October 16, 2023 • 25 mins
In this episode of the Community Check-In, BJ Adigun, director of safety net community partnerships and engagement at Excellus BlueCross BlueShield, sheds light on the various avenues to obtain health insurance, from individual and family plans to options for businesses, all while emphasizing the importance of preventive care. BJ breaks down eligibility criteria for different plans, including Medicaid, Essential Plans and Child Health Plus, and also discusses the reintroduction of annual recertification for certain plans. Whether you're an individual, a family or a business owner, this episode provides valuable insights into finding the right health insurance coverage to meet your specific needs.
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(00:03):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram
(00:26):
and Facebook. I'm Joel Lomonico,and welcome to this week's check in.
When we think of health insurance,it's probably pretty easy to get overwhelmed.
There are so many choices and thecosts of healthcare. Today, we're going
to sort some of this out withBjatigan, who is the director of Safety
Net, Community Partnerships and Engagement atexcel Us Blue Cross Blue Shield. He
(00:50):
is here with us today to talkabout all the ways to get health insurance,
how to find the right plan foryou, and even how to get
more out of your plan. BJ, Welcome to the commu Unity check In.
It's good to have you, greatto be here. Thanks for having
me. There is this belief Iwant to start off with the big elephant
in the room, if we may. The only way you can get the
(01:10):
good insurance finger quotes the good insuranceis you have to have an employer that's
going to offer it to you.And many people do get health insurance of
course through their employer, But whatabout those who don't have that benefit or
their employers don't even offer it becausemaybe they're too small. That's a great
question, because, like you said, health insurance can be a pretty complex
(01:34):
topic, and so we feel it'svery important for folks to remember that health
insurance isn't only offered through employers.Right. You have several options where you
can actually buy and purchase health insurancedirectly through an insurance company like ours at
excel as Blue Crossroom Shield, andyou also have an opportunity to access health
insurance through the marketplace or the NewYork State Health Exchange. And so the
(01:57):
ability to be able to buy rightfrom either an insurance company like ours or
through the state really is a byproductof the Affordable Care Act, which had
the goal of offering just many moreoptions for both individuals and families to be
able to have access to health insuranceproducts. And really, here in New
York State, we have some robustplans that I think folks would be surprised
(02:17):
offer some pretty as you said,good health insurance options. And we have
had the conversations about it becoming amore consumer driven market. There are many
more choices, and as we mentionedat the beginning, we want to find
not only the right plan for you, but the one that's going to give
you the most coverage that meets youwhere you are, where your family is.
(02:39):
So it's a good starting place.So let's break it down a little
bit further to talk about some specificplan options that New York State, perchance
has and it's arsenal that people canstart looking into. Yeah. Absolutely,
and so I really kind of thinkof this in two primary buckets. So
we talked a little bit about thatfirst bucket, which, let's say you
(03:00):
own a business, maybe it's asmall business, or you're an employer of
some sort. You have options thatare available to you to work directly with
a health insurance company like ours orpotentially through a broker and find the healthcare
insurance coverage options that would meet theneeds for you and your staff. Right,
So that's bucket number one through anemployer, But more broadly, when
(03:20):
you start talking about both individuals andfamilies, you actually can purchase health insurance
directly from us here at excel Us, or you can go through the exchange,
and in those two options, youhave a number of different opportunities to
find coverage that can meet the needsfor you and your family. All of
these products are income based, sojust you know, it's really based on
how much money you're able to generateand bring into your family. And let's
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say you have maybe some lower income, you could qualify for a products such
as Medicaid or the Essential Plan.Let's say you were looking for coverage options
for you know, a family memberthat's under nineteen. The Child Health Plus
Insurance product actually offers free and lowcost options for children under the age of
nineteen. Let's say you're in theretirement phase of your career, or you're
(04:08):
going to be turning sixty five.You can also buy Medicare through Excellers Crossloo
Shield. We offer Medicare advantage plansthat provide comprehensive coverage and supplement traditional Medicare
and make sure that you receive accessto the services that you may need for
that stage of your life. Sowhen we say everybody benefits, you know,
really we look at it whether ornot you're employed, unemployed from birth
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all the way through retirement. Wereally have options that can meet all the
needs regardless of where you might findyourself in whatever stage of life you might
doing in. And we're going togo back to this a lot, but
it is going to bear repeating alot about the fact that insurance is available.
It is not something that is onehundred percent tied to employment. I
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think that's one of the great thingsthe Affordable Care Act did is that it's
separated those two two things, whichwas often very prohibitive for many groups within
our community that kept them in arm'slength, or it was a barrier to
getting health insurance. Now it hasopened up the marketplace, and I would
suspect that that's been a great benefitto so many different populations within the community
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to know that these options are available. Absolutely absolutely, And so you know,
let's look at it really from youknow, the standpoint of a couple
of different scenarios, right. So, let's say you're a single individual,
you're twenty six, you're just offof your parents' health insurance coverage, and
you're looking for what some options mightbe for you out there in the marketplace.
