Alabama's federally-managed insurance marketplace, part of the 2010 Affordable Care Act, is set to begin open enrollment Tuesday and provide low-cost insurance mainly to residents who previously could not afford it. Nelson is the Anniston-based federal “navigator” tasked with helping residents to understand the program and their options.
"I just have to make sure insurance plans cover people's needs and that they can afford it," Nelson said. "It's that simple."
Nelson, who will be in the area for a full year, is one of many federally funded navigators set up around the state to help educate residents about the insurance marketplace. Nelson was assigned by Enroll Alabama, an organization established by the nonprofit AIDS Alabama Inc. AIDS Alabama received a $501,380 federal grant earlier this year to set up navigators in key parts of the state, including Huntsville, Tuscaloosa, Birmingham and Montgomery.
The marketplace is designed to provide affordable insurance, mainly to those who cannot afford it, by offering tax credits based on income to consumers and encouraging competition among insurance providers, thereby lowering costs. All the plans are required to offer at least the same 10 services, including newborn care, mental health and prescription drugs. Federal law prohibits insurers from denying coverage based on pre-existing conditions or gender. Where residents live in the state, their income, family size, age and whether they use tobacco will all affect the prices of the plans they can buy and the amount of tax credit they receive to supplement costs.
Three insurers have submitted to the federal government health plans for Alabama's insurance marketplace, including Blue Cross Blue Shield, United Healthcare and Humana.
What to do
Residents can enroll in the marketplace Tuesday through the website Healthcare.gov. Consumers can already check their eligibility at the site. The site can calculate what plans a consumer can afford and what tax credits they might receive. Enrollment runs through March 31 and coverage begins Jan. 1.
"You can select a plan on that website, but you'll actually be paying money to a private insurer like Blue Cross," said Rachel Dolan, policy specialist for the National Academy for State Health Policy, a Washington D.C.-based organization of state health policy makers. "The federal website is the only place where you can buy the plans and get the tax credits."
Dolan said the marketplaces will be beneficial to many uninsured people but also to some residents with less-than-ideal private insurance plans.
"Before, you just had to hope an insurer would cover you with everything you needed," Dolan said.
Nelson said the site is fairly straightforward and that most people familiar with computers will be able to use it and find an appropriate insurance plan. It's Nelson's job to help everyone else – residents with little knowledge of computers, who do not have Internet access or who are not well-educated.
The job will soon keep him very busy.
Starting Tuesday, Nelson will provide his services to a nine-county area, including Calhoun, St. Clair, Etowah, Dekalb, Cherokee, Cleburne, Randolph, Clay and Talladega counties. Nelson is undertaking an extensive 20-hour training course to be ready to work Tuesday. An Anniston resident, Nelson is a professional social worker who has previously worked with other nonprofits to help residents navigate and enroll in other federal programs, such as Medicaid and Medicare.
"I'll be doing mostly outreach, I'm going to contact all the nonprofit agencies and health care providers around and let them know that I'm here and available," Nelson said. "I'm trying to work with local groups because they'll know who needs help."
Nelson also plans to be at area health fairs and many other organized events to reach as many people as possible. He'll be equipped with a tablet computer to show residents the site in the field and help them enroll. Nelson stressed however, that he will not try to steer people to certain plans offered by a particular insurer.
"I just help them make health care decisions," Nelson said. "I just present the options and then they choose."
Though he will be providing outreach, Nelson will be available in his office Tuesday for residents with questions. After that, he initially plans to be in his office on Thursdays and will spend two days each week providing outreach through the region.
"And I'll be wherever anyone needs me to be for anyone who needs assistance," Nelson said.
Nelson's office is at 105 West 15th St., at the location of the Right Place, a nonprofit and partner with AIDS Alabama that focuses on the homeless and low-income housing. Rita Flegel, executive director of the Right Place, said her organization will assist in Nelson's efforts.
"There is a clear connect between housing and healthcare," Flegel said. "We have relationships and networks in place to help and reach people who need assistance."
In addition, volunteers will soon be added to help educate the public. Flegel said 16 volunteers are already lined up to take the navigator training.
"We anticipate having a lot of volunteers in the area," Flegel said. "All four of my staff are planning to take the training and help with enrollment."
Sonja Smith, project coordinator for Enroll Alabama, said the organization's goal is to enroll 5,000 Alabamians in the marketplace. Smith said any group, not just individuals, can request assistance from the navigators.
"If you have a community group, we can get a navigator to come out to you," Smith said. "We're malleable and can go everywhere."
Staff Writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.
Residents with questions about the insurance marketplace can call:
- The Right Place, 256-238-6231
- Enroll Alabama, 205-382-0242, or email firstname.lastname@example.org.
Residents interested in volunteering to help with navigation should request to do so only by email.