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Be on the Lookout for Fraudulent Insurance Activity

Some consumers in New Mexico have been purposely misdirected to private insurance brokers when they thought they were visiting the official Health Insurance Exchange website, healthcare.gov, or calling a qualified broker or enrollment counselor.  This is a serious issue because the official exchange is the only place to get financial assistance for premiums and out-of-pocket costs.  In addition, brokers continue to offer plans that do not meet the standards for a qualified health plan, leaving consumers with weak insurance that doesn’t shield them from tax penalties.

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An enrollment counselor at the Southwest Women’s Law Center reports that she has seen an influx of consumers that have been victims of this scam.  The center’s Staff Attorney, Paige Duhamel, talked to a number of consumers who said that the brokers “talked at a rapid pace to pressure the consumer, refused to answer questions and caused a great deal of confusion and stress about the enrollment process.”  

It is important that consumers know what to do to avoid these types of issues.  Below are signs of fraudulent activity to keep an eye on when seeking enrollment assistance:

1) You are being charged an enrollment or sign-up fee

2) Your plan’s deductible is more than $6,350

3) The assister has you pay for the first few months’ premiums in advance

4) The assister does not speak to you about financial assistance or Medicaid eligibility

5) The assister asks you if you have a pre-existing condition

6) If you do enroll, the assister does not send you any documentation about your enrollment

7) The assister a) is unwilling to give you their name and direct contact number, b) has an out-of-state contact number, c) has a non-1800 number, or d) has a direct contact number that is anything other than the number for healthcare.gov (1-800-318-2596).  Always take down the name and phone number of the person with whom you are speaking

8) The assister only talks to you about one health insurance carrier’s plan

 

Health Action

Get Covered. Stay Covered. Keep Your TV!

Health Action NM teamed up with local Albuquerque Theatre company, Blackout Theatre, to produce a Young Adult enrollment video! Check it out, share it with your friends, and tell us what you think!

 

Get Covered. Stay Covered. Keep Your TV!, by HealthActionNM
Health Action

Joseph Martinez Accepts the Health Equity Advocate of the Year Award!

Health Action NM's team member, Joseph Martinez, graciously accepted Families USA's Health Equity Advocate of the Year Award for 2015! Joe was joined by other advocates from all over the United States to brainstorm and share strategies at the annual Families USA conference held in Washington D.C. on Jan 22-24.

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Joseph Martinez works tirelessly to ensure that all people living in the state of New Mexico have access to affordable, accessible, and accountable health coverage, no matter what. He truly is an advocate in every sense of the word and here at Health Action NM we are proud to say that Joseph Martinez is a part of our advocacy team.

Congratulations Joe!

Health Action

Deck the Halls with Health Action NM

   

Happy Holidays and best wishes for the upcoming New Year! May our year bring good health, prosperity and contentment.  Thank you for the partnership we share with you! 
 
This year, Health Action NM partnered with many local organizations throughout New Mexico to achieve the following: 
  • Established presence in 36 communities in 12 counties of New Mexico. Our focus was and remains hard-to-reach uninsured families.
  • Convened 278 outreach and enrollment events attended by 9621 persons.
  • 1643 families and individuals were enrolled at these events and another 1080 were connected to enrollment assisters and provided with follow-up.
  • 75% of the events were bilingual and all material provided by HANM was bilingual.
We are thankful for the many persons of action from many communities across New
Mexico who continue to step forward, neighbors helping neighbors, to assist one another to
get enrolled and learn how to use their healthcare coverage. Our vision is to use enrollment
as a springboard for developing grassroots health advocacy leadership across the state.
 
Additionally, Health Action New Mexico is persistent in monitoring that the State of New
Mexico works on all cylinders to get all who are eligible enrolled, oriented on how to use
and keep their healthcare coverage.
 
At the Legislative Session in January, we will be asking for greater access to quality,
affordable dental care for all by permitting dental therapists to practice in New Mexico
under the general supervision of dentists and trained in our community colleges.
 
