really not a great system because why? Because people fall off every single year. Even in employer-sponsored coverage, sometimes people fall out of coverage because they forget to fill out the paperwork with their jobs. The same thing happens with people on Medicaid or public insurance. Right after COVID, and I don't know if you all remember, the unemployment rate went up to 16% in New York State.

Now it's down to around 3% or 4%. A lot of people signed up for Medicaid. Why? Because they lost their jobs and they needed health coverage in order to be protected from the pandemic and to get the care that they needed. What we didn't want to have happen as the pandemic has lingered was we didn't want people to suddenly be thrown off of coverage. What the federal government did is they put in these public health emergency rules where everyone was just automatically renewed for several years. At this point, the public health emergency has been declared to be over as of May.

As a result, the states are now having to require people to come back in and fill out the paperwork to retain coverage. As a health policy expert, I think this is a terrible idea. If I had it my way, everyone would have coverage and no one would have to qualify for one. Everyone would just get coverage because I think everyone should be healthy and that's a human right, but that is our current healthcare system where we require everyone to come in and recertify for coverage or renew through open enrollment.

Tiffany Hanssen: Well, I think universal healthcare is a whole other conversation.

Elisabeth Benjamin: Yes. [laughs]

Tiffany Hanssen: We're not going to open that can of worms right now.

Elisabeth Benjamin: That's happening right now, this whole big redetermination thing. For example, in New York State, our renewal rate is around 77%, which means we're losing around 23% of our people because they're no longer eligible for Medicaid or the slightly higher than Medicaid program called Essential Plan, a higher-income level program. We are losing people, but everyone should know that they may still be eligible for a qualified health plan. Now, some people actually got job-based coverage in the interim, and so they're rightfully going off of Medicaid or the Essential Plan.

Tiffany Hanssen: Sure. We do have, as you mentioned, people fall away because they forget to re-up their coverage, maybe they changed their personal financial situation, or their personal health situation has changed and they don't update based on that. We also have, I would contend, a real fear on a lot of folks' part that they're going to make the wrong choice. There's a lot of procrastination based in fear of like, "I don't know what I'm doing. I don't understand what to pick from where and what all of these terms mean." I just want you to address, first of all, just this fear that I'm going to make the wrong choice.

Elisabeth Benjamin: The first thing you should know is New York State's awesome because we actually fund local groups to help people enroll in coverage. Those are called navigator organizations. You can go on the marketplace and you can either get help in person or over the phone and people can help you work your way through the marketplace so that you don't make the wrong choice and that you make the right choice for you and your family.

Number one, there's lots of help if you wanted in-person help, local, trusted people, or you can just call the marketplace and work with the call center folks. They answer the phone, they're pretty smart. They know what they're doing. In New York, we're lucky because we have a lot of what we call enrollment assisters. Now, I think in terms of making the wrong choice, I think there's a lot of moving pieces that's important to keep in mind.

What are your prescriptions? Make sure you have a list of those. What doctors or hospitals do you want to go to? Make sure you have a list of that before you start taking on the process of renewing or even enrolling for the first time through the marketplace. Then the marketplace, the web pages are pretty easy. They walk you through, do you want health insurance? Yes, or no? What's your name? What's your income? They ask a lot of questions about whether you're disabled or pregnant.

Why would they do that? Because you might actually get enhanced financial assistance for applying for coverage. You want to answer all those questions as truthfully as you can. Then, eventually, you get to the part where you have to select a health insurance company. You wouldn't necessarily know, which is why it's always helpful to go to a navigator, but there's a whole website dedicated that matches the health insurance plans with the network so you can make sure that your doctor or your hospital or the pharmaceutical that you might need is in the health plans network or formulary.

Tiffany Hanssen: I want to get to that prep in a second about what folks should have at their fingertips as they start to dig in and maybe get to a decent plan that they've decided on for themselves. I want to re-invite our listeners into this conversation because I know there are questions we know that folks have. A lot of questions about, not only just the re-enrollment process, but about what all of those terms might mean, how we go about picking the best plans for ourselves and our families.

Listeners, we really want to hear from you. 212-433-WNYC, 212-433-9692. You can also text your question to us at that number. 212-433-9692. We're talking open enrollment. Whether it's through your work plan, whether it's through the ACA plans, we want to really zero in on what it is that is tripping you up the most. 212-433-9692. Call or text us.

We talked a little bit, Elisabeth, there about some of the prep that you mentioned; folks should have their prescriptions on hand, they should have a list of the doctors that they frequent. There's other information that folks are going to have to have at their fingertips when they start to go through this process. I'm thinking specifically of income information, tax information, so let's go through a little bit of-- Maybe we can make a checklist for folks.