You don't have insurance for your employer, and so you're looking for insurance
(05:41):
for yourself. Your income maybe ishigh enough to where you don't qualify for
products such as Medicaid. But herein New York State, we have the
Essential Plan, which is an opportunityto have access to a great health insurance
option for little to no cost,without a pocket expense. It's a zero
dollar toductible for members who were enrolledin the Essential Plan. And the really
(06:02):
good thing about our program here atexcel Us is that we were ranked number
one in New York State for theEssential Plan, and so you're going to
have access to really be able tosee things like preventive services, make sure
the prescription coverage is being paid for, and really have good coverage on a
very reasonable at a very reasonable cost. And so when you think about an
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individual who finds themselves in that stageof life, you know the Essential Plan
is a really, really, reallygood option. And that also goes to
that point of cost bjay is thatyou're not getting reduced services or options because
those costs are low. Those twothings don't necessarily have to go together.
Maybe that's a perception that we're goingto be working to get passed within the
(06:47):
community to say affordability does not meanbargain basement or low or low priority or
low coverage. Yeah, that's areally good point. And so when you
think about a plan and like youto the Essential Plan or even if you're
on Child Health Plus or Medicaid.Through our network, we work with just
about every doctor, hospital, specialtyservice across mainly the entire state of New
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York. And so just because you'reon the Essential Plan, I don't want
folks to feel like you won't getthe same type of coverage that you would
get if you were on an employercoverage, because you will. They take
our insurance. You'll have access tothe specialties, the services that you may
need. And there's also an opportunityto make sure that you're receiving the types
of plans that can meet you whereyou are in your healthcare journey. So
whether you're dealing with the chronic condition, if there are certain medications that you
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need in order to be able tomaintain a healthy lifestyle, all of that
is covered under what are some greatoptions both in the individual and family Exactly
having those things and meeting people wherethey are that it's a big part of
what insurance should be doing. Bjaand again is our guest this week on
the Community check In Director of SafetyNet, Community Partnerships and Engagement at excel
Us, Blue Cross, Blue Shield. We're talking about health insurance, what's
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available, how to get it,how to maximize your plan. We've talked
a little bit about single because that'swhere many people have that experience, coming
into needing health insurance for the veryfirst time, coming off a family plan
or mom or dad's plan, andnow moving out onto your own. Now,
let's talk about what the families arefacing, because a family that's a
that's a big catch of a lotof different types of things, and not
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every family looks the same or hasthe same type of care. So let's
try to hit somewhere on the target, un at least start this to conversation
about what families might be looking forand have available to them. Yeah.
Sure, it's another really good question. So let's consider you. Let's say
we have a single mom who havetwo kids that are under the age of
nineteen. They're living at you know, very low income or maybe near the
(08:48):
pottery level. There's several types ofplans that might be available first for her,
right, so we talked about Medicaidand the essential plan that that single
mom could have rolled in so thatthey have their health insurance covered. There
are two children that are under theage of nineteen. Child Health Plus is
a quality option that they could thenenroll their children into, and so it
provides and offers the same type ofessential health benefit benefits as other plans with
(09:13):
little to no cost out of pocketfor both the family member and for the
child. And finally, because shedoes have those two kids, we could
also provide coverage through an opportunity forthem to make sure that they are receiving
services, whether it be school basedservices, things that they may need to
access because of special conditions that thechild might have. Child Health Plus covers
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all of those services. So againbeing able to reiterate the fact that you
know, just because you're receiving thiscoverage, you're going to get the same
type of coverage as if you wereon a family plan through an employer,
right, And so for us,we really want folks to make the connection
that just because you're not receiving thoseinsurance products through an employer, you still
have the opportunity to access high qualityand affordable health care through several different options
(10:01):
that you can find at both excelUS, BCPs, dot com or you
can call us and we can workdirectly with you and your family to make
sure you get enrolled in proper healthinsurance coverage. Now, when it comes
to those of us who do receivehealth insurance through our employers, it's not
a set it and forget it kindof a relationship that we have. Every
(10:24):
year we go through an election periodand we have to make sure that that
coverage is going We're going to electto have the coverage in a new calendar
year, and we're going to makesure that it still lines up with our
needs. I want to talk aboutthat process of re certification because that's really
what it means, and also talkto us about it from the perspective of
not having that employer helping us throughthe process. What does that recertification look
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like, and if you can talka little bit about how people are moving
through it if they are the onesdriving the bus, so to speak,
when it comes to their health insuranceneeds. Yeah, so you mentioned two
really key points. And you know, typically an annual enrollment or open enrollment
period that I think most of yourlisteners will be familiar with, right,
and so it typically starts in Novemberends in January, and this is when
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if you're receiving insurance through an employerbased coverage, you have to make the
selections, make sure that you havethe right health insurance coverage for you and
your family, and make sure thatduring that period you're making all the right
selections for the types of coverage andbenefits you're going to be receiving over the
course of the following year. Now, for these individuals and families that we're
talking about, maybe who are receivingservices directly through Excelis or through the New
(11:35):
York State Health Exchange, Traditionally,before the pandemic, they also had what
they called basically an annual recertification period, so it typically takes place during the
time that they enrolled. So let'ssay I enrolled in Medicaid in June of
twenty twenty, So for June oftwenty twenty one, I'm going to have
to go through make sure that Ican still receive those benefits or are eligible
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to receive those benefits, and thenfor the next year be enrolled in that
coverage. Well, during the pandemic, that process actually was halted across the
entire country, so you were justbasically automatically renewed in whatever health insurance plan
that you were in. And sowith the pandemic being over, we're now
actually going through the process where eachand every individual now has to re certify