This year, our 20th anniversary, we want to do even more. We want expanded dental
access to become a reality as we introduce legislation for the fourth time to make this
happen. We want to set up local community associations to create a pipeline of vetting and
supporting persons from their rural, tribal and underserved communities to become homegrown
dental therapists. We want newly insured families to better understand how to use
their new coverage and how to use their appeal rights when benefits are denied. We want
rural, homeless, veterans and Hispanic families to get access to the health care that they
need. We have expanded our field team to include a member in the border communities.
We want communities to learn how to be their own champions for change and to recognize
that health is much more than the health care system.
 
Never before has our mission of affordable, accessible, accountable health care for all made
such transformative steps towards this goal. But much could be taken away and much
more needs to be done. We can only do this with your help and support.
 
Please go to https://donatenow.networkforgood.org/donatehealthactionnm and make a generous tax deductible donation today. You can also mail a check to 3700 Osuna Rd, NE, Suite 504, Albuquerque, NM 87109.  
 
With your financial support, Health Action New Mexico can keep passionately working to
make greater access for health and dental care an authentic human right for all in New Mexico.
 
Cordially,
 
Barbara K Webber
Executive Director
                                                                        
 
“I’m looking forward to… (being able to) take
care of my teeth, get new eyeglasses, and I
might be able to get some help for an issue I’ve
been struggling with for years… The stress of
not being able to see a doctor …was difficult.
Not having health coverage is bizarre at this
age.”
- Iris 63, whom HANM helped with
resources for an appeal to get Expanded
Medicaid.
 

Health Action NM
http://healthactionnm.nationbuilder.com/

Health Action

Open Enrollment Season is Here: November 15, 2014 – February 15, 2015!

By: Colin Baillo (Central NM Apprentice- Health Action NM)

The open enrollment period for purchasing individual or family coverage through the NM Health Insurance Exchange has arrived!  Beginning November 15, 2014 the exchange, www.bewellnm.com, will once again be available for those seeking coverage, this time without the technical difficulties that plagued the website during the last enrollment season.  The enrollment period is only three months long, ending February 15, 2015.  Here are some important things to keep in mind if you intend to purchase or renew coverage on the exchange:

Before shopping on the exchange, see if you are eligible for Medicaid

You can visit https://www.yes.state.nm.us to sign up for Medicaid.

Medicaid is a public health coverage program that provides cost-free insurance to low income Americans.  Individuals making less than $16,105 a year and families of four making less than $32,913 a year are eligible for Medicaid.  Medicaid is available throughout the year, unlike plans acquired on the exchange, which can only be purchased during the open enrollment period.  If you are 1) between the ages 19-64 and 2) are a U.S. citizen or lawfully present immigrant and meet household income requirements, you may be eligible for free health insurance.

Visit http://kff.org/interactive/subsidy-calculator/ to see if you qualify for Medicaid.  You will need to provide your zip code, annual income, and the number of people in your family. 

You can also use the chart below to determine whether you and your family qualify for Medicaid:

 

Household Size

Income per Month/Year

1 person

Less than $1,342/$16,105

2 people

Less than $1,809/$21,707

3 people

Less than $2,276/$27,310

4 people

Less than $2,743/$32,913

5 people

Less than $3,210/$38,516

6 people

Less than $3,677/$44,119

 

Is this your first time buying health insurance? 

If you don’t qualify for Medicaid, the next step is to visit http://www.bewellnm.com, where you can shop for health coverage.  It is important to keep in mind that the window for obtaining coverage through the exchange is limited, lasting from November 15, 2014 to February 15, 2015.  Shopping for insurance can be a daunting task.  Luckily there are experts available to help you find the plan that is right for you. 

The New Mexico Health Insurance Exchange Enrollment Assistance Center is offering free assistance and advice on finding appropriate coverage, tax credits, and more.  You can even purchase coverage on site.  The enrollment center is in Albuquerque, located at 2301 San Pedro NE near Indian School.

