Health Plans Face Uphill Battle to Reach Newly Uninsured
August 24, 2020
Health Plans Face Uphill Battle to Reach Newly Uninsured
Reprinted with AIS Health permission from the Aug. 24, 2020, issue of Health Plan Weekly
Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment.
AmeriHealth Caritas, which is run by Independence Blue Cross in partnership with Blue Cross Blue Shield of Michigan, says it has launched a series of videos designed to help potential Medicaid enrollees learn how they can apply.
Meanwhile, Fort Worth, Texas-based Care N’ Care Health Plan, which offers Medicare Advantage (MA) plans, is urging newly unemployed seniors — who already were Medicare-eligible but delayed signing up because they still had health insurance through a job — to get coverage now.
Still, reaching those who have been laid off and are suddenly in need of coverage is not an easy task, warns Jerry Vitti, founder and CEO of Healthcare Financial, Inc., a Boston-area company that connects low-income, elderly and disabled populations with public benefit programs.
“Traditionally, plans go to hospitals, community health centers, community agencies, opportunities like ethnic festivals and so forth where you have touchpoints,” or chances to interact with people who may be potential members or who might need help enrolling, Vitti tells AIS Health. With the pandemic ongoing, these in-person touchpoints are largely not available, he says.
That means insurers must reach people in other ways. AmeriHealth Caritas, which operates in 13 states and the District of Columbia and serves approximately 5 million Medicaid, Medicare and Children’s Health Insurance Program members, is promoting two videos and a one-page handout that offer enrollment assistance.
The first AmeriHealth Caritas video is “Medicaid 101,” which explains how the program works, and the second is “How to Enroll in Medicaid.” The one-page handout explains in relatively simple terms how people can get organized and apply for Medicaid coverage in their state of residence.
Care N’ Care, which has both MA HMO and PPO plans, is hoping to reach newly unemployed and uninsured seniors by stressing in a public relations campaign that those people don’t need to wait until open enrollment begins later this year to choose an MA plan.
“These newly uninsured seniors comprise one of the tragic but seldom talked-about consequences of the coronavirus,” says Wendy Karsten, Care N’ Care CEO. “These seniors had coverage under their employer’s health insurance but now need to hurriedly enter the individual insurance market and shop for a Medicare plan.”
There’s evidence of a significant unmet need for consumer assistance in navigating health coverage options, including individual market coverage and Medicaid coverage, according to an analysis released Aug. 7 by the Kaiser Family Foundation.
The report, based on a survey conducted in spring 2020, found that nearly one in five consumers who looked for coverage or actively renewed their coverage received consumer assistance in the past year. Most who enrolled in coverage with help said the assistance made a difference, and two out of five said it’s unlikely they would have found coverage without help, according to the report. Another 12% of target consumers tried to find help but did not get it, suggesting there is a shortage of consumer assistance.
“Most people who are uninsured or have marketplace or Medicaid coverage do not know or are unsure if the ACA has been overturned, if their state has expanded Medicaid eligibility, or time frames when they can apply,” the report said. “Consumer assistance could help people identify and navigate replacement coverage options.”
Most state Medicaid agencies have tried to make it easier for people to apply for coverage during the pandemic by offering a dedicated phone line for enrollment assistance, providing real-time eligibility decisions, and waiving interviews and other documentation requirements, according to a June 17 Health Affairs blog post. Some states also have allowed hospitals or state Medicaid agencies themselves to presume people are Medicaid-eligible and start coverage before they’ve completed the necessary paperwork.
Newly Uninsured Are Not ‘Typical’
Medicaid managed care organizations are conducting their own outreach, and “they’re really great at consumer engagement with the Medicaid population,” Vitti says. “But the folks who are newly uninsured are not a typical Medicaid population,” and states and plans may need different types of communications to reach people and enroll them, he says. In addition, Vitti notes, funding has been cut across the board for health care navigators who can assist prospective members in signing up for coverage.
In fact, Medicaid plans so far are not seeing as big an influx of enrollees as they might have expected in the pandemic. Much of the Medicaid enrollment gains that publicly traded insurers have seen are related to suspended eligibility redeterminations during the public health crisis, not job losses, executives said during the companies’ recent second-quarter earnings calls.
Coverage ‘Falls Between the Cracks’
“People are forgoing health care, mostly preventive non-emergency visits, in favor of more pressing needs like eating and paying rent — addressing these underlying social determinants of health is primary, so health coverage kind of falls between the cracks,” Vitti says. “Another reason may be that people are expecting to return to work when this is all over and are just waiting to get their old employer coverage back.”
Since “at the very least I think we’re looking at a protracted COVID-related recession,” he says, “we should eventually see the enrollment increase they were expecting.”
Still, outreach to people who might be eligible for coverage is proving challenging in this environment, Vitti says: “The plan folks we work with are extremely committed to the population, but there’s a lot of financial, operational and medical strain on the system. So folks are trying the best they can in an environment that just doesn’t lend itself to being able to do everything.”
by Jane Anderson