Navigators turn to paper applications to enroll N.C. residents for subsidized insurance

jmurawski@newsobserver.comNovember 4, 2013 

  • How to request subsidy amounts

    In the absence of the federal subsidy calculator, which hasn’t functioned properly since enrollment started five weeks ago, subsidy amounts can be requested by mail, interrupting the process by at least several weeks.

    Once a subsidy amount is determined, insurance shoppers can calculate the amount they would pay for subsidized policies by subtracting the monthly subsidy from the monthly insurance premium. People at the lowest income levels will qualify for the biggest subsidies, in some cases offsetting most of the value of the monthly premium.

    Navigators are relying on a number of unofficial calculators, including applications created by the Kaiser Family Foundation, WebMD and EnrollAmerica., a privately-created consumer finance website in New York, is designed to mimic several key functions of It has uploaded details of North Carolina’s subsidized health plans, showing estimated subsidies, premiums, deductibles and other details, in the counties where those plans are being offered.

    In October, the site had 100,000 visitors, including 5,000 from North Carolina, said co-founder and CEO Jonathan Wu. He said the site’s subsidy estimates may not always be exact, but they are reliable.

  • Find a navigator

    North Carolina residents interested in scheduling a session with an insurance navigator in their area can do so by calling the N.C. Appointment Center for the Affordable Care Act, 855-733-3711.

Figuring out health insurance is never a simple matter, but it’s even more convoluted when online networks choke under pressure. That’s a lesson Cindy Murray learned last week during her visit to the Alliance Medical Ministry in Raleigh for a personal tutorial on coverage under the new federal health law.

Murray, 53, was anxious and excited about the prospect of finding insurance for the first time in six years since losing coverage after a divorce. Armed with a slew of questions, the part-time hair stylist sat down with Keith Ward, a trained insurance “navigator,” to review her health insurance options.

After a two-hour consultation with Ward, she left the Raleigh clinic carrying paper forms to be filled out manually at home.

Unable to log in to the buggy federal enrollment website,, Ward and other navigators have devised a creative way to bypass digital technology: paper, pen and envelope.

The downside: It could take weeks for Murray’s federal subsidy amount confirmation to come back by snail mail. At that point she will finally be able to schedule a follow-up meeting with a navigator to begin comparing insurance plans.

“I actually thought I’d know when I walked out of here,” Murray said afterward of her insurance subsidy. “I think I lost a lot of time.”

Despite the high-tech debacle associated with the health law’s website, navigators plod on. In the Triangle alone, they have distributed hundreds of paper applications and processed scores of them for people eager to get the application process underway. Most will remain in limbo until the website is fixed and enrollments can go through.

These nonprofit volunteers, part-timers, legal assistants and social workers have unexpectedly seen themselves recast from a supporting to a starring role in the controversial federal health program, taking over duties for a malfunctioning insurance website that had been designed for the public to use without assistance.

To keep the public momentum going on subsidized insurance, navigators have come up with creative workarounds – patching together a combination of paper forms, federal phone banks and insurance company web sites – to keep the uninsured on track with the nation’s new insurance mandate.

With the federal website expected to be down for at least several weeks, the public is dependent on alternative sources of information about the insurance mandate: navigators, insurance agents, counselors and the government’s phone-in customer service reps, as well as a growing list of online resources.

A smattering of enrollees

The law – titled the Affordable Care Act but known to many as Obamacare – not only requires most Americans to obtain health insurance, but includes a financial penalty for failing to do so. The health law provides subsidies for people within certain levels of household income and allows for exemptions for those who qualify for economic hardships.

The law primarily applies to the minority of residents who buy individual individual policies or are uninsured, about 1.3 million people in North Carolina. Those who already have coverage – through their employer, Medicare or Medicaid – are not immediately affected.

Navigators say they can walk clients through the application process all the way to the point of enrolling – and have done so in a number of instances – but the final step requires getting through on the government website or calling the federal assistance toll-free number.

A smattering of North Carolina residents have managed to log on and enroll, and some have completed the process by phone, navigators say. The number of successful enrollments remains unclear, and insurance companies refuse to discuss their enrollment figures, but the feds say they will disclose state-by-state totals in mid-November.

The application process can be laborious and time-consuming without the federal website, which was designed as a one-stop resource. Details about insurance policies and subsidy amounts have to be gleaned from separate sources, and at this time can’t be reconciled online with a seamless, automated function.

“The stepped approach to the process is a challenge, with the website not taking you through A to Z in one sitting reliably,” said Jennifer Simmons, the navigator project coordinator for Legal Aid of North Carolina, which has deployed nearly 60 navigators throughout the state.

Still, navigators say there is no urgency to apply just yet, as subsidized coverage doesn’t begin until Jan. 1.

Razor-thin margins

Ward, a navigator with CapitalCare Collaborative in Raleigh, said many of the people he advises find the subject overwhelming. Such people typically work in retail, hospitality or other industries that don’t insure their workforce.

Cindy Murray is one such example. She never gave much thought to insurance until her divorce in 2008. Previously, she was on her husband’s policy at work, which covered all her medical expenses, she said.

Murray, a stay-at-home-mom for 16 years, said that after her divorce, she cleaned houses for two years before she found work as a hair dresser. She’s been in the hospital once for a head injury and has relied on the Alliance Medical Ministry clinic to check out a hand injury, sprained foot and similar ailments.

She arrived at Alliance Medical Ministry loaded with questions: What happens to her federal subsidy amount when her alimony payments run out? Does child-support count as income for subsidy purposes? Do savings withdrawn from a retirement account count against her income?

Her navigator consultation was confidential, to protect her medical privacy. She agreed to talk about her experience.

“I didn’t know anything,” Murray said. “I’m afraid of the whole thing.”

Her biggest concern: a catastrophic medical bill that bankrupts her. But she’s also worried that, even with subsidies, she won’t be able to afford the unsubsidized remainder of her insurance on her part-time minimum-wage job.

Her budgeting margin for insurance expenses is razor-thin.

“If it’s going to be $50 (a month), then I might as well keep coming here,” she said, comparing a hypothetical subsidized premium to her occasional reliance on Alliance Medical Ministry. “What worries me is the penalties you pay if you don’t get insurance.”

Navigators say that individual circumstances vary, but anxiety is a constant.

“The biggest frustration is that, even though you can’t get coverage until January, if they could just see their options,” said Debora Owens, a navigator with CapitalCare Collaborative. “These people with these horrible Cobra payments, with their renewal letters, with their preexisting conditions – you could take their anxiety level down.”

Murawski: 919-829-8932

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