(12:22):
or re establish that they still areeligible to receive the benefits they're receiving,
whether it's Medicaid Essential Plan or fromChildhealth Plus. And so each month we're
working with members across the community tomake sure that they are still able and
eligible to stay enrolled in those services. If they're not making sure that they
get enrolled into the proper service,and if there are people who are looking
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maybe for let's say a more broadernetwork or very specific coverage, making sure
that they actually have access to expertsand dedicated staff who can walk them through
that process and make sure that theyeither remain in their health insurance package or
are enrolled into a similar package thatmeets them or their families needs. And
so it's been really, i thinka great example of how New York State
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has really done a great job inbuilding many different types of options in healthcare
coverage plans for individuals and families,and it it reinforces, i think the
importance of making sure that you stayon top of your health and also to
have it as much as possible.Perhaps you don't have a family that goes
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to use that coverage and now it'snot available because it has lapsed and they
weren't aware of it, or orsome other thing comes that prevents them again
from getting that necessary preventative care oremergent care that they need. And it
goes to what Excel's Blue Cross BlueShield has been doing and being very aggressive
about it, I might add,is to get into the community, to
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meet people where they are and evenif it means kind of you know,
knocking on doors, you know,you know, literally and figuratively, to
be able to make sure that peoplehave this knowledge at their disposal. Yeah,
for sure, for sure. Andyou know, we've been really intentional
in trying to get that message outbecause to your point, you know,
we've heard stories of folks who goto let's say, try to fill a
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prescription and they find out that theirhealth coverage has lapsed, and so then
having to help and support them throughthat process so that they can have access
to those services or those prescription drugs, maybe those doctor visits that they're really
going to need down the road,so that they can maintain as healthy a
lifestyle as possible. And the onething about healthcare that I tell people all
the time is, you know,it's one of those things that's in the
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back of your mind and you don'trealize you need it until you actually do
need it. And so once wehave an opportunity to establish that relationship in
the community where we're a trusted partner, it really doesn't make it that much
easier for us to be able tosupport them through that journey and make sure
that they're living their healthiest lives.This is the Community Check In and BJAD
again as our guest this week,director of Safety Nets, Community Partnerships and
(14:50):
Engagement at excel As Blue Cross,Blue Shield. We're talking about health insurance,
what's available, how to get it, how to maximize it. We've
talked individual levels. Let's much overto the business owners. We talked a
little bit about them earlier. Let'scircle back around for those who are small
business owners, maybe even self employed. You know that's now it's still incumbent
(15:11):
upon that individual to handle healthcare benefitsfor themselves. Let's talk about some of
the options in that sphere that areavailable. Yeah. Absolutely, and so
We've talked a lot about maybe individualswho because of their current kind of income
situation would qualify for Medicaid Essential Planin some of those state subsidized health insurance
(15:33):
products. But let's say you're asmall business owner and maybe you make too
much money to qualify for those particularplans. We can also work with individuals
to enroll in the Qualified Health Plan, which has different levels based on your
income, where you would have someout of pocket expense for insurance coverage,
but you would still have the opportunityto access all of the different types of
(15:54):
services and receive all the different typesof supports that you would in any of
our other plans. Right, Andyou can access the Qualified health plan if
you're a small business owner through theNew York State Health Exchange, or you
can work directly with us that ExcelsBlue Cross Blue Shield as well to find
what options you may qualify based onyour insurance excuse me, on your income.
(16:15):
One of the other things I dowant to mention as well, is
that you know, we've differentiated alittle bit between what it's like to be
maybe looking for the individual plan orthe family plan. In this particular scenario,
you could be a small business ownerthat qualifies and enrolls in the qualified
health plan. But if you havechildren, you could then have them enroll
into Childhealth Plus. Right, Sothere's many different types of options that would
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be available for you, regardless ofwhat season of life you find yourself,
and that's why I think it's reallyimportant to really get connected understand what those
options look like. Think about thingslike, you know, what types of
services am I going to need toaccess? How often do I utilize my
health insurance? What types of costpotentially out of pocket may there be for
me and my family? Those areall very important factors going into selecting the
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right health insurance for you and yourfamily, and we're certainly here to help
walk you through that journey and makesure that you have the right coverage.
And I suppose having you and yourteam as a resource is great because talking
about what's actually covered in some ofthese plans and products, it could be
almost anything, and you have tobe able to really take advantage of the
expertise to know, Okay, howam I going to sort this all out?
(17:22):
To get a clear picture of whatplan is going to meet my need?
Absolutely absolutely, and that's why youknow it's always helpful to talk to
someone who maybe works in this spaceon a daily basis. Right, So
we talked earlier about how complex someof these questions can be, and there
are some questions that arise that youdon't even know you have until you have
the chance to maybe bounce some ideasoff of someone. And so, you
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know, we talked about if I'man individual, what does that look like
if I enroll into one coverage,but then for my children, maybe what
is that going to look like?And maybe it's going to be a little
bit different than what I thought.And even if you're a business owner,
right, there's probably a ton ofquestions that you would have based on the
side of the employees that you have, maybe the types of coverages that you
want to provide for those employees.Being able to have somebody that can walk
(18:07):
you through that process and help supportyou and making the right decision is very
important. Well, then let's vaultright into that those in the small to
large business category, and that canbe from say twenty employees up to hundreds
of employees for them being able tohave the knowledge necessary to find those right
types of offerings too. Again,it requires having someone to work as a
(18:29):
partner with them because they have tobe able to provide They got to hit
a sweet spot, I would suspectto make sure that they're offering the right
options to their employees. And nobodyknows their employees better than them. Yeah.
