Health Insurance offers Peace of Mind

Like many social service agencies, the staff at Brightpoint gets to know people at some of the toughest moments in their lives. It’s often emotional work, but it can be rewarding when we are able to help.

This past December, Kyle Lowe, Outreach and Enrollment Coordinator in the Covering Kids & Families (CKF) program, got to experience this firsthand.

Brightpoint’s CKF program offers licensed Indiana Navigators who provide FREE assistance to local families to help them understand and enroll in state and federal health insurance programs such as Medicaid, Hoosier Healthwise, Presumptive Eligibility for Pregnant Women, the Healthy Indiana Plan and the Health Insurance Marketplace. Brightpoint Navigators assist consumers at all points in the enrollment process and work with them to maintain their coverage once approved.
Kyle works in the CKF office in Warsaw, which is where he met Dianna and Ron Baker, a couple in their late 50s. Dianna was receiving hospice care for a terminal cancer diagnosis at the time Kyle became acquainted with her and her husband. Dianna had just been notified that she was being terminated from her employment effective December 10th, at which time she would lose her healthcare coverage and be uninsured.

Hospice care costs about $140 a day for someone who is uninsured and a month of hospice care would be several times more than the Bakers monthly income. A COBRA insurance plan was offered through Dianna’s soon-to-be-former employer, but that would cost the couple more than $1,200 a month to insure both of them and $592 a month JUST to insure Dianna. At this rate, to insure Dianna alone would cost 23% of the couple’s income. And, the Bakers would be required to pay 100% of the costs of their healthcare and then wait to be reimbursed by the COBRA plan – something that was not an option given their very limited income.

Dianna and Ron had been trying to make ends meet on Dianna’s short-term disability payments. Ron was unable to work because he was home trying to care for Dianna and spend time with her as they were going through this unimaginably difficult process.

This was Dianna and Ron’s situation when they came to Brightpoint seeking help with their health insurance options and trying to find a plan that they could afford. Kyle helped the couple complete an application for Marketplace insurance and they received an eligibility notice stating that more information was needed to determine their tax credit.
Kyle was able to contact Dianna’s benefit counselor at work and find out the information needed to determine the plan. However, upon returning to the application and updating the information, it changed the results now saying that neither Dianna nor Ron was eligible for a tax credit because they were offered insurance through Dianna’s employer (the COBRA plan.)

Fortunately, Kyle knew from his training that if the cost of employer-offered health insurance is more than 9.5% of a family’s income, they qualify for a tax credit because their health insurance isn’t considered affordable.
So the Bakers made another trip to the Brightpoint office and waited on the phone with Kyle for about 40 minutes in order to speak to a Marketplace representative. When they finally got through, the Marketplace representative insisted that Dianna and Ron didn’t qualify for a tax credit because they were offered health coverage through COBRA. After more back and forth, the representative finally came back and said they were eligible for a $360 tax credit.
Kyle still wasn’t satisfied because his training had taught him to know better. He further questioned the representative about the tax credit because he had used the healthcare.gov web site and it showed that the Bakers should be eligible for an $896 tax credit.

After another 45 minutes on the phone, Kyle’s persistence paid off. The Marketplace representative eventually agreed that Kyle’s calculations were correct and the Bakers indeed qualified for a full tax credit of $896 and cost-sharing reductions. Kyle was able to enroll both Dianna and Ron in medical, vision, and dental coverage for $200 a month – a $1,000 savings compared to what they would have paid through the COBRA coverage.

But the Bakers were still concerned that Dianna’s hospice care would not be covered and if it was, they were worried that it wouldn’t be in-network. Their health insurance was not going to do them a lot of good if they couldn’t get this needed care at an affordable price.

Kyle was determined to put Dianna and Ron’s minds at ease. He contacted a MDwise representative to find out EXACTLY how their plan would cover hospice care and to make 100% sure she could continue with her current palliative care workers.
But there was still one more hurdle to overcome. The Baker’s new insurance coverage was not going to begin until January 1st – two weeks away. Dianna required daily hospice care so she couldn’t afford to be uninsured for any amount of time. Kyle went to bat for Dianna one more time by contacting the Director of Kosciusko Home Care and Hospice. The Director very generously offered to cover Dianna’s COBRA insurance until her Marketplace plan began in January!

Dianna and Ron were extremely relieved to have the financial stress of healthcare lifted from their shoulders – especially at such a difficult time. No one should have to worry about how they are going to pay for end-of-life care when what they really need to be doing is enjoying the company of loved ones.

“I’m honored to be a part of a program that is able to help people during such stressful times,” said Kyle as he retold Dianna and Ron’s story. “Dianna was very worried that she’d be leaving Ron behind in debt for her care so it was a huge relief for her to know that her healthcare expenses were taken care of.”

Unfortunately, Dianna passed away on New Year’s Day on her way back from visiting family in Pennsylvania for the holidays. We join Kyle in sending our condolences to Ron Baker and all of Dianna’s family. We are grateful to Dianna and Ron for allowing us to share their story.