Visit http://bewellnm.com/find-an-hcg/ to find a Health Care Guide near you.

You can also contact New Mexico’s consumer hotline by calling 1-855-99-NMHIX.

You may be eligible for a tax credit that acts as a discount on your insurance premiums and out-of-pocket costs.  You will need to know your household income to determine your eligibility.  Check out the Kaiser Family Foundation’s subsidy calculator to see how much you can save on your health plan. Right now, you can view price estimates for plans that you can purchase that factor in tax credits at https://www.healthcare.gov/see-plans/.  Insurance lingo can often be confusing.  If you run in to any terminology that you are unfamiliar with, check out BeWell NM’s healthcare glossary.

Shop around before renewing your health plan

If you purchased a plan on the exchange last year then you will be re-enrolled in to the same plan for 2015 unless your insurance company stops offering your plan or you choose to purchase a new plan.  If you like the coverage you received you should still be sure to review your plan before renewing it, as the premiums, co-pays, and other aspects of your plan’s cost may have changed.  In other words, you may pay more than you did last year for the same plan, so be sure to review your plan and shop around.  There may also be new plans offered on the exchange that are more affordable or better suit you and your family’s needs.

Sign up by December 15th if you want your coverage to start January 1st

While the enrollment period lasts through February 15th, you can start using your coverage at the beginning of 2015 if you sign up by December 15th.  If you wait until the end of the enrollment period to sign up for coverage, your insurance will kick in on March 1st, 2015.

Premiums in New Mexico are lower than they were last year

New Mexico has announced that premiums on the exchange will be lower than last year’s, which is great news for state residents shopping on the exchange.  According to the Albuquerque Journal, “premiums will drop on average by 7 percent at Molina Healthcare, 1.5 percent at New Mexico Health Connections and 1 percent at Blue Cross and Blue Shield of New Mexico.  Premiums will be unchanged at Presbyterian Health Plan.”  A new insurance company, Christus Health Plan, has entered the marketplace this year.

The penalty for lacking insurance is higher than it was last year

If you don’t obtain some form of health coverage, you may have to pay a shared responsibility fee.  The penalty was the greater of $95 per adult or 1% of income in 2014.  This year the penalty has increased to the greater of $325 per adult or 2% of income.  You can avoid the penalty by finding health coverage.

A hardship exemption exists for those who truly cannot afford insurance.  To see if you qualify for a hardship exemption, visit https://www.healthcare.gov/fees-exemptions/exemptions-from-the-fee/.

89% of uninsured Americans don’t know about the upcoming open enrollment period… so spread the word!

It is crucial that the uninsured know about the limited window of opportunity to obtain health insurance through the exchange.  According to a survey conducted by the Kaiser Family Foundation, 89% of the uninsured population doesn’t know about the upcoming enrollment period.  Be sure to do your part by telling everyone you know and care about that coverage is available to them and that they may be eligible to receive discounted insurance premiums.  It is estimated that, so far, 28 million Americans gained health insurance as a result of the ACA.  Tens of millions stand to gain from the law this year as well.  We are approaching another historic moment in which Americans are finally able to obtain the security of meaningful, affordable, and non-discriminatory health insurance.  Let’s do all we can to make sure that moment is realized.

Health Action

New Mexicans are well served by health care reform

By
PUBLISHED in the Albuquerque Jourmal: Wednesday, June 4, 2014 at 12:05 am

For Levi Casas, sometimes just getting out of bed was exhausting.

Although he’s decades younger, there were some days when he felt like he was 80 years old. Born and raised in Las Cruces, Levi worked a steady job until he was diagnosed with pancreatic cancer.

After chemotherapy ravaged his system, Levi was no longer able to work. Without a job, he lost his health insurance. Soon he went from fighting cancer to fighting for access and affordable treatments that could save his life.

Fortunately, Levi was able to get the care he needed through new health care options. Today, with his cancer treatments covered by Medicaid, Levi’s tumor has shrunk considerably and he is nearing the end of his chemo sessions.

