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Health insurance can be confusing.
Meet Quentella Perry, who helps people plow through the complexities while working for Covering Wisconsin, a nonprofit organization based at the University of Wisconsin-Madison that educates people about health insurance and helps them choose a plan.
Just as accountants are busy during tax time, Perry and her colleagues have their hands full helping people navigate the choices offered during the Affordable Care Act open enrollment period.
The open enrollment period is a time during which people can change or sign up for a health insurance plan – either through their employer or the federal health insurance marketplace, where many applicants qualify for subsidies.
Open enrollment for a 2023 plan runs from Nov. 1 through Jan. 15. Those wanting to start coverage on Jan. 1 must sign up by Dec. 15.
Outside of this time period, people can enroll in plans only under certain circumstances, including getting a new job, getting married or having a child. Those who meet the criteria can enroll in state-run Medicaid programs like Wisconsin’s BadgerCare Plus, throughout the year.
Regardless of the source of health insurance, though, most people face some level of confusion.
This is where Perry and people like her come in.
Perry will resolve that confusion.
She will answer questions.
She will walk applicants through the steps.
Applicants emerge with an insurance plan that meets their needs.
Perry is a licensed health insurance navigator at Covering Wisconsin. The nonprofit operates statewide, including in Milwaukee County, where an estimated 55,000 people lack insurance — 35,000 of whom live in the city of Milwaukee, according to the Milwaukee Health Care Partnership.
Covering Wisconsin is part of a coalition of organizations and agencies working to increase enrollment among all residents, particularly those who currently lack insurance.
Becoming a health insurance navigator
Perry, 40, was born and raised in Milwaukee. She has been a navigator for four years but previously spent years as a certified application counselor, or CAC.
CACs work within a medical setting, such as a hospital, to assist patients when they apply for health insurance. They often transition into navigators, who have more experience and can assist CACs when they encounter especially complex or challenging cases.
“This is my passion. I believe education is key. Educating individuals within the community is key. This is something I love doing, and this is why I continue to do this work,” Perry said.
“We don’t receive commissions; all the information we give is impartial. Our services are free to individuals,” she added. “A lot of the agent brokers – they work off commission – and individuals have a hard time trying to figure out if they have their best interest in mind.”
A confusing system
Education must always be the first goal of a navigator, said Cheryl Isabell, Milwaukee community engagement lead at Covering Wisconsin.
“To understand what a premium is … . To explain to them what a copay is. If you’ve never had insurance, or have had to pay for health insurance coverage, you don’t know,” Isabell said.
Even folks who are fluent in the process might struggle to keep track of all that information.
“It’s very confusing,” said Winona Grieger, navigator at Milwaukee-based Gerald L. Ignace Indian Health Center, which also employs insurance navigators. “Every person that you work with – it’s never the same. Everything is always different.”
After the client understands all these moving parts, “then we discuss different plans,” Isabell said.
Officials urge enrollment
The Wisconsin Department of Health Services has sent out a “call to action” to organizations like Covering Wisconsin.
The mandate is simple: enroll, enroll, enroll.
The call comes as additional financial assistance for health coverage is available.
If people “have looked before and just chose not to have health insurance coverage, because it wasn’t affordable for them, they should look again,” Isabell said.
Another major change is fixing what insurance professionals call the “family glitch.”
“If you’re employed, your employer may offer health insurance coverage, but it’s only affordable for the employee – the family plan may be unaffordable,” said Isabell.
Until now, those family members were ineligible for alternative assistance through the marketplace, which left families with bad options: a prohibitively expensive employer plan or a marketplace plan without financial assistance.
“Now that the family glitch has been fixed, the family members have the opportunity to get those tax credits (through the marketplace), so now the whole family can be insured,” Isabell said.
Navigators remain concerned about the potential end of the federal public health emergency, which has allowed people covered by BadgerCare Plus to keep coverage regardless of changes in their income or household size. BadgerCare Plus recipients have also not been required to update their information, which is required every 12 months under normal circumstances.
When the public health emergency finally ends, recipients must update their information and be re-evaluated to determine if they can maintain their coverage.
Although the public health emergency has been extended 11 times since its original declaration in January 2020 and is currently extended until Jan. 11, many health care professionals anticipate its end in 2023.
“A lot of individuals are used to having help through the state program, and with everyone going back to work and everybody becoming employed, some individuals will potentially be at a loss of their coverage, because of them being over the income limit,” Perry said.
Make an appointment with a navigator
To make an appointment with a navigator at one of a number of agencies, you can use this online tool hosted by Covering Wisconsin.
A version of this story was originally published by Milwaukee Neighborhood News Service, a nonprofit news organization that covers Milwaukee’s diverse neighborhoods.