By Bryan Thompson, November 25, 2015
Navigator Lyn Weatherhead, with the Southwest Kansas Area Agency on Aging,
assists a client with enrollment for the health insurance marketplace. Through
an effort known as Cover Kansas, navigators are working throughout the state
to help people enroll in health insurance for 2016. (Photo by Bryan Thompson)
Since enrollment opened Nov. 1 for 2016 health insurance in the federal marketplace, an effort called Cover Kansas has branched out across the state to help Kansans find a plan that best suits their needs.
At a recent outreach event at the Dodge City Public Library, most of the chairs in the public meeting room were full as people waited for the consultations with marketplace navigators.
Don and Louise Tawzer, of Dodge City, signed up for insurance through healthcare.gov last year, after Don retired from the job that had furnished their health coverage. But he turned 65 this spring, so he’s now on Medicare. Louise isn’t there yet, so she needs coverage in 2016 through the Affordable Care Act, commonly referred to as Obamacare.
“We’re looking at roughly $1,200 more a year next year for the same plan, according to the letter we got from Blue Cross Blue Shield,” Don Tawzer said. “There may not be anything available, but we just want to look and see if there’s something that’ll help.”
The Tawzers sat down with health insurance navigator Lyn Weatherhead, from the Southwest Kansas Area Agency on Aging.
“What we can do is just go through, without putting any of your information in, go in and take a look at the plans that they offer, based on your income, and just see what there is available,” Weatherhead said.
After reviewing their options, the Tawzers concluded that Louise’s current policy is probably their best option — even though the premiums will be nearly $100 a month higher than this year.
“Because of our income, we do have some help with the credit on your taxes, or whatever they call it. So, if we didn’t have that, it would be considerably higher,” Don Tawzer said.
About 80 percent of the people who buy insurance through the federal marketplace get some level of premium tax credit. But premiums aren’t the only costs that need to be taken into account.
“The biggest cost for us has been the prescription part,” said Don Tawzer, who added that his wife’s drug costs “went up dramatically” when they left the insurance through his former employer.
Another important consideration is the cost of co-payments, co-insurance and deductibles. Don Tawzer said there’s a limit to the out-of-pocket costs his wife is required to pay per year — but it’s around $5,000.
Those expenses also are a big concern for Joe and Sylvia Ascencio of Dodge City.
“Deductibles are pretty high. Like, for instance, for us the deductible it’s $2,500 for each one of us,” Joe Ascencio said. “And so, in a way, it’s like not having insurance. So, the insurance is good if you go to the hospital, you break a leg or something. Other than that, it really doesn’t help.”
Until April, the couple had health insurance that was furnished at no cost to them by Joe Ascencio’s employer.
“I was insured, but I lost my job,” he said. “So I was forced to retire two years earlier. So I end up with no health insurance, no coverage, and here we are. So we had to find a solution.”
Ascencio is diabetic, which without the Affordable Care Act would’ve made it challenging to get insurance on his own. He’s grateful for the coverage the federal marketplace offers.
Like the Tawzers, he appreciates the federal subsidy, which knocks the premiums down to a manageable level.
“If I didn’t have any help from the federal government, I won’t be able to pay this much money, so I’d have to do without insurance,” he said. “And I’m sure there’s a lot of people out there doing exactly that, because the insurance premiums are so, so expensive.”
Both families said they’re thankful to have a well-trained insurance navigator to guide them through the enrollment process and to help them understand the choices and trade-offs among the 26 coverage plans available in Kansas.
The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.