Health care reform has given thousands of New Mexicans a new chance at a healthier life like Levi’s. More than 422,000 previously-uninsured people in New Mexico have new options for accessing high quality, affordable health care – either through Medicaid or the New Mexico Health Insurance Exchange.

But the story doesn’t end there. Although the first round of open enrollment through NMHIX ended on March 31, thousands of New Mexicans are still eligible to sign up for low- or no-cost insurance options all year round.

If you are a family of four earning less than about $32,000, or an individual earning less than about $16,000, you could be eligible for no-cost insurance through our state’s expanded Medicaid program. You can enroll at any time and begin coverage immediately. In addition, Native Americans are also eligible to sign up for insurance at any point during the year, regardless of income.

Thanks to these new health care options, it is easier than ever to apply and enroll in Medicaid. Eligibility is now simply based on income.

This means that thousands more New Mexicans who previously did not qualify for Medicaid can get the care they need. This is also great news for those that were previously turned down when they applied – including childless adults who, for the first time in New Mexico, may qualify for Medicaid.

For many, financial assistance means that their health insurance costs are less per month than a cell phone bill. But the benefits – like doctors’ visits, prescription drugs, and screenings for diseases like cancer and diabetes – can be truly priceless.

Native Americans in New Mexico also stand to benefit from better access to health care plans – particularly important for our state, where they make up more than 10 percent of the population. Improving access and quality of care is something our tribal communities desperately need.

Native Americans in New Mexico experience large health disparities compared to the rest of the state and are more likely to be sicker and die younger. They also are face unique obstacles in access and affordability of care.

For those living on a reservation, health care facilities and services are limited and typically do not offer in-patient services, specialty or major emergency care. Those living off the reservation must find health care that meets regulations from Indian Health Services, whittling down their choices.

Now if you are Native American you can purchase private insurance through NMHIX at any time, and, if your household income is below $34,470 for an individual or $70,650 for a family of four, you won’t have to pay for out-of-pocket costs like deductibles, co-payments and co-insurance.

This makes providing care to one out of 10 New Mexicans even more affordable.

During open enrollment, more than 95,000 new people signed up for insurance through NMHIX or Medicaid. This is a great success, and it will continue to grow as more Native Americans and people eligible for Medicaid enroll in coverage.

That’s thousands more people like Levi that will have access to quality, affordable life-saving care.

New Mexicans who want to enroll can contact Medicaid at yes.state.nm.us, or by calling 855-637-6574. Native Americans who wish to enroll can contact the Native American Professional Parent Resources, at 855-241-8137.

Original Link: http://www.abqjournal.com/410356

Health Action

Outreach and Education Campaign Contributes to Enrollment Surge

GUEST POST: Julie Bataille, Director, Office of Communications, Centers for Medicare and Medicaid Services

Today’s release of the final Enrollment Report for the first open enrollment period shows that over 8 million consumers enrolled in quality health coverage through the Health Insurance Marketplace.  These results clearly demonstrate that the affordable coverage offered through the Marketplace is what Americans need and want. 

These numbers were also achieved thanks, in part, to an unprecedented public outreach and education campaign to increase awareness among the uninsured about the new Marketplace, Medicaid, and the Children’s Health Insurance Program, in communities across the country.

Over the course of the initial open enrollment period, HHS officials, Federal agencies across the government, members of the Administration, and our partners outside of government, engaged in a combination of outreach strategies—including traditional media, social media, community-based outreach, and in-person assistance—to help uninsured Americans get the information they needed to find health coverage that meets their needs and budget.  The campaign also focused on those populations that would most benefit from access to affordable coverage, including ethnic and racial minorities.