Absolutely, And so when you thinkabout let's say, what we would
consider a small business, so thatwould be anywhere from two one hundred employees
or someone who had a larger business, you know, more than one hundred
(18:52):
employees. We've got a variety ofplans to meet the needs of any business,
and we're also dedicated to work veryclosely with both that business owner and
that staff to make sure that they'reenrolled in the type of coverage that are
going to meet their needs and needsfor their families. And so many of
our plans also include extra benefits.So, for example, we offer things
such as care management. We havea program in which we are able to
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help folks who have chronic conditions suchas let's say, mental health, diabetes.
We have a great care management teamthat's called Bright Beginnings, which works
very closely in maternity care management andsupports pregnant women throughout their pregnancy. And
so just based on what's happening andwhat's going on not only individually, but
with your staff and your entire company. We really feel like we can work
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very closely with you to make surethat you have the services and the products
that you need to be able toprovide comprehensive benefits for your employees. It's
more than prescription drugs and hospitalization andpreventative care. It can really be tailored
to the population that you are serving, whether you are providing it for employees
or your or trying to provide itfor the rights group within the community.
(20:03):
What's the endpoint bj When people arelooking to find the best coverage, where
do they start to filter out allof the information. Some of it can
be good for them, and someof it could be just too confusing to
make it be a good information.Yeah. I always say, you know,
it's never a bad idea to aska lot of questions. Right,
So, whether you're a business ownerwho's looking for the best coverage for their
(20:26):
employees, you're an individual who maybehas a very specific set of things that
they know will impact their health,or you're looking for coverage for a family,
right, ask a ton of questions, right, what types of costs
are going to be associated with thisplan? What types of copays may I
have that would be associated with thisplan? What type of network coverage will
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there be in the plan that I'menrolled in. The more questions you ask,
it provides a greater picture as towhat's going to be provided in these
benefits, maybe things that you're lookingfor that you didn't even realize you would
want in coverage. And the reallycool thing about it is that we do
have the ability to be able totailor these plans both for businesses and individuals
to meet their needs wherever they areright and so working very closely with us,
(21:11):
working closely with the New York StateHealth Exchange, I'm really confident,
especially here in New York State,that you can find a plan that would
meet those needs. And as weget ready to sort of wrap up our
conversation, of course, sometimes needschange, sometimes lif and lifestyles change.
Just going back to something we talkedabout earlier about enrollments and recertifications, you
do have the ability to change,though you do have to be careful or
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work with a professional to make surethat you're getting the right times to make
those changes that could be necessary.Absolutely and so that's a really good question
as well. And so typically whathappens is, if you're enrolled in one
of the New York State Health Exchangeproducts, you have the ability to enroll
at any time during the year,and so it's basically what they call open
(21:55):
enrollment period, right, And soif there's something that happens during the time
in which you're enrolled in one ofthese products, you can either work with
someone through the exchange or contact oneof our staff who's dedicated to working with
that population to make sure that youunderstand what the parameters are around choosing a
plan. There's also something that iscalled a qualifying event. So let's say
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you had, you know, employercoverage through your job. For whatever reason,
that employer coverage is no longer availableto you, maybe you got laid
off, maybe things have changed inyour family situation, you go through a
divorce, you have a baby.That actually is an opportunity to then revisit
the types of coverage that you wouldbe available to receive. And so we
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always make sure that folks understand andare at least aware of the fact that
some of these life changes do providean opportunity for you to seek the types
of coverage that now since things havekind of changed in your life, that
you can enroll for. And again, with all the options that we have,
we are very very confident that wecan find a plan that will meet
your needs, regardless of what stageof life you find yourself in. All
(23:00):
right, So, as we getready to wrap up our conversation, first,
you know, we've talked a lotabout excel Us Blue Cross Blue Shield.
Let's talk a little bit more aboutwhat's available through them. And also,
where is a great access point formembers of the community to come in
to start having a conversation with youand the team. Yeah, so two
great questions again, and so youknow, one of the things that's really
(23:21):
important for us as a company hereat excel Us is that we're a mission
based, nonprofit local company. RightWe have staff that live, work,
and commute here in our own community, and so it gives us an opportunity
to understand the varying needs that mayimpact community members and then be able to
tailor our services and our customer serviceto meet the needs of those that we're
(23:44):
helping. And if you visit excelUSBCBS dot com or you can give us
a call at one eight hundred ninethree nine seventy seven hundred. We have
a dedicated staff and can kind ofwalk you through all the different benefits that
are available to you and your familyand help support you in your healthcare journey.
And the one thing that I wantto leave folks with here if they
don't remember anything else, is thatwe really are committed to helping people in
(24:08):
this community to live their healthiest livesand we really want to be a partner
with you in that journey. Andwhen we do that, everybody benefits.
And there's many more questions we couldask, but for the moment, we
will tell Bjadagan, who's the directorof Safety Net, Community Partnerships and Engagement
at Excellus Blue Cross Blue Shield,thank you for your knowledge and for your
expertise, and thank you for yourteam that welcomes members of the community to
(24:30):
start having the conversation about health insuranceand how to maximize their coverage. Great,
thanks for having me, Thanks forjoining us on Community check In,
a presentation of excel Us Blue CrossBlue Shield at iHeartRadio. Podcasts of Community
check In are available on the iHeartRadioapp or wherever you find your favorite audio
content. For more ways to staysafe, healthy, and educated, visit
(24:53):
excel usbcbs dot com and follow onInstagram and Facebook.
