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Newly insured get help figuring out health plans

By ABBY GOODNOUGH The New York Times

This article was published August 3, 2014 at 3:33 a.m.

PHILADELPHIA -- Advocates of the Patient Protection and Affordable Care Act, focused until now on persuading people to buy health insurance, have moved to a crucial new phase: making sure the 8 million Americans who did so understand their often complicated policies and use them properly.

The political stakes are high, as support for the health care law will hinge at least partly on whether people have good experiences with their new coverage.

Advocates say teaching the newly insured how to be smart health care consumers could advance the law's central goal of keeping costs down, such as by discouraging emergency room visits, while still improving care.

For those reasons, hospitals, clinics, insurers and health advocacy groups around the country are organizing education efforts, aimed particularly at lower-income people who might not have had insurance in years, if ever.

The Centers for Medicare and Medicaid Services has jumped in, too, with a project called From Coverage to Care, which provides educational materials to community groups and medical providers who are trying to teach health and insurance literacy.

"It's not like you enroll and, voila, you immediately know how to use it," said Rebecca Cashman, a program coordinator for Resources for Human Development, a nonprofit group that is trying to help Philadelphians understand their new coverage. "There are a lot of people who really have some big questions about, 'What now?'"

Last week, Salwa Shabazz arrived at the office of a public health network with a bag full of paperwork about her new health insurance -- and an unhappy look on her face. She had chosen her plan by phone in March, speaking to a customer service representative at the federal insurance marketplace, but now she had problems and questions.

"I've had one doctor appointment since I got this insurance, and I had to pay $60," Shabazz told Daniel Flynn, a counselor with the health network, the Health Federation of Philadelphia. "I don't have $60."

Flynn spent almost two hours going over her Independence Blue Cross plan, which he explained had a "very complicated" network that grouped doctors and hospitals into three tiers. Shabazz, who has epilepsy, had not understood when she chose the plan that her doctors were in the most expensive tier.

"None of that was explained when I signed up," she said. "This is the first I'm hearing it."

Many people who signed up for private coverage through the new marketplaces had never had health insurance, and even the basics -- such as what a premium is and why getting a primary care doctor is better than relying on the emergency room -- are beyond their experience. Others have a sense of how insurance works but find the details of the marketplace plans confusing, especially if they signed up without the help of someone who understood them.

In one sign of widespread confusion, a recent Kaiser Family Foundation survey of programs that helped people apply for marketplace coverage, found that 90 percent had already been re-contacted by consumers with post-enrollment questions.

Insurers, too, are trying to help ease their new members' confusion. Independence Blue Cross, which enrolled 165,000 people in its marketplace plans, has representatives traveling the Philadelphia region this summer in a semitrailer, the Independence Express, and offering educational seminars.

Independence also has tried to reach all of the new members by phone to welcome them and "make sure they understand what they bought," said Paula Sunshine, the company's vice president of consumer sales and marketing.

Independence, the region's largest insurer, is also holding informational sessions for health care providers and groups such as Resources for Human Development and the Health Federation of Philadelphia, which help people enroll in marketplace plans and answer questions about them. It has also stocked its website, ibx.com, with short videos that explain things such as prescription drug benefits and how to find a doctor.

"It's important that every place they turn they have access to answers," Sunshine said of the new enrollees, half of whom Independence estimates were previously uninsured.

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