GETTING HEALTHCARE COVERAGE coverage can be tricky for those not covered by an employer’s insurance plan. We interviewed Melanie Hall, executive director of Family Healthcare Foundation in Tampa, for more information about how physicians can help patients navigate the healthcare system.
Central Florida Doctor (CFDr): How can doctors help uninsured patients who want to comply with the Affordable Care Act insurance mandate?
Melanie Hall: It is important for consumers and providers to understand that the plans offered by the Health Insurance Marketplace are commercial insurance products — and are the same plans offered outside of the Marketplace. The only difference is that the Marketplace can provide subsidies in the form of tax credits to make the coverage more affordable. If a physician’s office accepts Blue Select plans, for example, it would not matter if the plan was purchased individually or through the Marketplace; the plan would offer the same coverage for the consumer and the same reimbursement for the provider. So, doctors can encourage their patients to look at their options on the Marketplace. They can also help them understand the value of having access to free preventive services, like an annual physical and certain screenings, such as colonoscopies. Lastly, they can let their patients know that 90 percent of those who enrolled in the Marketplace last year received financial assistance.
CFDr: What options can they suggest for people who are not eligible for subsidy assistance?
Hall: If a patient is below 100 percent of the Federal Poverty Level (approximately $11,700 annually for an individual), they will fall into the “Medicaid Gap” because Florida has not expanded Medicaid. As a result, they are not eligible for tax credits through the Marketplace. Some counties have county health plans that provide varying levels of service, from primary care to coverage for hospitalizations, but it does depend on the county. Federally qualified health centers can also provide services on a sliding scale, as well as the network of free and charitable clinics.
CFDr: How can doctors assist people who may be eligible for Medicaid coverage? Is there a place where they can refer them? Where can doctors refer patients or potential patients who may need help understanding what assistance they can receive through Medicaid?
Hall: The Department of Children and Families assists with Medicaid applications as well as helping consumers apply for other types of assistance for which they may be eligible. There are also Medicaid Access sites in many communities, and many hospitals assist uninsured patients with Medicaid applications.
CFDr: Where can doctors refer patients for information about Medicare? Where can patients receive help understanding their coverage?
Hall: SHINE (Serving Health Insurance Needs of Elders) is a free program offered by the Florida Department of Elder Affairs and your local Area Agency on Aging. SHINE contact information can be found at floridashine.org.
CFDr: Where can doctors refer patients who need more information on their insurance options? Anyplace in Polk County?
Hall: Healthcare.gov features a Find Local Help function that allows users to enter their ZIP code and locate navigators or assisters near them. Navigators can provide education about their options and help them compare plans on the Marketplace.
CFDr: Where can doctors and medical staff send them to learn more about healthcare options?
Hall: The Family Healthcare Foundation partners with Winter Haven Hospital to provide navigator services at the hospital and several other community settings. Coveringtampabay.org is a website that includes an interactive map that helps locate sites where assistance is provided. It also lists enrollment events in Polk, Pasco, Hillsborough, and Pinellas counties.
CFDr: Where can doctors send patients to learn more about paid insurance options (including supplemental Medicare coverage)?
Hall: The resources I previously mentioned.
CFDr: Are there any Polk County area resources you can recommend?
Hall: The Florida Department of Health in Polk County can provide information on many of the services and resources available for those that remain uninsured.
CENTRAL FLORIDA HEALTH NEWS staff report