Elisabeth Benjamin: Sure. The checklist is, know your Social Security number and the Social Security number of everyone in your family, know your address. Then I think the next checklist-- I'm mindful that a lot of Brian Lehrer listeners might be independent employees. They might be artists, they might be writers, they might be actors. For you all, it's really important to have last year's tax statements in front of you, and the number you really need to understand is your adjusted gross income. That's Line 11 on the IRS 1040.

Why is that important? I think people think, "Oh, I'm never going to be eligible for financial assistance because my income's too high," but for people that work for themselves, often, they have a lot of deductions, and those deductions count in terms of bringing down your income to that adjusted gross income level. We really want to make sure we get everybody's deductions entered into the marketplace website so that you can maximize the most financial assistance you're eligible for.

Tiffany Hanssen: We're talking with Elisabeth Benjamin, vice president of Health Initiatives at the Community Service Society and co-founder of the Health Care for All New York Campaign. Call us with your health insurance questions, 212-433-9692. You talked about defraying some of that cost, Elisabeth, but it's worth noting that anybody shopping for an ACA plan this year could notice that premiums are actually going up by about 5%. That's according to NPR's Marketplace.

I'm wondering what that looks like, practically speaking, and if we're maybe coming in with some ways to defray costs, is it going to just be offset by some of these increases or--

Elisabeth Benjamin: I have bad news for you. That's the national increase. In New York State, unfortunately, the Department of Financial Services approved a 13.5% rate increase this year on average. The good news is there are 12 carriers in the individual market and depending on where you live, but it's certainly in the New York City area. I'm not clear, I'm sorry, I meant to look it up beforehand.

I can't remember what the approved rate increase on average was for New Jersey, so for your New Jersey listeners, I apologize, I should have done that in advance. The good news is even though your rate of increase went up, you are insulated. If you go through the marketplace and you apply for financial assistance and your income's under 600% of poverty, you're insulated from those increases.

There's only a maximum amount that you can be expected to pay going up the income line up to 8.5% of your gross family income. It can be as low as 0%, 2%, or 4%, so it's really worth meeting with a navigator and applying. Just so people know, for example, 600% of poverty is $87,000 for an individual, and I believe $180,000 for a family of four. That's the beauty of the American Rescue Plan and the fact that the [unintelligible 00:13:40] that we were able to extend the enhanced subsidies for a couple more years.

Tiffany Hanssen: I want to bring a caller into the conversation here, Alana in Brooklyn. Good morning, Alana. Welcome to The Brian Lehrer Show.

Alana: Hi. First of all, just thank you so much for talking about this today. I've been on Medicaid since 2020 when I got laid off from my job and I've been holding onto it, but my husband needs coverage and I'm just worried because we're married and we're connected on the healthcare plan. If he signs up for an affordable healthcare plan, will I get kicked off Medicaid, potentially?

Elisabeth Benjamin: No. There's an answer to that. What you need to do, and you can call my office and we can help you do it if you're not really savvy with the marketplace account, you just need to be mindful of when your renewal date is so you will stay on until it's your time to recertify. They just started what they call the unwind of these public health emergency rules, and so they're doing a cohort every month.

We can't do all 9 million people at once. It's just I think-- Not only would our brains explode, but also the computer system might explode. They're doing a cohort like 400,000 people every month or so. When you go onto the website, you can look under Eligibility or Plans tab and you can see when your redetermination date will be coming up or your end date, and then we can help your husband enroll in coverage if he hasn't.

Today's the day. Today's the first day of open enrollment for January 1st, getting coverage for January 1st, 2024. You really want to try to apply for coverage by December 15th if you want to have coverage for January 1st. Then every month it goes up to the 15th. You have to apply by the 15th of the month to get coverage for the first of the following month. Otherwise, you'll be the first of the month after the following month, if that makes any sense. It's just bureaucratic.

Tiffany Hanssen: Elisabeth, quickly, if people are looking for the Community Service Society phone number--

Elisabeth Benjamin: Sure. It's 888-614-5400.

Tiffany Hanssen: Okay. It's a good spot for-- Again, one more time just for listeners actually.

Elisabeth Benjamin: Sure. 888-614-5400, and they can also call the New York State of Health Marketplace which I'll give you that number in one second. [chuckles]

Tiffany Hanssen: Oh, that's okay. In the meantime, while you're looking that up, just tell us a little bit how-- In other ways, how can CSS be helpful to people?

