So You're Enrolled – What Now? Navigating Health Care System


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Robert Cyr

With the deadline to sign up for federally-mandated health insurance come and gone on March 31, many of the estimated 7 million across the country and nearly 200,000 Connecticut residents enrolled in Access Health CT (AHCT), and perhaps yet another 5,917  who may be eligible to enroll because they left voice mails before the midnight deadline,  may be first-time customers of any health insurance plan, facing a whole new world of insurance jargon.
Signing up online in Connecticut had proved to be daunting for some, however, regardless of help centers, registration fairs and volunteer “navigators.” Many will soon be seeing common, yet often misunderstood, insurance terminology for the first time, such as “premium,” “co-pay” and “deductible.”
A premium is the monthly cost of insurance, while a co-pay is the amount that the insured must pay at each doctor’s visit or prescription that insurance doesn’t cover. A deductible is the amount that some plans require the customer to pay while a claim is pending.
“The process is still challenging even for people with many years of professional experience,” said Karen Clarke, spokesperson for HealthyCT, a not-for-profit state insurance company created under the ACA.
Once enrolled in a plan through HealthyCT with a chosen provider, customers are able to choose from a list of doctors online or from hard copy insurance documents mailed to them, she said. The printed documents in the mailed “welcome package” include dental coverage and pharmacy plan information. The group also has a staff of nurses to answers calls about specific benefits and plans.
“Some people are often wondering whether their doctor is in the network…our network is the same whether you buy plans on or off the exchange,” she said.
For those who missed the March 31 deadline and are getting ready for the next open enrollment period beginning Nov. 15, there are some things that should be kept in mind, Clarke said.
“Usually what people go for is the lowest price,” she said. “But they should weigh other things, like whether they’ll have to pay out of pocket for certain services, or whether their prescriptions are covered. Sometimes a plan that costs $10 more will save you thousands in the long run. You have to think about what your needs are, how often you use the doctor and  medication, and if you will you need surgery in the next year.”
The most common first step after enrolling is finding healthcare providers if existing doctors aren’t in their network, or customers are finding primary providers for the first time. Each insurance plan varies by cost, coverage and participating doctors, and that information is found online or through documents mailed to the customer, said Elizabeth Krause, a spokesperson for Access Health Connecticut, the state group created under the ACA to help with enrollment.
“Carriers say directories are constantly updating and adding doctors,” she said. “There’s a push for people to use online directories, but certain groups are more accustomed to a paper directory. Even before you enroll, you can look at a provider network to decide if you want to purchase the plan.”
Editor’s Note: will be following this new challenge – how to  navigate the health care system – which is as much a news story, as enrolling.