July 27, 2023
Certified Application Counselor shares success story
MOBILE, Ala. — Earlier this year, the Centers for Medicaid and Medicare Services (CMS) announced a Marketplace Special Enrollment Period for qualified individuals and their families who lost Medicaid or Children’s Health Insurance Program (CHIP) coverage because of the end of the continuous enrollment condition, also known as “unwinding.”
This allowed individuals and families in Marketplaces served by HealthCare.gov to enroll in health insurance coverage outside of the annual open enrollment period. The Mobile County Health Department and Family Health, its primary care division, have Certified Application Counselors ready to help consumers as they look for health coverage options through the Health Insurance Exchange.
CMS officials recently asked Certified Application Counselors to share stories of consumers who successfully transitioned from Medicaid to the Marketplace or other coverage. Cassandra James, the Certified Application Counselors project manager, shared the following story.
“We had a patient who lost his health insurance due to being laid off. He made enough income within eight months before losing his job and insurance to qualify for a tax premium credit. He called and said that he had heard of me from a family member, and he wanted to know if I could help him with health insurance.
“Well, I asked him a few questions regarding his income status. From the information he provided to me, I assured him I could assist. I scheduled him an appointment for the same day. When he came in, I noticed by his breathing that something was not right. I asked him if he has issues breathing and sleeping? He said yes.
“I proceeded to assist him with his application. Once we completed it, he was approved for a tax premium credit of $864. With a monthly premium out of pocket of $26.54 a month and a zero-dollar deductible. He was so excited! I informed him that his health insurance begins the following month and that he would be receiving his health insurance card a week from the day he was approved. I told him that once he received his card, to come in and I would assist him with activating his card and assigning a PCP (primary care physician) to his card.
“He came back once receiving his cards. We were able to activate his card and assign a PCP and he was able to set up auto pay for his monthly payment. I was able to schedule him an appointment with a PCP. He went in to see his PCP. After his examination, his doctor discovered that he had a heart condition that could possibly cause him to lose his life. So, he had an appointment scheduled with a cardiologist. That is why he was having issues with breathing. He was able to have surgery and now he is doing great.
“He called to say thanks for saving his life, because if it wasn’t from me helping him with health insurance and being observant, he wouldn’t have known about his condition, nor would he have been able to afford surgery. I told him it was a pleasure assisting him and that I was so happy he is doing well.”
Certified Application Counselors can be found at all Family Health centers conveniently located throughout Mobile County. To make an appointment, please call the Family Health center located closest to you. For a list of sites, you may visit https://mchd.org/family-health/#locations or call 251-690-8964.