Elisabeth Benjamin: We can schedule an enrollment appointment, and we can have our navigators sit down with you either in person or over the phone. Most people like doing it over the phone, and we can just help you get through that eligibility, make sure you're maximizing the amount of financial assistance you're eligible for, and then we can help you sort through your doctors, your prescriptions, and make sure that you're enrolling in the best plan for you.

The other thing we can do is talk you through-- Which we started to touch upon, Tiffany, but we didn't really get there. There's different metal levels in these health insurance plans.

Tiffany Hanssen: Right. I do want to get to that.

Elisabeth Benjamin: Do you want me to talk about that now?

Tiffany Hanssen: You know what? I want to bring another caller in really quickly because you were talking about these navigators and folks that you can call to have help you wind your way through this whole process. I think Linda has a question about this. This has popped in my mind too. Linda on the Upper West Side in Manhattan here. Good morning, Linda. Welcome to The Brian Lehrer Show.

Linda: Morning. Hi.

Tiffany Hanssen: What's your question?

Linda: My question, I think you started to answer while I was calling, but how do you get an advisor who's not promoting a particular type of plan? I've been barraged with people pushing the Advantage plans, which I've been told you don't want. I have a doctor I love whom I've gone to for years but who's begun to charge a concierge fee every month. What I'm looking for is the basic coverage, but I also love having a doctor I know knows me, not just somebody that's assigned to you, but somebody who can represent you if you have major medical issues in a hospital and all of that.

When you need something like that, you need more. The question is, how do you get advice both on lowering your cost if your income is lower and on choosing a plan?

Tiffany Hanssen: Elisabeth. Thank you, Linda, and I'm going to echo Linda. I've run across that as well, where you get on the phone with somebody you think is an advisor, and then all of a sudden, they're pushing all of these plans and then you just-- It just further frustrates you and perpetuates this whole process, which can be so daunting.

Elisabeth Benjamin: Right. First of all, it sounds like Linda is-- When she said Medicare Advantage plans, I think that means she's on Medicare. Medicare is a different system. You don't go through the New York State of Health Marketplace. My organization can help you, Linda, sort through your Medicare options and whether you need a supplemental plan or if you want to do a Medicare Advantage or not, and talk through the pros and cons of that, or also do a Part D plan.

Our phone number again is 888-614-5400, but there's also a dedicated organization that does not take money from health insurance companies called the Medicare Rights Center, and they're a very close partner of my organization, Community Service Society. Their number is 800-333-4114. I think Medicare Rights Center is just an outstanding group of people. They don't take any compensation from health insurance companies, and I think that that would be a good resource for you.

Tiffany Hanssen: All right. Elisabeth, we have another Medicare question. I want to get to Mia in Manhattan. Good morning, Mia.

Mia: Good morning. On my end, the number didn't come through. It was 800-33. Was that 3-4114?

Elisabeth Benjamin: Yes. 800-333-4114. Well, there's a lot of duplication. It's 800-333-4114.

Mia: Great. Thank you. I think you answered my question by virtue of the caller just before me. I was wondering if there was something similar to a navigator available for people on Medicare. Are you saying the CSS deals with navigators and also the Medicare Rights Center? Am I correct?

Elisabeth Benjamin: Yes, that's exactly right.

Tiffany Hanssen: I wonder, Elisabeth, do these navigators just do-- people will focus only on Medicare, people will focus only on people who have questions about their ACA, people who only have--

Elisabeth Benjamin: The nice thing about my organization is our phone number is one-stop shopping in terms of getting help. You may not know what you're eligible for. That's the whole point. We do get a grant to help people provide navigator services, which are solely for marketplace plans and public coverage; Medicaid, Essential plan, Child Health Plus, Emergency Medicaid for undocumented immigrants, and qualified health plans. We can help you with Medicare, but if you go to some other organizations, they're just like Medicare Rights Center. They're really experts on Medicare.

The federal government does fund a program called the SHIP program that provides Medicare enrollment assistance. There's other great organizations like New York Statewide Council on Senior Citizens. There's lots of great groups out there that can help with Medicare enrollment for free that are independent. There's also, you can call us, and if you don't even know what you're eligible for, we can just help you do it all.

We're really lucky that we have a partnership with the state Department of Health that funds us to be able to be a one-stop shop so you don't have to figure out which phone number you're supposed to call.