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel USBCBS dot com and follow on Instagram
(00:26):
and Facebook. I'm Joel Lomonico,and welcome to this week's check in.
When we think of health insurance,it's probably pretty easy to get overwhelmed.
There are so many choices and thecosts of healthcare. Today, we're going
to sort some of this out withBjatigan, who is the director of Safety
Net, Community Partnerships and Engagement atexcel Us Blue Cross Blue Shield. He
(00:50):
is here with us today to talkabout all the ways to get health insurance,
how to find the right plan foryou, and even how to get
more out of your plan. BJ, Welcome to the commu Unity check In.
It's good to have you, greatto be here. Thanks for having
me. There is this belief Iwant to start off with the big elephant
in the room, if we may. The only way you can get the
(01:10):
good insurance finger quotes the good insuranceis you have to have an employer that's
going to offer it to you.And many people do get health insurance of
course through their employer, But whatabout those who don't have that benefit or
their employers don't even offer it becausemaybe they're too small. That's a great
question, because, like you said, health insurance can be a pretty complex
(01:34):
topic, and so we feel it'svery important for folks to remember that health
insurance isn't only offered through employers.Right. You have several options where you
can actually buy and purchase health insurancedirectly through an insurance company like ours at
excel as Blue Crossroom Shield, andyou also have an opportunity to access health
insurance through the marketplace or the NewYork State Health Exchange. And so the
(01:57):
ability to be able to buy rightfrom either an insurance company like ours or
through the state really is a byproductof the Affordable Care Act, which had
the goal of offering just many moreoptions for both individuals and families to be
able to have access to health insuranceproducts. And really, here in New
York State, we have some robustplans that I think folks would be surprised
(02:17):
offer some pretty as you said,good health insurance options. And we have
had the conversations about it becoming amore consumer driven market. There are many
more choices, and as we mentionedat the beginning, we want to find
not only the right plan for you, but the one that's going to give
you the most coverage that meets youwhere you are, where your family is.
(02:39):
So it's a good starting place.So let's break it down a little
bit further to talk about some specificplan options that New York State, perchance
has and it's arsenal that people canstart looking into. Yeah. Absolutely,
and so I really kind of thinkof this in two primary buckets. So
we talked a little bit about thatfirst bucket, which, let's say you
(03:00):
own a business, maybe it's asmall business, or you're an employer of
some sort. You have options thatare available to you to work directly with
a health insurance company like ours orpotentially through a broker and find the healthcare
insurance coverage options that would meet theneeds for you and your staff. Right,
So that's bucket number one through anemployer, But more broadly, when
(03:20):
you start talking about both individuals andfamilies, you actually can purchase health insurance
directly from us here at excel Us, or you can go through the exchange,
and in those two options, youhave a number of different opportunities to
find coverage that can meet the needsfor you and your family. All of
these products are income based, sojust you know, it's really based on
how much money you're able to generateand bring into your family. And let's
(03:44):
say you have maybe some lower income, you could qualify for a products such
as Medicaid or the Essential Plan.Let's say you were looking for coverage options
for you know, a family memberthat's under nineteen. The Child Health Plus
Insurance product actually offers free and lowcost options for children under the age of
nineteen. Let's say you're in theretirement phase of your career, or you're
(04:08):
going to be turning sixty five.You can also buy Medicare through Excellers Crossloo
Shield. We offer Medicare advantage plansthat provide comprehensive coverage and supplement traditional Medicare
and make sure that you receive accessto the services that you may need for
that stage of your life. Sowhen we say everybody benefits, you know,
really we look at it whether ornot you're employed, unemployed from birth
(04:32):
all the way through retirement. Wereally have options that can meet all the
needs regardless of where you might findyourself in whatever stage of life you might
doing in. And we're going togo back to this a lot, but
it is going to bear repeating alot about the fact that insurance is available.
It is not something that is onehundred percent tied to employment. I
(04:54):
think that's one of the great thingsthe Affordable Care Act did is that it's
separated those two two things, whichwas often very prohibitive for many groups within
our community that kept them in arm'slength, or it was a barrier to
getting health insurance. Now it hasopened up the marketplace, and I would
suspect that that's been a great benefitto so many different populations within the community
(05:16):
to know that these options are available. Absolutely absolutely, And so you know,
let's look at it really from youknow, the standpoint of a couple
of different scenarios, right. So, let's say you're a single individual,
you're twenty six, you're just offof your parents' health insurance coverage, and
you're looking for what some options mightbe for you out there in the marketplace.
You don't have insurance for your employer, and so you're looking for insurance
(05:41):
for yourself. Your income maybe ishigh enough to where you don't qualify for
products such as Medicaid. But herein New York State, we have the
Essential Plan, which is an opportunityto have access to a great health insurance
option for little to no cost,without a pocket expense. It's a zero
dollar toductible for members who were enrolledin the Essential Plan. And the really
(06:02):
good thing about our program here atexcel Us is that we were ranked number
one in New York State for theEssential Plan, and so you're going to
have access to really be able tosee things like preventive services, make sure
the prescription coverage is being paid for, and really have good coverage on a
very reasonable at a very reasonable cost. And so when you think about an
(06:25):
individual who finds themselves in that stageof life, you know the Essential Plan
is a really, really, reallygood option. And that also goes to
that point of cost bjay is thatyou're not getting reduced services or options because
those costs are low. Those twothings don't necessarily have to go together.
