Donna Medica sat alone for well over two hours in the North Plains Library last Friday. She was well equipped with her computer, a large notebook of paperwork and a head filled with information about Cover Oregon, Oregon’s version of the Affordable Care Act. 

She was there, she said, because she really cares about people and believes everyone should be insured. That’s why Medica, a librarian, applied to be a “community partner enrollment assister” there to help community members navigate the Cover Oregon website and fill out the required forms. Funded by a grant, she’ll dedicate 30 hours a week to educating the public about the changing health care system — available plans, cost comparisons and financial aid — for the next six months.

But so far, Medica hasn’t had a lot of takers.

“I think people aren’t really thinking about it,” she said.    

The number of folks attending question and answer sessions has been low, thanks at least in part to the fact that the Cover Oregon website is not ready to take online applications. Medica said the latest information indicates it should be ready in about two months. And although citizens can’t apply by using it right now, the site is still a source of useful information.

“You can hop online and see the insurance companies, see what the policies are and read descriptions of the policies. You can also get an idea of what your tax credits will be,” explained Medica.

A complicated situation may require an insurance agent’s help to navigate, and by law, that assistance must be provided free of charge. For instance, if you need to see one specialist, the website can help find a plan for which the doctor is a provider. However, if you need to see several specialists, an agent can better navigate the situation.

The state of Oregon has tried to eliminate some users from the application system by pre-approving them for Medicaid. About 260,000 food stamp recipients and parents whose children are part of the Healthy Kids program received fast-track notifications in the mail in recent months. The letters indicate an automatic approval for Medicaid and offer a choice of two plans. 

Enrollment is automatic with the return of the letter with choices marked.

“That’s 260,000 people not clogging up the website,” noted Medica.

Anyone who is currently receiving food stamps, or whose children are part of the Healthy Kids program — but didn’t receive a letter — can find out if they’re eligible for fast-track by calling 1-800-699-9075.

Insurers who generally insure Oregonians are available through Cover Oregon, Medica said, but insurers and their offerings are specific to regions within the state — so someone who moves from the Hillsboro area to Ashland would need to reapply.

Only a person’s geographic location and smoking status are considered when calculating insurance rates during the Cover Oregon application process, although Medica said the site does ask for personal information, such as how often you see a doctor, if you have outstanding medical bills or if you use a lot of prescription medications — but answering those questions is not mandatory.

Small business owners also can use the Cover Oregon site. Businesses with fewer than 25 employees will receive tax credits if they provide coverage. The employer can choose the plan and coverage level, or they can leave the choices up to the worker.

Employees go to the site to apply, and the employer is billed once per month for all covered participants. Business owners are being encouraged to contact an insurance agent for advice.

Oregon’s system mirrors the current system for Medicare, with the window for signups extending from October to December each year. During this open enrollment period, changes may be made to coverage levels and insurers. The new coverage will then take effect Jan. 1 of the following year. 

In 2014, the first year of implementation, the open enrollment period goes through March 31 — and that date may be extended. However, anyone applying by Dec. 15 will be covered effective Jan. 1, 2014.

Paper applications are available through enrollment assisters and on the website, with an estimated turnaround time of approximately 45 days. 

Who needs to use the website or find an enrollment assister? Anyone who is currently uninsured, those who are underinsured, people who have been notified that their insurance is being cancelled and anyone with insurance coverage too expensive for them to afford.

Oregon’s most impoverished citizens will receive free coverage through Medicaid. Those who are between 138 and 250 percent above the poverty line could receive tax credits and other assistance. 

Those who wish to opt out of the Affordable Care Act do have choices. There are exemptions for certain classes of people, including Native Americans; those who cannot afford to pay; and those who are not documented to be living in the United States.

Medica said she is available to speak at churches, community group meetings and businesses. She can be reached at the North Plains Library, 503-657-5051.

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