Adela Flores-Brennan, Executive Director

Making sandwiches, kissing boo-boos, and knowing how to wash your kid’s favorite blanket without him ever knowing are all parts of being a parent. So is having useful and affordable health insurance for your child. CCHI took a special interest into looking at how families are satisfied with their experiences with coverage on the exchange, Connect for Health Colorado, and through the Children’s Health Insurance Program, known as CHP+. We wondered if the benefits were sufficient, if the coverage was affordable and whether families were able to access care in a reasonably timely manner. In talking to three parents, we found that for the most part, people are pleased with the coverage they have, whether it’s a plan purchased through Connect for Health Colorado or CHP+ (yay!), but that there’s always room for improvement. Some of these “pain points” that we uncovered represent interesting opportunities for future advocacy and attention.

Meet Tamera. Tamera has a four-year old and purchased a family plan in 2016 through Connect for Health Colorado. She hasn’t had any major issues with her child’s coverage, so far, even despite a minor medical issue last year – her doctor wasn’t available at the time, but she was able to see another doctor promptly. She’s generally been able to get her son an appointment in a timely manner and likes her plan’s on-call nurses who provide advice when she needs it. In terms of affordability, her plan has become more expensive in recent years and her deducible is quite high. Plus, a trip to the ER cost her over $600 plus medication. But even so, she thinks her plan is mostly affordable. That’s what we like to hear – so far so good!

The problem Tamera is now facing is with the lack of clarity about dental coverage. In previous years, dental coverage was embedded into their health plan; but now it’s not. She would really prefer a comprehensive plan where dental and even vision coverage were embedded in the plan. It would be easier to understand and she thinks it would save them a good deal of money because purchasing separate dental coverage for the family was rather expensive. Makes sense to us – CCHI strives to make sure not only that people have affordable coverage, but that they have comprehensive coverage that covers what they need, when they need it. Also, it’s incredibly important that people understand what they’ve purchased and how to use it.

The next parent we heard from is Jason. Jason is father to children ages 4 and 2. He purchased a plan through Connect for Health Colorado. Like Tamera, Jason’s rates went up this year, but he still finds the coverage affordable. He’s paying less now for four people than he was before he enrolled through Connect for Health Colorado when he was only paying for two. For the most part, everything has been fairly straightforward: purchasing coverage was easy and he’s been able to get services for his children in a timely manner. Jason’s biggest issues have been with notification and problem solving. He noted that some of the notifications his family receives can be confusing, and that there was a billing hiccup that took more time than he expected to resolve. Consumer notification is an issue that is always on CCHI’s radar. In order for consumers to be active players in their health care, the notifications they receive have to make sense. Plus, we think demanding high-quality customer service for resolving issues isn’t too much to ask—problems with billing and enrollment have to be solved in a timely manner, with clear and open communication so that people can get the health care they need, when they need it.

Our third parent is Virginia who has a daughter who was enrolled in CHP+. Her experience with the CHP+ program was extremely positive; she felt that the program met her needs at a cost that she could afford and that she had gained security for her family through the program. Using the insurance for her daughter was easy and straightforward, and having dental coverage was a big plus. Even though her income fluctuated, she found the CHP+ copays manageable. She received helpful customer service and valued CHP+ for treating her like a person. This type of interaction with health coverage and care is what we strive for and we hope to be able to help all parents have this great an experience with their children’s insurance.

And then there’s me. What better way to understand the need for advocacy in health care than finding out for myself? I have two children ages 8 and 11. CCHI uses the SHOP small business exchange at Connect for Health Colorado and I enrolled in a plan that allowed me to keep my children’s pediatrician. I’m happy to be able to say that I have pretty good coverage. For example, it was affordable or free coverage when we had to renew our EpiPen or swing by the grocery store for booster shots (since this working mom didn’t make time to get to the doctor in the school’s required timeframe for immunization records.)

The one problem I encountered was accessing some of the free preventive benefits that come with paying my regular insurance premiums. I took the last two years to experiment with these benefits. Two years ago, my kids’ annual check up and flu shots at the pediatrician were free, except for the vision screening – but, vision screenings are supposed to be a copay free service, right? Right. As it turns out, the vision screening (at least according to my insurance company’s interpretation of the benefit) has to be performed by an eye doctor, not a pediatrician. So, this past year, I played by the rules and took the kids to an in-network eye doctor. Making the appointment was tricky because the front desk staff didn’t seem to understand what I meant by preventive eye-screening. They kept asking what was wrong and why I was coming in… but there wasn’t something wrong. I really just want to make sure my kids don’t need glasses for reading all those Harry Potter and Percy Jackson books, or to see the front of the classroom.

Later at the appointment, there was a great deal of back and forth with the billing staff about the preventive health services portion of the essential health benefits, the Affordable Care Act, and the fact that I shouldn’t have to pay a copay. I eventually gave up and decided to pay (which I’m sure my embarrassed children appreciated). I figure I will take it up with the insurance company and the billing office another day (which I did, only to have the doctor’s office only refund half the charges, despite the insurance company telling me that I didn’t owe the doctor anything…so much for my small crusade to educate the eye doctor and get my refund).

So, is there a moral to any of this? Yes. One takeaway is that despite some premium increases in the individual market, the parents we talked to are still finding their children’s care to be affordable and useful for their families. [As a side note, there are significant increases expected in 2017 as well, but many people will experience an offset through premium subsidies that can reduce premiums, on average, by 11%.] The parent who enrolled her child in CHP+ especially appreciates the affordability of that program given her variable income. Thus, we need to shore up our efforts to keep private coverage affordable and to make sure programs like CHP+ continue to exist to provide the necessary low-cost access to health care that lower income families need. CCHI is looking for policy options that will help contain costs and improve accountability in the health care system in an effort to help slow premium increases. We also continue to remind people the importance of premium subsidies and how those subsidies can really help with affordability. With respect to CHP+, it clearly plays an important role in delivering comprehensive and affordable coverage for children. There will be opportunities in the coming months to encourage Congress to re-fund the federal CHIP program.

Second, dental coverage is important and parents value having the ability to get their kids to the dentist. We need to find ways to make it easy to enroll in dental coverage and make sure that the premiums and cost sharing are affordable for parents. Third, we have a long way to go to educate both consumers and providers about the availability and importance of the free preventive services offered under the Affordable Care Act. The purpose of those services is to increase access to prevention so that people can stay healthy and potentially avoid costlier episodes of care in the future. So along with my own personal lesson that health care snafus can happen to anyone, even those in the know, one important message is that increasing awareness of benefits, helping parents receive all the services they need at a price they can afford, and getting everything to work smoothly is going to take additional advocacy and effort from everyone.


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