Maybe that's a perception that we're goingto be working to get passed within the
(06:47):
community to say affordability does not meanbargain basement or low or low priority or
low coverage. Yeah, that's areally good point. And so when you
think about a plan and like youto the Essential Plan or even if you're
on Child Health Plus or Medicaid.Through our network, we work with just
about every doctor, hospital, specialtyservice across mainly the entire state of New
(07:13):
York. And so just because you'reon the Essential Plan, I don't want
folks to feel like you won't getthe same type of coverage that you would
get if you were on an employercoverage, because you will. They take
our insurance. You'll have access tothe specialties, the services that you may
need. And there's also an opportunityto make sure that you're receiving the types
of plans that can meet you whereyou are in your healthcare journey. So
whether you're dealing with the chronic condition, if there are certain medications that you
(07:39):
need in order to be able tomaintain a healthy lifestyle, all of that
is covered under what are some greatoptions both in the individual and family Exactly
having those things and meeting people wherethey are that it's a big part of
what insurance should be doing. Bjaand again is our guest this week on
the Community check In Director of SafetyNet, Community Partnerships and Engagement at excel
Us, Blue Cross, Blue Shield. We're talking about health insurance, what's
(08:01):
available, how to get it,how to maximize your plan. We've talked
a little bit about single because that'swhere many people have that experience, coming
into needing health insurance for the veryfirst time, coming off a family plan
or mom or dad's plan, andnow moving out onto your own. Now,
let's talk about what the families arefacing, because a family that's a
that's a big catch of a lotof different types of things, and not
(08:24):
every family looks the same or hasthe same type of care. So let's
try to hit somewhere on the target, un at least start this to conversation
about what families might be looking forand have available to them. Yeah.
Sure, it's another really good question. So let's consider you. Let's say
we have a single mom who havetwo kids that are under the age of
nineteen. They're living at you know, very low income or maybe near the
(08:48):
pottery level. There's several types ofplans that might be available first for her,
right, so we talked about Medicaidand the essential plan that that single
mom could have rolled in so thatthey have their health insurance covered. There
are two children that are under theage of nineteen. Child Health Plus is
a quality option that they could thenenroll their children into, and so it
provides and offers the same type ofessential health benefit benefits as other plans with
(09:13):
little to no cost out of pocketfor both the family member and for the
child. And finally, because shedoes have those two kids, we could
also provide coverage through an opportunity forthem to make sure that they are receiving
services, whether it be school basedservices, things that they may need to
access because of special conditions that thechild might have. Child Health Plus covers
(09:35):
all of those services. So againbeing able to reiterate the fact that you
know, just because you're receiving thiscoverage, you're going to get the same
type of coverage as if you wereon a family plan through an employer,
right, And so for us,we really want folks to make the connection
that just because you're not receiving thoseinsurance products through an employer, you still
have the opportunity to access high qualityand affordable health care through several different options
(10:01):
that you can find at both excelUS, BCPs, dot com or you
can call us and we can workdirectly with you and your family to make
sure you get enrolled in proper healthinsurance coverage. Now, when it comes
to those of us who do receivehealth insurance through our employers, it's not
a set it and forget it kindof a relationship that we have. Every
(10:24):
year we go through an election periodand we have to make sure that that
coverage is going We're going to electto have the coverage in a new calendar
year, and we're going to makesure that it still lines up with our
needs. I want to talk aboutthat process of re certification because that's really
what it means, and also talkto us about it from the perspective of
not having that employer helping us throughthe process. What does that recertification look
(10:48):
like, and if you can talka little bit about how people are moving
through it if they are the onesdriving the bus, so to speak,
when it comes to their health insuranceneeds. Yeah, so you mentioned two
really key points. And you know, typically an annual enrollment or open enrollment
period that I think most of yourlisteners will be familiar with, right,
and so it typically starts in Novemberends in January, and this is when
(11:11):
if you're receiving insurance through an employerbased coverage, you have to make the
selections, make sure that you havethe right health insurance coverage for you and
your family, and make sure thatduring that period you're making all the right
selections for the types of coverage andbenefits you're going to be receiving over the
course of the following year. Now, for these individuals and families that we're
talking about, maybe who are receivingservices directly through Excelis or through the New
(11:35):
York State Health Exchange, Traditionally,before the pandemic, they also had what
they called basically an annual recertification period, so it typically takes place during the
time that they enrolled. So let'ssay I enrolled in Medicaid in June of
twenty twenty, So for June oftwenty twenty one, I'm going to have
to go through make sure that Ican still receive those benefits or are eligible
(11:58):
to receive those benefits, and thenfor the next year be enrolled in that
coverage. Well, during the pandemic, that process actually was halted across the
entire country, so you were justbasically automatically renewed in whatever health insurance plan
that you were in. And sowith the pandemic being over, we're now
actually going through the process where eachand every individual now has to re certify
(12:22):
or re establish that they still areeligible to receive the benefits they're receiving,
whether it's Medicaid Essential Plan or fromChildhealth Plus. And so each month we're
working with members across the community tomake sure that they are still able and
eligible to stay enrolled in those services. If they're not making sure that they
get enrolled into the proper service,and if there are people who are looking
(12:43):
maybe for let's say a more broadernetwork or very specific coverage, making sure