Tiffany Hanssen: Elisabeth, I promised we'd talk about these different levels. Again, another area that can be a bit confusing for folks, because depending on where you're at and what plan you're looking at, there could be gold, platinum, premium, bronze. I think, one, a lot of people assume that, oh, if I get gold, it's "better than bronze," or platinum is better than whatever. I just wonder, is it a case where those delineations are not about what's better because finding what's better for you might not just be picking the premium plan or the platinum plan or the gold sparkly plan, whatever it is?

Elisabeth Benjamin: The first thing that I strongly recommend people to do-- There's four levels. Well, actually five. There's catastrophic for young people, but we're not going to talk about that right now. For most people, there's bronze, silver, gold, and platinum. Typically, the lower the metal tier, a bronze, you're going to have a lower monthly premium, but you're going to have a super high deductible like over $4,000 or $6,000 a year, which means you have to pay all your healthcare up till the moment you hit that deductible.

The other thing that's not great about a bronze plan is that that even applies to pharmacy, pharmaceutical drugs. If you buy a silver or higher plan, then your drugs are not subject to the deductible. The other thing is, after a lot of agitation by the consumer movement, the bronze plans now have one or two visits to a doctor without having to hit the deductible. You really have to look at each plan design super carefully.

I'm really sorry to inform you there's around 90 different options in the five boroughs, so it's quite difficult for people to make those choices. You really need to talk through the what it is that you need. I think people should be-- if you're super young and healthy and you don't really anticipate ever going to the doctor or needing a doctor during the year, then maybe a bronze plan is just perfect because you have almost like-- if you get hit by a bus, so you pay the first $4,000 or $6,000, the rest of it it's covered by the health insurance company.

If you're a little older and maybe a little more nervous about taking on that kind of risk, you might want to pay a little more monthly that'd be able to access your coverage sooner on a first-dollar basis.

Tiffany Hanssen: I want to just bring in one more caller here, Elisabeth, before you head out. It's because you did a call-out at the beginning of the show. We have Cynthia in Manhattan who is an actor and a freelance editor. Hi, Cynthia.

Cynthia: Hi.

Tiffany Hanssen: Yes, your question.

Cynthia: Thank you for taking my call.

Tiffany Hanssen: For sure.

Cynthia: I was one of those people that got kicked off of Medicare just last month, and so then, I had to go into the marketplace and fill out all the information. I have multiple sources of income. I work part-time as a bookkeeper, I'm a freelance editor, and I'm also an actor. Over the summer, I did some commercial work which it pays really well, but when I was filling out the information on the marketplace, they asked you for recent pay stubs.

Those recent pay stubs don't really reflect what I make for the entire year. I don't make that amount of money every single week or every single month. That was just like a one-off. I'm not really sure how to fill out the information so that it's accurate.

Elisabeth Benjamin: I don't mean to interrupt you. It's tricky.

Tiffany Hanssen: Thanks, Cynthia.

Elisabeth Benjamin: Come to us and we'll help you do it. You don't want to have that be as an annualized base. You want to have that income registered as whatever. Say it was like $10,000. You want to say that's for the whole year, not for the month because the system's going to read you having $10,000 a month and so then your income's suddenly $120,000, which isn't accurate.

We know how to fill out those little pieces so that that won't trip you up. You can call the marketplace, and they can help you fill out those little pieces. Their number is 855-355-577. That's a lot of duplicates. Again, 855-355-5777.

Tiffany Hanssen: And that's for--

Elisabeth Benjamin: That's for the New York State Health Marketplace. They can definitely also help you do that. That's exactly why you want to go to a navigator if you're a self-employed person because it's really tricky getting all these one-off jobs incorporated into the database. The database is really going to try to true-up your income with whatever you filed in your 2022 taxes.

It's tricky because you want to be accurate about-- Almost in a weird way, what you're making in 2023 is irrelevant because it's what you expect to make in 2024 that matters if you're going to be getting a qualified health plan as opposed to Medicaid. Whereas, if you're going to be applying for Medicaid, what you're making right now in 2023 is what matters. It's very complicated and that's why we're funded to help you until that bright, shiny day when we have a healthcare system that's a little less [crosstalk].

Tiffany Hanssen: That's another conversation, Elisabeth.

[laughter]

Elisabeth Benjamin: Can't blame a girl for trying. Anyway, one day it hopefully will be better for people.

Tiffany Hanssen: Elisabeth, we're going to leave it there. Elisabeth Benjamin is vice president of Health Initiatives at the Community Service Society and co-founder of the Healthcare for All New York Campaign. Elisabeth, thanks so much for your time today.

Elisabeth Benjamin: Sure. Talk to you later. Thanks again for having me. Good luck, everybody. Happy open enrollment day.

Copyright © 2023 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.