Applying to enroll in the Patient Protection and Affordable Care Act doesn't have to be like pulling teeth.
"Most people should be able to do this on their own if they are comfortable with a computer," said Angie Zaegel, vice president and chief operating officer for Neighborhood Health Clinics of Fort Wayne.
Dental care for adults, it should be noted, is not among the essential health benefits mandated by the federal health insurance program. Adult dental and vision coverage would have to be bought separately.
But filling out the Affordable Care Act enrollment application might take as long as a visit to the dentist.
"Don't expect to be in and out in five minutes. We are planning on 45 minutes to an hour," Zaegel said.
Neighborhood Health Clinics, 1717 S. Calhoun St., is one of 19 federally approved health centers in Indiana that will provide outreach and enrollment assistance for the Affordable Care Act.
Neighborhood Health Clinics is also among local nonprofit agencies awaiting federal approval as certified assistance counselors. If and when they receive the OK and five hours' worth of Internet training, those agencies will begin providing free help for the open enrollment process, which begins Tuesday and lasts through March 31. Individual insurance coverage begins Jan. 1.
The agencies' target audience is the low-income uninsured population whom the Affordable Care Act was designed to aid when President Barack Obama signed it into law in 2010. Uninsured patients made up nearly 67 percent of the 15,584 people who received care in 2012 from Neighborhood Health Clinics.
"Our staff will focus on what we call in-reach," Zaegel said. "We are going to contact all of our uninsured patients and tell them about the enrollment office hours, make sure they know that they are eligible for health care coverage. We are going to start calling them."
She said she expects most will qualify for insurance premium subsidies, which are based on income levels.
Info at the ready
The Affordable Care Act requires everybody to obtain health insurance or pay a fine. People who already are insured – by employer-provided coverage, an individual policy, Medicare or Medicaid – do not have to enroll.
The Volunteer Center, one of the agencies that will provide enrollment assistance, says on its website that 56,000 residents of Fort Wayne have no health insurance.
Whether uninsured people apply at home – at the website healthcare.gov – or seek assistance from a counselor, following the online enrollment application "was really self-explanatory. It was easy to navigate through the different fields," said Bobbie Alvarez, patient service coordinator for Neighborhood Health Clinics.
Applicants should have certain information on hand to fill out the form:
•Social Security numbers or document numbers for legal immigrants.
•Employer and income information, such as pay receipts or W-2 tax forms, for every member of a household who seeks coverage.
•Policy numbers for any health insurance policies that cover household members.
Applicants also must complete a form called an Employer Coverage Tool for any employer-provided insurance plan for which a member of the household is eligible.
The application is five pages for a short form for individual applicants and 12 pages for a long form for households of more than one person. Much of the required information is what a person must submit for most applications: name, address, phone number, email address and the like.
The section on job and income information asks for employer name, address and phone number; wages, tips and other income; and deductions including alimony and student loan interest.
Another section asks whether an applicant is enrolled in private insurance, Medicaid, Medicare, Children's Health Insurance Program, Tricare, VA health care or the Peace Corps.
Enrollment applications are available at healthcare.gov. Applicants can click "Get Insurance," then click "Individuals & Families" or "Small Business Owners" and scroll to Indiana on the "Choose your state" box. The website is supposed to steer applicants through creating an account, applying, picking a plan and enrolling.
"You put in the information and it brings up your options on what you might be interested in," said Teri Timmerman, outreach and enrollment team leader for Neighborhood Health Clinics.
Assist, not advise
Several insurers – Anthem, Physicians Health Plan, MDwise and Coordinated Care – will provide coverage in northeast Indiana under four price ranges (bronze, silver, gold and premium). Managed Health Services was added to the list on Friday, although coverage details are not expected until this week. But assistance counselors are prohibited from steering applicants to plans or prices.
"You can't say, 'I'd go with that one,' " Timmerman said.
"Navigators can only assist in the process. They cannot advise on any plan," Alvarez said. "So once the consumer comes in and starts asking questions, there is a stopping point for us."
"Navigators" and "assistors" are often used interchangeably. The main differences between the two are funding sources and training requirements.
Four groups in Indiana received federal navigator grants, including United Way Worldwide and the Terre Haute-based Affiliated Service Providers of Indiana, which is collaborating with community mental health centers and Ivy Tech Community College.
Neighborhood Health Clinics hired two application counselors and expanded the hours of a community relations specialist. It has set up space on its third floor for four enrollment application stations and a waiting area. Appointments will start at the top of the hour and are strongly encouraged over walk-in visits.
Zaegel said local and state agencies expect they will have kinks to iron out as the enrollment process unfolds.
"Nobody has said, 'we have all the answers, we have it all worked out.' " Zaegel said. "If anything, we've heard on conference calls, 'Please let us know how it's going.' They want to hear feedback from the ground up."
Congressional Republicans have been trying to delay or defund the Affordable Care Act. What happens to assistance agencies if the start of enrollment is stalled for any reason?
"Everything is going as planned," Zaegel said. "We can't afford to pretend that there might be some disruption, because we have to be ready.
"Overall, it's going to be a wonderful thing for this community," she said. "We have a large number of uninsured people, and this is badly needed. I'm excited about being a part of it."