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Storefront navigators to offer health insurance advice, for a fee

June 19, 2013
by Alison Knopf, Contributing Writer
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Entrepreneur bets that worried consumers will be willing to pay, even if federally-funded navigators offer help for free

“Navigator” is a common word in health insurance, a word which is increasingly used to denote the person – or button on a website – to help consumers figure out their policy, claims, and bills. But in Affordable Care Act parlance, it has a special meaning: those people who help consumers get enrolled in health insurance via the exchanges. Instead of brokers, who are certified and licensed, the navigators get grants from the federal government to help enroll consumers. Navigators are not yet up and running but they will be by October 1, when the state insurance exchanges are scheduled to come on line.  

But there’s another kind of navigator out there too – entrepreneurs who are not insurance brokers but who see that people are terribly confused about what the ACA will mean for them. Nashville, Tennessee-based Bernard Health, which has been in business since 2006, is now setting up what founder Alex Tolbert describes as “H&R Block-type storefronts” where people can walk in and get advice for a fee. “But instead of giving tax advice, we give health insurance advice,” Tolbert told Behavioral Healthcare. There are already two stores in Nashville. Other stores will open in Cleveland, Ohio and Austin, Texas this summer, with a total of nine stores by early 2014.

The chain of health care retail stores is only one of Bernard Health’s three business units, but it is one specifically geared to play into the confusion created by the ACA’s exchanges. The stores will also help people enroll in Medicaid.

Advice for behavioral health providers

Traditionally, behavioral health care providers have had the option to help their patients get enrolled in Medicaid – that’s the only way they will get paid if the patient is eligible – so it is in their interest to help with this time-consuming enrollment. Enrolling for private health insurance is even more difficult, since there is always a waiting period for coverage. Yet, when someone presents with a mental or substance use disorder, it is usually an emergency.

Before those emergencies occur, Tolbert said, providers shouldbe thinking about the best way to help patients get signed up for coverage quickly. “You have to ask, ‘What’s my risk for being in a situation where I’m providing uncompensated care, or losing revenue because I’m turning patients away?’” If that risk is significant for your organization, it may be time to get help.   

“A place like Bernard Health isn’t the only option,” said Tolbert. You could hire someone in-house to enroll patients, he suggested, or connect consumers to a grant-funded navigator in your region.

Different choices

In Tennessee emergency departments, a social worker is supposed to sign people up for TennCare – the state’s privatized Medicaid program. But there is only one TennCare option available at present. “The ACA is going to be a lot different,” he said. “Staying up to speed on all that is going to be challenging.”

Tolbert was in school at Vanderbilt University, earning an MBA and a law degree, when he started Bernard Health in 2006 out of an interest in health savings accounts. Then, along came President Obama and health care reform. Tolbert saw consumers’ need for advice, and recognized that as some state laws cut fees to insurance brokers (states are disbursing the navigator grants, using federal dollars), brokers were dropping out of the field. “We want to be the national brand for health insurance advice,” said Tolbert, capable of providing health insurance quotes, self service insurance applications, or complete advice and service package.  

A hand to hold

For those who need help selecting among health insurance plans, there is a fee. “Most people decide to buy one of our service products, which cost either $199 or $299,” said Tolbert. Typical questions that consumers are asking now – even in advance of the ACA – are things like “I’m turning 65 but I still work, I’m trying to decide if I should stay on my employer plan or take Medicare. But if I take Medicare, will my wife lose coverage and do I need a policy for her if I do?” and so on. At present, Bernard Health also gives advice on how to manage benefits available under COBRA for people who are eligible.

But starting in October, Tolbert expects that many of the questions will undoubtedly be about eligibility and sign-up for either the Medicaid expansion or exchange-based health insurance policies. 

The stores will not tell people what policy or coverage option to choose – that will be up to the consumer – but they will help people sift through the options. “All of the advisors in our stores are independent and non-commissioned,” said Tolbert, noting that regulations prohibit charging customers for advice and receiving a sales commission.

For consumers with incomes at 400% or less of the Federal Poverty Limit (FPL), there will be two challenges: calculating whether they are eligible for the Medicaid expansion (income at 138% or less of FPL), or if not, calculating what their income-based insurance subsidy will be for purchasing insurance via the exchanges. Tolbert is betting that first-timers to health insurance would rather have a hand to hold (via telephone) than face the decision alone. And with health care reform, we’re all first-timers.