The Home Page Network

This week, Home Page correspondent Sara Vogt speaks with Carla Westlake, Outreach and Enrollment Coordinator for the Laurel Health Centers, about navigating the potentially murky waters of obtaining health insurance and managing prescription medication expenses.

Carla, a Certified Application Counselor for the Affordable Care Act (ACA), is an advocate for the individuals she serves, working with patients seeking insurance either through the Marketplace or the Pennsylvania Medicaid program. She also provides patients of the Laurel Health Centers with guidance in obtaining discounted or free medications through pharmaceutical company assistance programs with Rx Assist.

For anyone in the area needing insurance coverage—which includes both Laurel Health Center patients as well as members of the general public—Carla collects family size and income data to see if they qualify for state-based insurance. Documentation needed includes a recent tax return, W-2 form, 1099 form or Social Security benefits statement. The application is typically completed online at www.compass.state.pa.us. The second option would be the Affordable Care Act, which has a shortened open enrollment period this year that spans from 1 November to 15 December 2017 for coverage beginning 1 January 2018. Outside of the open enrollment period, Carla will determine if the consumer meets any of the special enrollment period criteria. Consumers may enroll or change their current plans outside of the open enrollment period under a variety of circumstances including: a change in household size as a result of a death, birth, divorce, or marriage; a recent loss of qualifying health coverage; or a change in eligibility for Marketplace coverage, among others.

There are also certain services—such as assistance with the Centers’ Sliding Fee program and help with prescription medication expenses—that Carla can provide only to Laurel Health Center patients.

Some pharmaceutical costs are extremely high and virtually unaffordable even for those who have insurance. Through Rx Assist, Carla can help patients determine if they are eligible for help with medication expenses. Carla uses Rx Assist Plus, a software program purchased by the Laurel Health Centers, which makes the process much easier. With Rx Assist Plus, Carla can search for a specific medication and the program tabulates the product’s availability for assistance. If assistance is potentially available, Carla will research the pharmaceutical company’s eligibility guidelines, which vary from company to company. Common guidelines include family size and income, and insurance coverage.

When asked about her biggest challenge, it is simply that she cannot help everyone—that there are cases where she hits a barrier that cannot be worked through. Listening to patients who are struggling with the choice of buying groceries or picking up their medications is not easy, but it is something that Carla has heard more than once. When this happens, she reports back to the provider so that they can determine if medication alternatives or samples might be an option.

Carla also spoke about the Laurel Health Centers’ Sliding Fee program, a financial assistance program based on family size and gross income. Patients can apply at any of the seven Laurel Health Centers even if they have health insurance coverage, and the program can be very beneficial for those with a high deductible. Eligible Sliding Fee program patients can also receive a discount card from ProAct that can be used at certain local pharmacies for medications. She also noted that the Laurel Health Centers offer a cash discount program for uninsured patients whose income level is too high for the Sliding Fee program and who pay at time of service.

Carla travels to the Mansfield, Elkland, Lawrenceville, Blossburg and Wellsboro Laurel Health Centers the first full week of each month. During the ACA open enrollment period, she is scheduled at Mansfield and Lawrenceville Laurel Health Centers one specific day each week to accommodate those needing her assistance during that busy time. Carla pointed out that for the Rx Assist program, she can only work with Laurel Health Center patients, who are generally referred through physicians. For the health insurance aspect of her position, however, Carla can assist any consumer and can be reached at 570-723-3424.

Some Tips from Carla:

The ACA Open Enrollment Period is much shorter this year, running from1 November to 15 December 2017 for coverage beginning 1 January 2018, and there are three options for applying:
1. Apply online at www.healthcare.gov.
2. Call 1-800-318-2596 and a representative will help you apply over the phone.
3. Call Carla at 570-723-3424 in mid-October 2017 to set up an appointment to meet with her for assistance with the application process.

Please be sure if you are navigating the ACA application on your own to use only the official website: www.healthcare.gov.

To apply for Medicaid, consumers can visit the Tioga County Assistance office in Wellsboro to request an application or can apply online at www.compass.state.pa.us