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NNY residents look for health coverage, confused by Affordable Care Act


To many north country residents, the federal Affordable Care Act may be summarized in one word: confusing.

That was a common refrain during a presentation about the law Tuesday night at the Italian-American Civic Association, Bellew Avenue, hosted by the Watertown company Benefit Services Group.

Even after company sales manager Richard J. Edsall explained some highlights of obtaining health insurance coverage through the health insurance marketplace, some attendees were more confused.

“This will never make any sense; it’s awful,” said one woman in the audience, which included about two dozen members of the public.

Mr. Edsall said people may try to navigate the health insurance marketplace system by themselves, but a broker will help make the process easier because brokers “have done this before.” The health insurance marketplace gives people the option to pick a broker, he said, although that is not required.

“There is no extra charge for the broker,” he said. “It’ll give you someone to act on your behalf. If you do not name a broker, the broker cannot legally help you.”

Brokers also will help people understand what their options are for coverage, said Paul J. DiFabion Jr., Benefit Services Group president.

“People don’t face it until they’re right up against it,” he said. “Now, it’s here. People have no idea what their requirements are. Part of the problem is it’s evolving on a daily basis. It’s quite confusing.”

Mr. DiFabion said he also is concerned for people who need to get coverage, yet ignore the requirements and may be out of luck in obtaining coverage and may have to pay a fine. Fines could amount to $695 or more by 2017, Mr. Edsall said.

But as people have had difficulties logging on to the Web-based exchange, Mr. Edsall posed the question: ‘If you can’t get enrolled, then why would you be fined? Will fines be put on hold? I don’t know; I can’t speak for the government.”

He said it may be less expensive for some people — especially those who are young, rarely use their health plan and are relatively healthy now — to pay fines versus a combination of a premium, copays and/or deductible, and other related costs. But, if they do that, they’ll have no insurance plan in place if something happens to them in the future. Medical expenses would then come out of pocket.

“If they can’t get people on, it won’t work,” Mr. Edsall said, regarding the overall system.

He said there are a few steps people can follow: make an account/web portal before you start talking to someone, provide information about your family, then choose a health insurance plan.

Premiums, deductible, copays and other rates are different in each plan. On the exchange, there are multiple insurance carriers.

Mr. Edsall said he’d encourage people to go with a carrier with which they’re familiar, such as Excellus BlueCross BlueShield or MVP, as they may use the same, or close to the same, network physicians who already accept various Excellus or MVP plans locally.

During the open enrollment period, which lasts through March 31, people must sign up electronically by the 15th of each month in order to obtain coverage by the first day of the following month. People who enroll now, and up until Dec. 15, will have coverage effective Jan. 1. As of that date, there will be no exclusion of coverage from pre-existing conditions.

Another avenue to help limit people’s confusion is use of navigators, housed within community agencies throughout Jefferson, Lewis and St. Lawrence counties. They will help clients go over various plans for which they are eligible, but people may not be able to have applications submitted since the Federal Data Services Hub is down. As of late Tuesday, a message on the home page of the New York State Health Marketplace said it was unable to process new applications because of the hub issue. New applicants were asked to return later.

For more information, call Benefit Services Group at 786-0201, or visit

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