Navigate the healthcare marketplace with help from LMH Health

Having trouble navigating your health insurance options? LMH Health can help you discover what may be available to you.

Navigating healthcare, especially health insurance, may seem like a daunting task. Making your way through the maze of terms, options and deadlines can be confusing. What’s available, what do you qualify for and where should you look for insurance?

There are a number of options available to you, though it may take some leg work.

• You’re eligible for Medicare if you’re age 65 or older or if you have certain disabilities. The government pays for much of your healthcare through this federally run program.
• Medicaid is another program available for people with low-incomes. Around 80 million people – nearly one in four Americans – are eligible for this program funded by state and federal governments. It’s run by each state, so your eligibility depends on where you live.
• If you’re employed, group health insurance may be available through your employer. Around 49% of Americans have employer-sponsored insurance, according to the Kaiser Family Foundation.
• The Healthcare Marketplace is available to individuals who do not qualify for Medicare or Medicaid and who do not have a health plan sponsored by employers. The Exchange was developed through federal legislation (The Affordable Care Act) and is administered in each state differently with health insurers who choose to participate.

All of these programs can be confusing to understand, especially without someone to guide the way. LMH Health is stepping up to help you determine your best option for healthcare coverage with the introduction of a new role to our organization – a marketplace navigator.

“Having a marketplace navigator is important for a number of reasons. They assist patients during open enrollment and help identify when there are life changes that qualify for a Special Enrollment period,” said Michele Vanoni, senior director with LMH Health patient accounts. “The navigator also helps answer questions about cost, maximize cost savings and provide technical support for individuals who struggle with technology or may not have access.”

To fill the role of the navigator, LMH Health turned to Penny Steele in late 2021. Prior to becoming a financial counselor at LMH, she worked as a contractor for the Centers for Medicare & Medicaid Services (CMS) for eight years. Steele helped customers with their questions, which required extensive training on available products, continuing education and training. This background provides her with a unique skillset that she uses to help patients.

“Getting some kind of coverage for healthcare is vital and we can help. If you don’t have insurance through your employer, Medicare or Medicaid, you might think that you can only enroll for health insurance through the marketplace during a certain window, and that’s not necessarily true,” she said. “You may experience a qualifying life event that makes you eligible at another time.”

What is a qualifying life event?

According to the Health Insurance Marketplace, available at Healthcare.gov, there are four basic types of qualifying events. Some examples of qualifying events include, but aren’t limited to:

• Loss of health coverage, including losing job-based, individual or student plans; losing eligibility for Medicare, Medicaid or the Children’s Health Insurance Program (CHIP); or turning 26 and losing coverage through a parent’s plan.
• Changes in household, including getting married or divorced; having a baby or adopting a child; or a death in the family.
• Changes in residence, including moving to a different ZIP code or county; students moving to or from the place they attend school; seasonal workers moving to or from the place they live and work; or moving to or from a shelter or transitional housing.
• Other qualifying events, including a change in income; becoming a U.S. citizen; or leaving jail or prison.

If any of these situations apply to you, then you have 60 days from the event to enroll in coverage through the marketplace.

How do I start the enrollment process?

You’ve got a variety of options to get enrolled for health insurance through the marketplace. You could use an agent, broker or certified enrollment partner, visit Healthcare.gov to enroll online or contact the marketplace call center to enroll by phone. If you’d like assistance navigating the process and your options, Steele is ready to help.

“Make sure you have your tax returns or know your family income. Eligibility for Medicaid or the price you pay for insurance through the Marketplace is based on income and family size, so it’s important for this information to be correct,” she said. “The IRS looks at the income guidelines so if you provide inaccurate information, you might be required to pay back the tax credit you received in advance.”

You’ll also need to provide:

• Basic information about everyone applying for coverage, including names, social security numbers and their relationship to you
• A mailing address for everyone applying for coverage
• Employer information for everyone in the household
• Health coverage information, if anyone in the household currently has a health plan
• Immigration document information (for lawfully present immigrants)

With this information in hand, Steele helps residents determine which level of service plan fits their needs or if they are eligible for Medicaid. Plans are currently available through three insurers – Medicia, Ambetter and Blue Cross Blue Shield of Kansas. People who live in other areas may have different choices available to them. 

Does Medicaid expansion play a role?

Medicaid expansion is a hot topic – one that the Kansas Legislature is set to revisit during the 2022 legislative session. Kansas is one of just 12 states that hasn’t implemented the expansion for adults with income up to 138% of the federal poverty level, which was $17,774 for an individual in 2021. The Kaiser Family Foundation found that states implementing Medicaid expansion have improved overall mortality rates, including rates for individuals with specific health conditions. Expansion states have also reduced racial, ethnic and socioeconomic disparities, saved money in their budgets and boosted economies.

“Individuals without group health coverage have a huge financial and administrative burden that many are unable to meet which results in individuals not obtaining healthcare or receiving preventative care,” Vanoni said. “If Kansas were to pass Medicaid expansion, it would allow more options for our patients – especially those at the low end of the income scale.”

If you’re struggling to determine if you qualify for marketplace insurance, Medicaid or need help to make sense of health insurance options available to you, our marketplace navigator might be just the resource you need. Give us a call at 785-505-2922 and see how we can help you.