that they actually have access to expertsand dedicated staff who can walk them through
that process and make sure that theyeither remain in their health insurance package or
are enrolled into a similar package thatmeets them or their families needs. And
so it's been really, i thinka great example of how New York State
(13:05):
has really done a great job inbuilding many different types of options in healthcare
coverage plans for individuals and families,and it it reinforces, i think the
importance of making sure that you stayon top of your health and also to
have it as much as possible.Perhaps you don't have a family that goes
(13:26):
to use that coverage and now it'snot available because it has lapsed and they
weren't aware of it, or orsome other thing comes that prevents them again
from getting that necessary preventative care oremergent care that they need. And it
goes to what Excel's Blue Cross BlueShield has been doing and being very aggressive
about it, I might add,is to get into the community, to
(13:46):
meet people where they are and evenif it means kind of you know,
knocking on doors, you know,you know, literally and figuratively, to
be able to make sure that peoplehave this knowledge at their disposal. Yeah,
for sure, for sure. Andyou know, we've been really intentional
in trying to get that message outbecause to your point, you know,
we've heard stories of folks who goto let's say, try to fill a
(14:07):
prescription and they find out that theirhealth coverage has lapsed, and so then
having to help and support them throughthat process so that they can have access
to those services or those prescription drugs, maybe those doctor visits that they're really
going to need down the road,so that they can maintain as healthy a
lifestyle as possible. And the onething about healthcare that I tell people all
the time is, you know,it's one of those things that's in the
(14:28):
back of your mind and you don'trealize you need it until you actually do
need it. And so once wehave an opportunity to establish that relationship in
the community where we're a trusted partner, it really doesn't make it that much
easier for us to be able tosupport them through that journey and make sure
that they're living their healthiest lives.This is the Community Check In and BJAD
again as our guest this week,director of Safety Nets, Community Partnerships and
(14:50):
Engagement at excel As Blue Cross,Blue Shield. We're talking about health insurance,
what's available, how to get it, how to maximize it. We've
talked individual levels. Let's much overto the business owners. We talked a
little bit about them earlier. Let'scircle back around for those who are small
business owners, maybe even self employed. You know that's now it's still incumbent
(15:11):
upon that individual to handle healthcare benefitsfor themselves. Let's talk about some of
the options in that sphere that areavailable. Yeah. Absolutely, and so
We've talked a lot about maybe individualswho because of their current kind of income
situation would qualify for Medicaid Essential Planin some of those state subsidized health insurance
(15:33):
products. But let's say you're asmall business owner and maybe you make too
much money to qualify for those particularplans. We can also work with individuals
to enroll in the Qualified Health Plan, which has different levels based on your
income, where you would have someout of pocket expense for insurance coverage,
but you would still have the opportunityto access all of the different types of
(15:54):
services and receive all the different typesof supports that you would in any of
our other plans. Right, Andyou can access the Qualified health plan if
you're a small business owner through theNew York State Health Exchange, or you
can work directly with us that ExcelsBlue Cross Blue Shield as well to find
what options you may qualify based onyour insurance excuse me, on your income.
(16:15):
One of the other things I dowant to mention as well, is
that you know, we've differentiated alittle bit between what it's like to be
maybe looking for the individual plan orthe family plan. In this particular scenario,
you could be a small business ownerthat qualifies and enrolls in the qualified
health plan. But if you havechildren, you could then have them enroll
into Childhealth Plus. Right, Sothere's many different types of options that would
(16:37):
be available for you, regardless ofwhat season of life you find yourself,
and that's why I think it's reallyimportant to really get connected understand what those
options look like. Think about thingslike, you know, what types of
services am I going to need toaccess? How often do I utilize my
health insurance? What types of costpotentially out of pocket may there be for
me and my family? Those areall very important factors going into selecting the
(17:02):
right health insurance for you and yourfamily, and we're certainly here to help
walk you through that journey and makesure that you have the right coverage.
And I suppose having you and yourteam as a resource is great because talking
about what's actually covered in some ofthese plans and products, it could be
almost anything, and you have tobe able to really take advantage of the
expertise to know, Okay, howam I going to sort this all out?
(17:22):
To get a clear picture of whatplan is going to meet my need?
Absolutely absolutely, and that's why youknow it's always helpful to talk to
someone who maybe works in this spaceon a daily basis. Right, So
we talked earlier about how complex someof these questions can be, and there
are some questions that arise that youdon't even know you have until you have
the chance to maybe bounce some ideasoff of someone. And so, you
(17:44):
know, we talked about if I'man individual, what does that look like
if I enroll into one coverage,but then for my children, maybe what
is that going to look like?And maybe it's going to be a little
bit different than what I thought.And even if you're a business owner,
right, there's probably a ton ofquestions that you would have based on the
side of the employees that you have, maybe the types of coverages that you
want to provide for those employees.Being able to have somebody that can walk
(18:07):
you through that process and help supportyou and making the right decision is very
important. Well, then let's vaultright into that those in the small to
large business category, and that canbe from say twenty employees up to hundreds
of employees for them being able tohave the knowledge necessary to find those right
types of offerings too. Again,it requires having someone to work as a
(18:29):
partner with them because they have tobe able to provide They got to hit
a sweet spot, I would suspectto make sure that they're offering the right
options to their employees. And nobodyknows their employees better than them. Yeah.
