Last week, I sat down with Nancy O’Connor, administrator of Centers for Medicare and Medicaid Services' Region 3  (Pennsylvania, Delaware, Maryland, Virginia, West Virginia, and Washington, DC) to talk about how to find affordable health insurance before the Marketplace closes on March 31 for purchasing coverage for 2014. The Marketplace is the Affordable Care Act-mandated website that allows you to comparison shop for government-subsidized health insurance. Below is a transcript of the interview, which you can hear in full in my weekly public health podcast. The interview has been edited for clarity and brevity.

Teagan Keating: Because states get to choose if they will expand Medicaid eligibility to more of their residents, many states have chosen not to do so. Pennsylvania is still debating how to address Medicaid expansion. In states like Pennsylvania, there is a large group of people with low incomes who are not eligible for the current Medicaid program and who do not qualify for cost-saving discounts for Marketplace insurance coverage that are part of the Affordable Care Act. This means that until their state expands Medicaid, many of the people who need the financial assistance most will not be able to get any. So what happens to people who would have been covered by Medicaid?

Nancy O'Connor: Unfortunately, a lot of these folks don't have health-care coverage. They can go onto the individual market and purchase a plan but many of them just cannot afford to do that.

The problem is that if you don't qualify for Medicaid based on your income, but you still don't make a lot of money, you might not qualify for subsidies that would really cut down on the cost of the premium.

The different market reforms were put in place just to make health insurance affordable for people. In Pennsylvania, we're seeing that almost 80% of the people who enroll in a health insurance plan on the Marketplace are actually qualifying for premium tax credits and cost-sharing reductions.

If you're 30 years old or younger, you can purchase a catastrophic plan. The catastrophic plans have a very low premium, so you might be able to afford it. The deductibles are very high, but you know, a person would be able to take advantage of three primary care visits a year, they would have a low premium, and at least they would have some health-care coverage if some catastrophic event happened in their life. If you're over 30 years old and you have a hardship exemption—when you don't make enough income to file taxes, or you're in a bankruptcy situation, there are different categories of these exemptions—you can qualify to purchase those catastrophic plans.

I was on looking for an insurance plan. I was astonished at the variety of plans, meaning the very low premium plans with incredibly high deductibles--$6,500 deductibles – up to plans that cost close to $300 a month but have no deductible. It showed that there's a huge range of what can be considered "affordable."

There is a range because we want to have a multitude of options out there for people. I think what people have to keep in mind is what is [their] situation. So when you're shopping on the Marketplace, you do want to think about cost and what you can afford. You [also] want to make sure that if you need certain drugs or if you need [certain] types of care that what you're signing up for [plans that] offer that as a benefit. And then you also want to be sure that access to your doctor or a hospital that you want to go to is part of the network of providers within that health plan.

You're still buying a product, so you have to be sure it's something you will actually be able to use. Is it helpful to remember that you're purchasing insurance that will make a difference in your life and your health?


Do you think that maybe some of sticker shock for the Marketplace plans is because we're not used to seeing how expensive insurance really is?

I think that what people don't think about is just the sheer cost if you get sick. So that premium may look like a lot of money a month, but it only takes one visit to an ER because you've broken your leg and need some kind of surgery. One hospital stay can actually bankrupt you.

Most people don't find it easy to say, "I'm going to spend $150 a month and I'm probably not going to get sick, I'm probably not going to have an accident." Are there psychological roadblocks that are hard to overcome? It's tough to convince people they should be more risk-averse.

I think that's true with a lot of insurance. For example, homeowner's insurance. You buy a house, and you don't buy the house and you have that insurance. You're not thinking that house is going to burn down but you know what? If you have a fire and your house burns down, you're mighty glad you had that insurance! So health care is the same thing, it's just we've never required people to hold health insurance policies.

And the other thing that's important to note is that you can't sign up for insurance just whenever you feel like it. There is the open enrollment period and it's coming to an end now.

Right now, we're nearing the end of the first open enrollment period for the Marketplace.

Do you have a giant clock counting down?

I do, yes!

Because of online shopping, many of us have the mentality of, "You can buy anything you want at any time you want." So why does the open enrollment period exist, why does it end, and why are there these limitations?

Realize you're enrolling in a product that a company sells. So the companies who provide these products, they have to build their business around the plan that they're selling. So there has to be a set period of time where we get everybody into a plan. For the Marketplace, that period ends on March 31.

This seems like it could be really complicated and confusing, and having been on, it could get definitely be overwhelming. What kinds of options do people have to get some kind of information or help--is there anyone out there who will help them?

Absolutely. You can go onto the website, there's a Learn tab. In that Learn tab you can learn about health insurance, about the Marketplace. You can learn about what happens if you lose your job and you don't have insurance for a certain period of time. You can learn about what a premium is. There are a lot of things you can learn on the website.

And it's not complicated insurance company speak. It's all plain language.

Definitely. And on that website there is a button, "Find Local Help," and you can click on that and find an assister in your community and go to that organization or find a navigator who can sit down with you and talk to you face to face to help you enroll in the a plan. You can also call 1-800-318-2596 and speak to a customer service representative and that person will also answer any questions that you might have and help you enroll in a plan.

There are plenty of resources out there for people, it's just a matter of connecting the people and resources to each other. And I think that's always the struggle, with really any kind of resource, making sure the people who need it are the ones who are getting it.

That's right. We're trying to jump up and down and wave our hands to people and say, "Hey everybody who doesn't have health insurance, pay attention!" Especially now because the Marketplace is closing at the end of the month.

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