By Haven Orecchio-Egresitz, The Berkshire Eagle
Navigating the world of health insurance can be confusing, and making the wrong choice or avoiding it completely can be expensive.
For more than 20 years, certified application counselors have worked with patients across Berkshire County to get them enrolled in policies that work best for their families.
“We’re really here to walk someone through the entirety of the process, from the start to the time they’re finally enrolled,” said Jason Cuddihy, program manager for Berkshire Health Systems’ Advocacy for Access. “We really want to minimize the chances anybody’s going to fall through the cracks.”
On Wednesday morning, five people sat in the waiting room of the program’s Pittsfield office, where they were to meet with one of six counselors to assess their insurance needs. The office, at 510 North St., has seen an average of about 8,000 patients a year since 2016. Fairview Hospital in Great Barrington sees about 300 applications for coverage per year.
South County patients are seen at the Advocacy for Access office at Fairview. Ecu-Health, a private, nonprofit agency, provides similar assistance to those who live in Northern Berkshire. The services are free.
In its 2018 Berkshire County Community Health Needs Assessment, Berkshire Health Systems noted that the county has a significant number of individuals and families who are uninsured or underinsured, primarily because of the area’s economic and employment difficulties.
It’s the goal of these programs to find these individuals and make sure they have access to affordable care, Cuddihy said.
Since BHS started the program in 1996, access to state health insurance has grown, making more people eligible for programs, Cuddihy said. Those who might not qualify for MassHealth because they are offered insurance through their employer, but still are struggling to meet deductibles, might qualify for help from an alternative program. Even higher-income residents, who earn 300 to 400 percent of the poverty level, could be eligible for subsidies to purchase health care plans through the state Health Connector.
Still, though, there are gaps that would prompt some individuals to opt to stay uninsured, Cuddihy said.
“Kind of the big ones we see are when someone’s healthy, doesn’t necessarily have to be young, but if they don’t see doctors, they don’t have to take any kind of medications, they don’t think they need health insurance,” Cuddihy said. “If they’re low-income enough, they’re not paying a tax penalty.”
Sometimes those who are self-employed and aren’t eligible for MassHealth might see the cost of plans through the Health Connector and get “sticker shock,” even with possible tax credits.
The cheapest plan on the Health Connector is $44 a month, he said.
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“Maybe they feel that they might not actually be able to afford that with all the other things you have to pay for, between rent and food and whatever else,” Cuddihy said.
The same thing goes for those who are offered insurance through their employer that is considered “affordable” by federal standards but might not be affordable under their personal circumstances.
Melissa Montoya, a navigator for Ecu-Health, thinks that the biggest barrier to uninsured Massachusetts patients is a lack of education.
Many people who she interacts with through their office might have lost their insurance because they didn’t keep their information up to date year after year.
“Some, I think, do not report things in fear of losing their insurance,” she said. “I don’t think they understand that keeping everything up to date would make things go smoother for them.”
Generally, those who end up seeking help from programs like Advocates for Access do so retroactively, after receiving from a physician a bill that they might not be able to pay.
While it might be too late to walk back that bill, the counselors work to connect them to plans that will ensure that such difficulties don’t happen again.
With hospital bills, though, uninsured individuals who qualify for MassHealth have a 10-day window to reapply for coverage. If they’re accepted, it could cover the services they’ve already received, Cuddihy said. If they don’t qualify for MassHealth but can’t afford their hospital bills, they also could apply for relief through the state-run Medical Hardship Program, as long as they received care less than one year earlier from a Health Safety Net provider, he said.
While patients can apply for these plans on their own, Cuddihy said that the process can be tedious for even those who are “computer savvy enough” to fill out the application online.
Sometimes applicants will apply, wait months for a decision and not hear anything back.
Alternatively, of course, patients can just walk in to the Advocacy for Access offices and be seen by counselors. It generally takes about an hour to help the average patient apply for plans. Those in North County can contact Ecu-Health for the same services, he said.
“If you’re going to apply on your own, you really have to be an advocate for yourself,” Cuddihy said. “If someone is applying on their own, they have to be in almost constant contact with MassHealth.”
Haven Orecchio-Egresitz can be reached at email@example.com, @HavenEagle on Twitter and 413-770-6977.
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