Absolutely, And so when you thinkabout let's say, what we would
consider a small business, so thatwould be anywhere from two one hundred employees
or someone who had a larger business, you know, more than one hundred
(18:52):
employees. We've got a variety ofplans to meet the needs of any business,
and we're also dedicated to work veryclosely with both that business owner and
that staff to make sure that they'reenrolled in the type of coverage that are
going to meet their needs and needsfor their families. And so many of
our plans also include extra benefits.So, for example, we offer things
such as care management. We havea program in which we are able to
(19:17):
help folks who have chronic conditions suchas let's say, mental health, diabetes.
We have a great care management teamthat's called Bright Beginnings, which works
very closely in maternity care management andsupports pregnant women throughout their pregnancy. And
so just based on what's happening andwhat's going on not only individually, but
with your staff and your entire company. We really feel like we can work
(19:40):
very closely with you to make surethat you have the services and the products
that you need to be able toprovide comprehensive benefits for your employees. It's
more than prescription drugs and hospitalization andpreventative care. It can really be tailored
to the population that you are serving, whether you are providing it for employees
or your or trying to provide itfor the rights group within the community.
(20:03):
What's the endpoint bj When people arelooking to find the best coverage, where
do they start to filter out allof the information. Some of it can
be good for them, and someof it could be just too confusing to
make it be a good information.Yeah. I always say, you know,
it's never a bad idea to aska lot of questions. Right,
So, whether you're a business ownerwho's looking for the best coverage for their
(20:26):
employees, you're an individual who maybehas a very specific set of things that
they know will impact their health,or you're looking for coverage for a family,
right, ask a ton of questions, right, what types of costs
are going to be associated with thisplan? What types of copays may I
have that would be associated with thisplan? What type of network coverage will
(20:47):
there be in the plan that I'menrolled in. The more questions you ask,
it provides a greater picture as towhat's going to be provided in these
benefits, maybe things that you're lookingfor that you didn't even realize you would
want in coverage. And the reallycool thing about it is that we do
have the ability to be able totailor these plans both for businesses and individuals
to meet their needs wherever they areright and so working very closely with us,
(21:11):
working closely with the New York StateHealth Exchange, I'm really confident,
especially here in New York State,that you can find a plan that would
meet those needs. And as weget ready to sort of wrap up our
conversation, of course, sometimes needschange, sometimes lif and lifestyles change.
Just going back to something we talkedabout earlier about enrollments and recertifications, you
do have the ability to change,though you do have to be careful or
(21:33):
work with a professional to make surethat you're getting the right times to make
those changes that could be necessary.Absolutely and so that's a really good question
as well. And so typically whathappens is, if you're enrolled in one
of the New York State Health Exchangeproducts, you have the ability to enroll
at any time during the year,and so it's basically what they call open
(21:55):
enrollment period, right, And soif there's something that happens during the time
in which you're enrolled in one ofthese products, you can either work with
someone through the exchange or contact oneof our staff who's dedicated to working with
that population to make sure that youunderstand what the parameters are around choosing a
plan. There's also something that iscalled a qualifying event. So let's say
(22:15):
you had, you know, employercoverage through your job. For whatever reason,
that employer coverage is no longer availableto you, maybe you got laid
off, maybe things have changed inyour family situation, you go through a
divorce, you have a baby.That actually is an opportunity to then revisit
the types of coverage that you wouldbe available to receive. And so we
(22:37):
always make sure that folks understand andare at least aware of the fact that
some of these life changes do providean opportunity for you to seek the types
of coverage that now since things havekind of changed in your life, that
you can enroll for. And again, with all the options that we have,
we are very very confident that wecan find a plan that will meet
your needs, regardless of what stageof life you find yourself in. All
(23:00):
right, So, as we getready to wrap up our conversation, first,
you know, we've talked a lotabout excel Us Blue Cross Blue Shield.
Let's talk a little bit more aboutwhat's available through them. And also,
where is a great access point formembers of the community to come in
to start having a conversation with youand the team. Yeah, so two
great questions again, and so youknow, one of the things that's really
(23:21):
important for us as a company hereat excel Us is that we're a mission
based, nonprofit local company. RightWe have staff that live, work,
and commute here in our own community, and so it gives us an opportunity
to understand the varying needs that mayimpact community members and then be able to
tailor our services and our customer serviceto meet the needs of those that we're
(23:44):
helping. And if you visit excelUSBCBS dot com or you can give us
a call at one eight hundred ninethree nine seventy seven hundred. We have
a dedicated staff and can kind ofwalk you through all the different benefits that
are available to you and your familyand help support you in your healthcare journey.
And the one thing that I wantto leave folks with here if they
don't remember anything else, is thatwe really are committed to helping people in
(24:08):
this community to live their healthiest livesand we really want to be a partner
with you in that journey. Andwhen we do that, everybody benefits.
And there's many more questions we couldask, but for the moment, we
will tell Bjadagan, who's the directorof Safety Net, Community Partnerships and Engagement
at Excellus Blue Cross Blue Shield,thank you for your knowledge and for your
expertise, and thank you for yourteam that welcomes members of the community to
(24:30):
start having the conversation about health insuranceand how to maximize their coverage. Great,
thanks for having me, Thanks forjoining us on Community check In,
a presentation of excel Us Blue CrossBlue Shield at iHeartRadio. Podcasts of Community
check In are available on the iHeartRadioapp or wherever you find your favorite audio
content. For more ways to staysafe, healthy, and educated, visit
(24:53):
excel usbcbs dot com and follow onInstagram and Facebook.
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