Let me share some of our key efforts with you:

  • Our efforts included over 7,700 outreach and enrollment activities across the country—including over 2,100 activities in Latino communities, and over 1,700 activities in African-American communities.
  • Over the course of Open Enrollment, more than 28,000 in-person assisters were trained, and they reached more than 2.4 million consumers through events, outreach activities, and storefront locations.  Over 4.7 million consumers were helped by more than 14,000 assistors at Community Health Centers nationwide.
  • Our Call Center supported more than 20.6 million calls from FFM states, including 1.2 million in Spanish, and more than 114,000 calls in other languages. Additionally, millions of people visited HealthCare.gov.
  • We launched Marketplace Facebook pages and Twitter accounts in both English and Spanish, and netted over 327,000 Facebook Fans in English and an additional 55,000 Fans in Spanish.
  • In our partnership work, more than 1,900 national, state, and local organizations in every state signed on to become “Champions for Coverage,” and worked to increase awareness and understanding of the Marketplace, as well as Medicaid and CHIP.  

Taken together, our outreach and education efforts during this first open enrollment period significantly raised awareness about the Marketplace and its benefits; ensured that consumers had the information and assistance they needed to apply for and enroll in quality coverage; and contributed to over 8 million enrollees. As we begin to work on year two, we plan to build on this success and the lessons learned over the past months to reach even more Americans who stand to benefit from the security of quality, affordable coverage.

Health Action

Notes from the field: An Enrollment Outreach Worker Supports Dental Therapists

Guest post by Maria Perez

I worked on consumer outreach and education during this first open enrollment period in New Mexico. And as I talked to the uninsured about the amazing possibility of gaining health coverage, the first reaction I usually got was one of suspicion.

“Do you work for the State? For the Insurance Companies?”

This happened a lot. Once I explain, sometimes two or three times, that I work for a non-profit organization devoted to issues of health access and advocacy, people begn to warm up to the idea that maybe this Obamacare thing is actually happening, and that somehow it may actually benefit them and their families.

Then they start getting excited and asking lots of pertinent questions.

One of the most common questions I got was “Will dental be included in these plans?” It is amazing how much people have to put off getting dental care in this state! It is not uncommon to hear stories of how working families haven’t been able to get dental care in over a decade.

I tell them that Medicaid does include dental care in its plan, and the relief that I sense from these folks is intense.

But the question remains, how will so many people who have been putting off their dental care gain actual access to the services when there is such a shortage of providers? I advise them to be patient in regards to this. Yes, they will gain access to dental care, but it will take some time to come up with a workforce solution.

For this very reason, New Mexico needs Dental Therapists!

Word of Mouth

StoryTellers as Agents for Change

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This is Iris Gersh.

At the age of 63, Iris found herself living with fibromyalgia and without health care. In the fall of 2013, she discovered that New Mexico had expanded their Medicaid program, allowing herself and many other New Mexicans to apply for coverage for the first time. She applied. A few months later, Medicaid sent her a denial letter for full coverage, and instead presented her with Family Planning coverage.

At age 63, Iris clearly needs coverage beyond Family Planning. She decided not to give up. With limited knowledge of how she might be able to change her situation, she began researching online what those options may be. Within a few short weeks, Iris reached out to HANM and the NM Center on Law & Poverty for assistance on filing an appeal with the Income Support Division office that denied her full Medicaid coverage. She filed the appeal, and was successful in getting full coverage.

As of today, Iris is now receiving full coverage through Medicaid and is able to afford the medication she desperately needs to fight her chronic fibromyalgia.

There is a need for these stories.

Like Iris, there are thousands more stories in New Mexico of people who have been positively impacted by new health coverage options. But many of them haven’t had the opportunity or the platform to share their story. As advocates for change, how can we give a voice to those who are fighting to be heard? These storytellers are, or can become, huge catalysts for change within their communities. They can get their communities excited about the new health coverage options, and inspired to take action.

As community advocates we all need to make sure these consumer voices are heard. These stories are a compelling picture of what’s happening in New Mexico - not just a statistic. So grab your iPhones, your voice recorders, or your notebooks. Go out with open hearts & ears, and find the consumer voices that have carried the weight of this struggle for better health care in New Mexico. They are the voices that shine the light of hope as we move forward.

Health Action

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