Updates

  • In My Own Words: Ferman G, from Florida

    At Community for a Healthy Exchange, we have heard too many stories of unaffordable out-of-pocket costs for critical treatments and medications.

    Ferman, a CHE member, has struggled with this issue under insurance he purchased from the state exchange. He decided to purchase the Silver Plan, a more expensive plan than he initially anticipated buying, so he could continue to see his regular providers to treat his hypertension. When Ferman’s doctor prescribed a blood pressure monitor for his condition, his insurance said they would cover it. However, he received a bill to pay for the entire cost of the device out of his own pocket.

    State exchange enrollees have reported paying out-of-pocket for healthcare services, prescriptions, and specialist appointments. Placing the burden of cost on patients in need can inhibit access to life-saving medical care. Under the average Silver Plan, patients may have to pay up to 50 percent out-of-pocket for necessary treatments and care.

    See Stories.

    Have you dealt with high out-of-pocket costs like Ferman? Costs that dissuade you from seeking or administering the care you need? Tell us your story!

  • Higher Healthcare Costs and Closing Co-Ops on the Horizon for 2016

    It’s no secret many Americans have faced challenges accessing affordable and fair health insurance through the federal and state health care exchanges. Being unable to see necessary doctors, dealing with high premiums and deductibles, and understanding what’s covered under each plan are just a few issues our members have experienced when shopping for coverage through their state exchanges. In addition to these issues, closing co-ops, and higher premiums appear on the horizon for the state exchanges in 2016.

    Co-ops were created under the Affordable Care Act as an alternative insurance option to corporate health insurers. Hoping to produce competition with the larger health insurance companies, co-ops encouraged affordable prices and lower premiums. Now these co-ops are beginning to shut down. In fact, 12 of the 23 created insurers in 2014, nearly a third, are shutting down. This will force over 500,000 enrollees to look for a new health care plan in 2016. New York, Colorado, Kentucky and South Carolina are just some of the states experiencing failing and closing co-ops.

    State exchange customers have voiced issues with the health exchange, especially high premiums and out-of-pocket costs, long before the co-ops shut down. Closing co-ops will likely bring even higher costs and limited plan choices for enrollees. According to the Wall Street Journal, 60 percent of enrollees will see the average rate for premiums in the Silver Plan rise by 6.3 percent. Some states are expecting premiums to jump by double-digit percentages--Alaska’s Silver Plan premiums will rise by 31.5 percent and Oklahoma will see a 35.7 percent hike.

    The Obama Administration reports that costs will still be manageable even with increased premiums and closing co-ops; 80 percent of returning customers will be able to buy plans with premiums under $100. Current enrollees are encouraged to revisit the website, review their health plans, and choose a new plan if theirs has closed, or if they want to switch plans to cut costs. Federal health officials have also announced new online tools to help current and future enrollees search for plans that cover their current doctors and preferred healthcare providers.

    Community for a Healthy Exchange works to make sure you have the most up-to-date information and news on changes taking place within the state healthcare exchanges. Working together, we can ensure families and patients have access to fair and affordable health insurance.

  • Celebrate caregivers during National Family Caregivers Month

    November is National Family Caregivers Month, a month dedicated to recognizing those who give their time and resources to provide unpaid care for family members and loved ones. First established by a Presidential Proclamation in 1997, the 2015 theme for National Family Caregivers Month is Respite: Care for Caregivers.

    At Community for a Healthy Exchange, we know that caregivers play a huge role in helping to manage or make healthcare decisions for a loved one. The biggest hurdle for many caregivers is helping their loved ones access the affordable healthcare they need. Oftentimes caregivers act as intermediaries for those they care for, helping them enroll in an insurance plan, understand their benefits, and access the healthcare they need. This role is more difficult when caregivers encounter problems with the insurance their loved ones purchased from a state healthcare exchange.

    A new study by The National Alliance for Caregiving (NAC) and the AARP Public Policy Institute articulates the important role caregivers play in the health and wellness of those who cannot take responsibility for their own care. Below are the top five findings:

    1. Number of Caregivers: More than 30 percent of the entire U.S. population, an estimated 43.5 million adults, provided unpaid care this year alone. The majority of these caregivers provided care for multiple issues affecting the elderly, such as Alzheimer’s or Dementia.

    2. Time: Caregivers dedicate a large amount of time, unpaid, to provide care. Approximately 25 percent of all caregivers spend 40 hours or more providing services a week.

    3. Assistance with Basic Daily Tasks: A large portion of caregivers help with personal care tasks—things such as getting in and out of bed, or navigating stairs—that healthy people complete everyday but those who are elderly, or medically-challenged may find difficult.

    4. Healthcare Intermediary: A caregiver’s responsibilities expand far beyond providing help with daily tasks. Many times caregivers act as an intermediary for their loved one communicating with healthcare providers, agencies, or insurance companies. In fact, 63 percent of all caregivers advocate for their loved ones to receive necessary health coverage or services.

