Patient Education and Health Insurance Literacy

1. Patient Education and Health Insurance Literacy Outreach and Enrollment Distance Learning Series Welcome to the Outreach and Enrollment Webcast Series You can use the Join.Me Control Buttons (green) to navigate to: Connect to the call via the internet Connect to the call via the phone Use chat to ask a question to the host CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

2. O&E Distance Learning Series Visit CHAMPS Distance Learning Page for more information • Making the Business Case for O&E • Monday, May 5, 2014, 1:00PM – 2:30PM Mountain Time • Best Practices for Young Adult Outreach • Tuesday, May 20, 2014, 2:00PM – 3:00PM Mountain Time • Maximizing O&E Staff and Continued Enrollment • Tuesday, June 3, 2014, 1:00PM – 2:30PM Mountain Time • Rural Outreach Strategies • Tuesday, June 24, 2014, 10:00AM – 11:00AM Mountain Time • Outreach to Special Populations • Tuesday, July 22, 2014,10:00AM – 11:00AM Mountain Time • Planning for Successful Outreach • Tuesday, August 19, 2014,2:00PM – 3:00PM Mountain Time • Diving Deep on Premium Tax Credits • Tuesday, September 23, 2014,10:00AM – 11:30AM Mountain Time www.champsonline.org/events/distancelearning CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

3. Community Health Association of Mountain/Plains States (CHAMPS) www.champsonline.org CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

4. Colorado Community Health Network CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

5. Presented by: Liz Tansey Colorado Community Health Network Covering Kids and Families Community Health Center Outreach and Enrollment Training Coordinator ltansey@cchn.org CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

6. Learning Objectives • Educate consumers on how health insurance works • Educate consumers on when to seek what type of medical care • Educate consumers on how to retain their health insurance CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

7. Health Insurance Literacy Low health insurance literacy causes • Problems obtaining, processing, and understanding basic health information and services Causes • Low language literacy • Low health literacy CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

8. The Value of Health Coverage CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

9. Resources CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

10. Terminology Premium • Set amount of money • Paid to the health insurance company • Typically paid monthly • Keeps coverage active Deductible • Set amount of money • Paid to the provider • Must be met before insurance company pays • Shares costs among patient and insurance company CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

11. Terminology Co-pay Co-insurance Set amount of money Paid to the provider at the time of service • Set percentage of health care costs after deductible has been met • Generally billed later CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

12. CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

13. In-Network vs. Out-of-Network CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

14. Medication Tiers • Prior authorization • Step therapy • Quantity limits CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

15. Samantha’s Coverage Premium: $117/month Deductible: $600 Co-pay for office visits: $30 Co-insurance: 20% Out-of-pocket maximum: $1,500 Skiing Accident Co-pay: $30 Tests and X-rays: $600 Wellness Visit 20% of lab test costs CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

16. Educating Patients • Handouts • Workshops • Group appointments • One-on-one appointments • Community events CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

17. Utilizing Coverage • When to visit the ER • When to visit the CHC • How to prepare for an appointment CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

18. Emergency Care • An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm • Emergency room care should only to be used in the case of an emergency CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

19. Primary Care Through the CHC • Illness • Minor injuries • Lifestyle changes and support • Health screening • Wellness visits • Care coordination • Disease management CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

20. Preparing for an Appointment CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

21. Appealing • Check the details of the insurer’s appeals process • Have all the paperwork in order • the bills from the provider • the patient’s explanation of benefits • copies of denial letters • medical records • letters from the provider • Enlist the help of the provider • Take detailed notes when speaking with the insurance company • time and date • length of the call • the name and title of the person you speak with • all the details of the conversation • follow-up activities and next steps by all parties • Write down the argument • Follow up  CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

22. Timeline of Appeals Process • Urgent Care – 72 hours • Non-urgent care not yet received – 30 days • Non-urgent care already received – 60 days CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

23. Staying Enrolled • Private insurance • Pay premiums • Report life changes • Medicaid/CHIP • Future open enrollment periods CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

24. Paying Premiums James Covered Grace Period $100 due Grace Period $100 due Grace Period $300 Paid John Grace Period $100 due Grace Period $100 due Grace Period $300 Unpaid Uninsured CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

25. Reporting Changes Qualifying Life Events Reporting to HealthCare.gov Moving to a new state or service area Losing another type of health coverage Changes in citizenship or immigration status A change in income A change in household status A change in family size Online Log in Select application Select “Report a life change” By phone 1-800-318-2596 Reporting to Connect for Health Colorado Call 855-PLANS-4-YOU (855-752-6749) CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

26. Staying Enrolled in Public Insurance Administrative Renewals Non-Administrative Renewals If eligible, enrollment continues with no action needed If no longer eligible, a denial is available so patient can shop for insurance through the marketplace The patient can appeal coverage decisions Patient sent pre-populated form 30 days to confirm, sign, and return If eligible, enrollment continues If no longer eligible, a denial is available so patient can shop for insurance through the marketplace The patient can appeal coverage decisions CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

27. Future Open Enrollment Periods • November 15, 2014 – February 15, 2015 • January 1, 2015 coverage • No insurance? • Sliding fee scale • Referrals • Planning for the future • Emails • Text messages • Post cards CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

28. Advocacy Resources The Coverage Gap Medicaid expansion advocacy Work with your state PCA Work with CHAMPS Work with NACHC Work with other community organizations The Family Glitch Federal rules change Federal advocacy Work with your state PCA Work with CHAMPS CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

29. Additional Terminology Resources Department of Labor Glossary of Health Coverage and Medical Terms How Health Insurance Works Infographic by Adelante con la Salud Latino Health Care Engagement Project in Colorado Families USA Glossary of Insurance Terms (English or Spanish) Enroll America’s Get Covered Guide (English or Spanish) CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

30. Additional Resources From Coverage to Care Roadmap by CMS (English or Spanish) Partnership for Prescription Assistance website Kaiser Health News/National Public Radio Appeals Story CHAMPS/CCHN Outreach and Enrollment Distance Learning Series

31. Thank you for Participating Please join us Monday, May 5 from 1:00-2:30 p.m. MT Making the Business Case for Outreach and Enrollment With Northwest Regional Primary Care Association Please join us Tuesday, May 20 from 2:00-3:00 p.m. MT Best Practices for Young Adult Outreach With Enroll America Link to survey CHAMPS/CCHN Outreach and Enrollment Distance Learning Series