Yvonne Gallop needed a new knee.
But what the San Mateo tennis instructor said she didn’t need was an exorbitant price tag or a shift away from the Kaiser health insurance and providers she received through her partner’s tech company. But a company purchase and its switch to UnitedHealth left Gallop in a bind. She wanted to keep Kaiser but didn’t know if she could afford it on a salary between $16,000 and $17,000 annually.
Enter the Affordable Care Act.
“When that came through, I was blessed,” Gallop said.
Gallop tried navigating the sign-up process herself but hit the snags that bedeviled the Covered California system in its beginning weeks last year. Near tears, she called the Human Services Agency where an employee helped Gallop qualify in for a subsidized Kaiser silver plan for $59 per month out of pocket.
“The experience was very simple. The county was amazing. The woman in the office and at Kaiser were amazing. The majority of Americans were blessed by this,” Gallop said.
The new knee came Feb. 3 with a $1,250 price tag and Gallop, 55, said she’s once again ready to triumph on the tennis court.
HSA officials are hoping more county residents like Gallop are similarly victorious in securing health care. With the window for subsidized plans set to close March 31 and not reopen until October, those in the enrollment trenches are shifting into overdrive getting the word out, connecting with people outside of the typical government atmosphere and encouraging people like Gallop to share their positive experiences as a counter to publicized technical glitches and worry about rate changes for existing policy holders.
“Our goal is to ensure no one is left out,” said HSA Director Iliana Rodriguez.
Medi-Cal enrollment will be available year-round for eligible individuals but the others have only the next month to get on board. Rather than wait for that population to call for help, HSA employees are trying new ways to reach them.
“Locally, HSA is partnering with local congregations and service providers to bring enrollment out to the communities, we are opening our regional offices on selected Saturdays and our phone center will be open on Sundays throughout the month of March,” Rodriguez said.
As of Jan. 3, more than 6,000 applications in San Mateo County were received for Medi-Cal which was expanded under the ACA. More than 11,200 residents have enrolled in private health plans though Covered California as of Dec. 31, according to HSA’s data.
Those figures do not include individuals who adjusted their coverage through personal agents.
Part of the enrollment challenge for some might be knowing just where to begin. Covered California’s website and call centers only process clients who qualify for a subsidized insurance plan. The county’s call center and offices process both those policy holders and those eligible for expanded Medi-Cal. Covered California will answer all inquiries but Medi-Cal clients will be transferred over to San Mateo County.
A general guideline is those making under $16,000 should call the county while the others turn to the state. Either way, HSA and Covered California tout the “no wrong door approach.”
Many of the newly insured in the county are those now eligible for Medi-Cal under the new rules.
One instance given by HSA is an unemployed man who couldn’t afford private coverage and didn’t meet the guidelines for the traditional Medi-Cal. Due to the ACA’s expansion of Medi-Cal, he is insured as of January.
HSA is also encouraging those with pre-existing conditions to take advantage of the fact they can no longer be denied.
Another resident who benefited was bankrupt from expenses and living with several illnesses including diabetes and leukemia, according to HSA. Like Gallop, he and his wife now have the Kaiser silver plan.
These are all examples of actual impacts on actual county residents who wouldn’t otherwise have care, said Edwin Chan of HSA.
Gallop said she is frustrated when she hears others complain about the ACA and blame President Barack Obama for their insurance companies raising rates. The government’s only mistake was not closing a loophole allowing companies to do that, she said.
She also understand that word about enrollment hiccups might initially turn people off but said that the effort is worth the payoff.
“Is it a pain in the ass? Sure. My company’s website can be a pain. That’s just life,” she said.
(650) 344-5200 ext. 102
Health care events
Enrollment events for health insurance and other programs are being held:
• 2 p.m. to 5 p.m. Saturday, March 8: Community United Methodist Church, 777 Miramontes St., Half Moon Bay;
• 1 p.m. to 5 p.m. Saturday, March 15: Broadmoor Presbyterian Church, 377 87th St., Daly City; and
• 1 p.m. to 5 p.m. Saturday, March 15: Siena Youth Center, 2625 Marlborough Ave., Redwood City.
HSA is holding special enrollment hours 9 a.m. to 1 p.m. on March 22: 400 Harbor Boulevard, Bldg. B, Belmont
• 271 92nd St., Daly City;
• 1487 Huntington, South San Francisco;
• 400 Harbor Boulevard, Bldg. B, Belmont; and
• 2415 University Ave., East Palo Alto.
For more inforrmation, visit www.smchsa.org or call 800-223-8383.