How do I find the right person to hire for this?
July 25, 2021 6:21 PM Subscribe
I am having an extremely difficult time dealing with applying for and enrolling in my state's ACA health insurance plan. Are there people who will do this for me for a fee?
I've been trying for two months now (have spent close to 30 hours on the state's website as well as on the phone with literally a dozen different people and am getting nowhere) and at this point I'd like to simply hire someone to do it for me even if it's expensive. As a cancer survivor I cannot be without insurance for even a day. My income is too high for Medicare, is right in the range for a decent and affordable marketplace plan with subsidies. My current plan ends in 2 weeks (right after a major surgery which may have complications). I do not qualify for COBRA.
I have gotten nowhere by: contacting the hospital where I get care AND contacting my state rep's office (both refer me back to the numbers I have already called/people I have already talked to)
Who can I hire to help me? I have heard some professionals are certified specifically to do this type of thing - not a lawyer or a social worker but something else? An advocate? At this point I'm looking to pay a private pro rather than use any state organizations for low income people because those have steered me very wrong so far.
I am a Mass resident (but currently out of state for my procedure, so cannot do anything in person).
I've been trying for two months now (have spent close to 30 hours on the state's website as well as on the phone with literally a dozen different people and am getting nowhere) and at this point I'd like to simply hire someone to do it for me even if it's expensive. As a cancer survivor I cannot be without insurance for even a day. My income is too high for Medicare, is right in the range for a decent and affordable marketplace plan with subsidies. My current plan ends in 2 weeks (right after a major surgery which may have complications). I do not qualify for COBRA.
I have gotten nowhere by: contacting the hospital where I get care AND contacting my state rep's office (both refer me back to the numbers I have already called/people I have already talked to)
Who can I hire to help me? I have heard some professionals are certified specifically to do this type of thing - not a lawyer or a social worker but something else? An advocate? At this point I'm looking to pay a private pro rather than use any state organizations for low income people because those have steered me very wrong so far.
I am a Mass resident (but currently out of state for my procedure, so cannot do anything in person).
Response by poster: Difficulties: the online system not accepting my multiple proofs of income, bumping me down to Medicare, terminating my plan, and similar even after I've paid my monthly premium and spoken to representatives who insist I'm enrolled.
Also I googled "patient advocates my city" but notice that they seem to work more with making home care/facility decisions than with insurance enrollment.
posted by CancerSucks at 6:41 PM on July 25, 2021
Also I googled "patient advocates my city" but notice that they seem to work more with making home care/facility decisions than with insurance enrollment.
posted by CancerSucks at 6:41 PM on July 25, 2021
(As a quick note, Medicaid is based on income limits while Medicare is the one that's for seniors + some folks with particular long-term disabilities.)
posted by mochapickle at 6:43 PM on July 25, 2021 [1 favorite]
posted by mochapickle at 6:43 PM on July 25, 2021 [1 favorite]
I agree that it would be useful to know what problems specifically you are having, and what answers you have received from your state's marketplace representatives when you bring those problems to them.
In my experience working in health care advocacy in two adjacent states to yours, there is likely to be an escalation unit within your marketplace that can help you or resolve your issue, if it is something that can be resolved. The trick is knowing what they are called and how to get to them.
A quick google search for "Massachusetts healthcare advocate" yields some results for organizations that may be able to assist you. I don't wish to endorse any particular one but for instance Ma Health Care Advocates might be able to help, and this appears to be a directory of advocates in Massachusetts for you to search.
In the absence of anything else, a traditional health insurance broker will likely be able to assist you.
posted by gauche at 6:44 PM on July 25, 2021 [1 favorite]
In my experience working in health care advocacy in two adjacent states to yours, there is likely to be an escalation unit within your marketplace that can help you or resolve your issue, if it is something that can be resolved. The trick is knowing what they are called and how to get to them.
A quick google search for "Massachusetts healthcare advocate" yields some results for organizations that may be able to assist you. I don't wish to endorse any particular one but for instance Ma Health Care Advocates might be able to help, and this appears to be a directory of advocates in Massachusetts for you to search.
In the absence of anything else, a traditional health insurance broker will likely be able to assist you.
posted by gauche at 6:44 PM on July 25, 2021 [1 favorite]
Did you already try the enrollment assistance offered here?
Enrollment Assisters, such as Navigators and Certified Application Counselors (CACs) are trained and certified individuals at organizations in your area that can help you apply for coverage, shop for plans, answer your questions about your eligibility, payments, plan details, and health care reform rules and requirements. Help from an Enrollment Assister is free for people of any income level.
posted by metahawk at 6:45 PM on July 25, 2021 [5 favorites]
Enrollment Assisters, such as Navigators and Certified Application Counselors (CACs) are trained and certified individuals at organizations in your area that can help you apply for coverage, shop for plans, answer your questions about your eligibility, payments, plan details, and health care reform rules and requirements. Help from an Enrollment Assister is free for people of any income level.
posted by metahawk at 6:45 PM on July 25, 2021 [5 favorites]
Yeah, what you want is probably a health insurance broker.
posted by tivalasvegas at 6:45 PM on July 25, 2021
posted by tivalasvegas at 6:45 PM on July 25, 2021
OP, if you contact the mods, you can anonymize this question, and then be more explicit about the insurance you're losing, the hospital that isn't being helpful, your usual home city for finding appropriate application assistance, etc.
[If one of your health insurance needs is out-of-state coverage, as the procedure you're having right now isn't in Massachusetts, have you gotten a quote from Harvard Pilgrim HC for the self-employed in MA?]
posted by Iris Gambol at 7:09 PM on July 25, 2021 [1 favorite]
[If one of your health insurance needs is out-of-state coverage, as the procedure you're having right now isn't in Massachusetts, have you gotten a quote from Harvard Pilgrim HC for the self-employed in MA?]
posted by Iris Gambol at 7:09 PM on July 25, 2021 [1 favorite]
I have had similar issues, in Washington State.
What you need is a Health Insurance Navigator. It shouldn't matter that you are out of state right now, just that you are a MA resident.
Here's some links to MA Health Navigators who should be able to help you, for free:
Boston Public Health Commission Health Navigators
List of MA Health Insurance Navigators, in Alphabetical Order
Greeater Lawrence
Community Action Council, Inc. List of Navigators
Hilltown Community Health Center Health Navigators
posted by spinifex23 at 8:27 PM on July 25, 2021 [5 favorites]
What you need is a Health Insurance Navigator. It shouldn't matter that you are out of state right now, just that you are a MA resident.
Here's some links to MA Health Navigators who should be able to help you, for free:
Boston Public Health Commission Health Navigators
List of MA Health Insurance Navigators, in Alphabetical Order
Greeater Lawrence
Community Action Council, Inc. List of Navigators
Hilltown Community Health Center Health Navigators
posted by spinifex23 at 8:27 PM on July 25, 2021 [5 favorites]
...bumping me down to Medicare...
What is your age? Marketplace plans are only for those not yet in Medicare (or of age to qualify).
posted by Thorzdad at 8:45 AM on July 26, 2021 [1 favorite]
What is your age? Marketplace plans are only for those not yet in Medicare (or of age to qualify).
posted by Thorzdad at 8:45 AM on July 26, 2021 [1 favorite]
You might also consider doing this backwards. Most MA health insurance companies on the exchange will have sales teams experienced in signing people up, which in many cases involves helping them do exactly what you need help doing.
posted by invincible summer at 10:51 AM on July 26, 2021 [1 favorite]
posted by invincible summer at 10:51 AM on July 26, 2021 [1 favorite]
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posted by Thorzdad at 6:29 PM on July 25, 2021