    5. Performing Medical or Nursing Tasks: The study found that many caregivers perform tasks that have traditionally been reserved for medical professionals. These activities include injections, administering medication, or complex care procedures.

    Community for a Healthy Exchange is a project of Caregiver Voices United, a 501(c)4 organization allied with Caregiver Action Network; a nonprofit organization that advocates for family caregivers who care for loved ones with chronic conditions, disabilities, disease or frailties of old age. CVU seeks to guide legislators to create policy that benefits family caregivers. Caregiver Action Network provides a number of resources and information on National Family Caregivers Month, including helpful information on this year’s theme: respite, and a list of support services providing rest and relaxation for caregivers.

  • In My Own Words: Tina M. from Colorado

    Sparse information, non-user friendly formats, and a lack of transparency related to covered benefits and actual out-of-pocket costs are just a few of the problems that make it difficult to navigate the state exchange websites.

    Community for a Healthy Exchange member Tina struggled to understand what her insurance covered when she purchased her plan through the state exchange. 

    Tina needs chiropractic treatment and pain medication for a herniated disc, but her current health insurance through the Colorado state exchange doesn’t cover it.  When she tries to find answers about medication options and coverage, she can’t get in touch with a representative from the state exchange. 

    Learn more about Tina and her struggle with the lack of transparency in insurance plan coverage and information through the state exchange website.

    Have you had difficulty understanding what your plan covers?—did you purchase a plan, but like Tina, your insurance doesn’t cover what you need it to? Tell us!

  • In My Own Words: Justin W. from Iowa

    Some Community for a Healthy Exchange members face challenges accessing the medicines they need through health insurance from their state exchange. 

    Justin has dealt with limited formularies, which is a restricted list of prescription drugs his health insurance offers.   His plan, purchased through the Iowa state exchange, doesn’t cover the blood thinner medication he needs to stay healthy.  He’s stuck paying out-of-pocket for his necessary prescriptions Read more about Justin’s struggles with accessing affordable prescriptions for his condition here.

    Have you faced problems similar to Justin’s—bought an insurance plan through the state exchange and realized that you can’t access the prescriptions you need because of the limited formulary? Tell us!

     

  • In My Own Words: Jennifer G from Iowa

    Many Community for a Healthy Exchange members have felt the impacts of “narrower networks” and are unable to choose the doctors they want or prefer for themselves or their loved ones.

    Jennifer is one of those individuals. Her daughter is disabled, therefore it’s important for her to continue care with her primary care physician. Jennifer didn’t realize that she was limited to a narrow network until after purchasing insurance through the state exchange. Now her daughter’s doctor isn’t covered on her current plan.

    Read more about Jennifer’s struggle with narrow networks here.

    Have you faced problems similar to Jennifer’s—purchasing a state exchange insurance policy and finding out you couldn’t see your doctor because of a narrow network? Tell us!

  • In My Own Words: Kathryn S. from Iowa

    When our community members speak up about the problems they’ve had with their health exchange, they are helping lawmakers realize real people are facing real problems when trying to provide reliable and affordable health coverage for themselves and their loved ones.

    Community for a Healthy Exchange member Kathryn explains how her medications are so expensive, she often chooses not to purchase them unless it’s an absolute emergency.

    See all of Kathryn’s story here.

    Have you faced problems similar to Kathryn’s—purchasing a state exchange insurance policy and finding out your necessary medications were still too expensive with a deductible, even worse, not covered at all? Tell us!

  • Supreme Court Rules on the Patient Protection and Affordable Care Act: What it Means for You

    On June 25, 2015, the Supreme Court held in King v. Burwell that the Patient Protection and Affordable Care Act, amended by the Health Care Reconciliation and Education Act, (“ACA”) makes premium tax credits available to taxpayers who obtain health insurance through exchanges established by the states or the federal government. Writing for a 6-3 majority, Chief Justice Roberts upheld the IRS’s rule that authorized credits regardless of whether the state or federal government establishes the Exchange.

    For consumers, this means that no matter what state you live in and whether your state or the federal government operates the health insurance exchange, as long as your income qualifies you or your family for a premium tax credit, you will continue to get your subsidy.

    If you have a question about whether you qualify for a premium subsidy, get in touch with a Navigator by visiting Healthcare.gov.

  • Cost-Sharing and Access to Affordable Care

    The state health exchanges exist to try to ensure everyone can access the care they need. Keeping health care affordable is a key component of keeping it accessible.

    Everything from comparing plans and benefits to understanding deductibles and out-of-pocket costs can make the task of selecting a health plan from your state’s health insurance exchange challenging, particularly when variables and costs vary so drastically among plans, even within the same “metal level” (i.e., bronze, silver, gold, etc.).

    But choosing a plan is just the beginning. Some patients and caregivers are learning their health care may cost more than they anticipated due to high cost-sharing, particularly when it comes to the cost of certain prescription drugs.

    What is Cost Sharing?

