“Now What Am I Supposed to Do?” When Clarity Becomes Confusion

By Stephanye R. Clarke


This past August, my Aunt Sylvia shared that thanks to her new health care coverage, she had a newfound peace of mind. Something she had not experienced since the last time she was insured in 1996.

Then she fell victim to a disruption of coverage. Sylvia works for a local school system and has a dramatic change of income during summer vacation. As a result, her coverage switched from her private insurer to Medicaid for the summer months. She was sent a letter from Access Health CT that said when she was back to her regular schedule in the school year, her private insurance would be reinstated.

Here’s where it got tricky—she wasn’t sure if providers would take Medicaid, so she didn’t schedule appointments. This amounted to a three-month window of uncertainty and was a sharp contrast to her initial peace-of-mind.

Sylvia has several letters in her possession, many containing conflicting information. According to what she was told by an Access Health CT call center representative in the summer, her coverage would revert once she reported her income change and verified it. To date, she isn’t sure which carrier she’s qualified for and has questions like—has she been changed back to her private insurer or is she still considered eligible for Medicaid?

She has given up on contacting the call center, thanks to memories of the first open enrollment period’s wait times. So many questions, so few clear answers. It is all very disempowering.

And she’s not alone. I’ve spoken with many people who share her frustration, confusion and anxiety. It makes me wonder, with a scaled-down in-person assistance program, how will people like Sylvia get resolution? To whom should people turn with for health insurance questions?

There are opportunities for true engagement, outreach and education and it would be shameful if Access Health CT missed this opportunity to be the best consumer-centered exchange in the country. Instead of just commercials reminding people about signing up for health care coverage, people need a clear understanding of the importance of shopping around for a coverage plan that works best for them. Make no mistake—shopping, and comparing plans and provisions are essential.

It’s critical that everyone be on the same page—able to understand coverage options. This includes consumers understanding the free preventive services/screenings they’re afforded as part of their insurance, and for people to get preventive care before acute needs arise. After all, coverage is just one of many steps needed to overhaul a broken system and yield a healthier America. Sylvia is depending on it.

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