    Cost-sharing is the total amount a patient is responsible for paying for covered health care services or prescriptions. This includes any co-payments, co-insurance, or deductible payments. Even when you or your loved one has paid the deductible for the year, you can still face high out-of-pocket costs.

    High cost-sharing may put certain medicines or treatments out of reach. And that can have negative consequences for patients’ health outcomes. That’s especially true for patients with significant chronic conditions or rare or acute diseases, for which treatment options may be limited.

    What can be done

    Some patients may qualify for subsidies (financial assistance) based on their income levels. These subsidies reduce the deductibles and other out-of-pocket costs those individuals or their family members are required to pay.

    Some protections have also been put in place through the Centers for Medicare & Medicaid Services, but there is still more to do to ensure patients and caregivers who are not eligible for Medicare or Medicaid can afford the health care they need.

    The Community for a Healthy Exchange believes that an important first step is making sure all patients and caregivers can more easily estimate their likely out-of-pocket costs when they are selecting a health plan on their state health exchange. Clearer explanations of benefits and cost-sharing levels will better position patients and their families to make informed choices.

    Beyond greater clarity, we also believe additional discussion is needed about how benefit levels for different types of treatments are set, to ensure that those patients who most need quality health care don’t find themselves facing prohibitive costs.

    There’s no question that cost-sharing is a complicated issue. We encourage you to start by taking the time to carefully review your or your loved one’s health plan (including deductible and other potential out-of-pocket costs) so that you have a better chance of knowing, upfront, what the impact will be to you and your family when using your coverage.

    Have you run into challenges with out-of-pocket costs being higher than you expected? Tell us more here.

    Have you been successful in selecting a health plan that keeps your out-of-pocket costs manageable? We’d also like to hear what you did to make the system work for you or a loved one. Tell us more here.

  • Exchanges Present Multiple Challenges for Enrollees

    Using the state Health Insurance Exchanges to purchase insurance—not to mention actually using that insurance—can be more challenging and expensive than many of us expected.

    Here are just a few of the challenges patients and caregivers face:

    These challenges can be overcome. It’s important that all patients and caregivers have access to fairly priced health coverage that works for them and improves their health care and quality of life.

    Tell us more about your experience and how you think the health exchanges can work better for all patients and caregivers. Share your story with us today and help others benefit from your experience.

  • Community for a Healthy Exchange

    The Community for a Healthy Exchange includes patients, caregivers, health care professionals, and others who want to help improve people’s experience with the state health exchanges and ensure everyone has access to health coverage that really works for their needs.

    Our goals are simple, yet important:

    • Ensuring that people who are struggling with the health exchanges or the coverage they got from them realize they are not alone. We want to let people know that others share their frustration, and there is hope to resolve their problems, individually and collectively.
    • Providing patients and their families with resources that will help them address their individual challenges and empower them to navigate the health care system more effectively.
    • Bringing patients, their families, and other concerned supporters together to share their experiences and learn from others’ experiences. We believe this is one important way in which we can raise awareness and foster a discussion about how we can enable all people to access coverage that meets their short- and long-term health care needs at a price that fits their family or individual budgets.

    You can learn more about the exchanges and the challenges facing patients and caregivers here.

    The Community for a Healthy Exchange is sponsored by the Caregiver Action Network (CAN). Learn more about our community and CAN here.

    Join the discussion by sharing your story with us here.

    Feel free to contact us if you have questions.

    We look forward to working with you!

  • Exchanges in the News: Exchange Enrollees Can’t Find Doctors?

    Recent press coverage reports that some patients with health coverage from the state exchanges are facing a new and unexpected problem in securing the care they need: they can’t find a doctor who will take them on as a patient.

    According to USA Today, because the “exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies.”

    Shawn Smith of Seymour, Indiana, for example, “spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.” She was finally successful in recent weeks.

    Or take Jon Fougner, a “recent Yale Law School graduate” who “sued Empire Blue Cross this month because he couldn't find a primary care doctor in his new ACA exchange plan.”

    The USA Today article includes a very important take-away: these people’s “experience underscores how important it is for consumers to check out doctor and hospital networks for plans before they purchase them—and to call doctors to make sure they are accepting new patients with their policies.”

    In addition, insurers “are also moving to smaller networks of doctors and hospitals in their exchange plans. These ‘narrow networks’ help them reduce costs, but they can also lead to problems when consumers look for doctors who will take them.”

    Unfortunately, as Community for a Healthy Exchange members already know all too well, this is just one example of how the exchanges’ lack of transparency and tools to help patients and their families understand exactly what their health plan covers is creating challenges when it comes to actually using the health insurance they’ve purchased.

    The exchanges can work well, but we need to work together to ensure they treat everyone fairly and really meet the needs of patients and caregivers, particularly those struggling with chronic and serious health conditions. Only then will the exchanges be able to truly fulfill their purpose of providing quality care at a low cost—for everyone.

    Read more about narrow networks here.

    Read the full USA Today article.