By Esteban Fernandez
Times West Virginian
FAIRMONT — Navigating the health care exchanges every year can be difficult, Jeremy Smith, program director for West Virginia Navigators, said.
Not only are there a variety of plans to pick from, with varying deductibles, co-pays and insurance networks, low knowledge of insurance vocabulary also limits how effectively state residents can navigate the exchanges. On Tuesday, the West Virginia Navigators made it easier for Marion County residents to steer through different insurance options to find the right one for them.
“Health care in America is expensive, so if you don’t have health insurance and you have to go in for a surgery or were in a car wreck or unexpected accident, without having health insurance it could bankrupt you and your family,” Smith said. “It’s really important to have coverage to protect yourself from something like that.”
The Navigators, in partnership with the West Virginia Primary Care Association and West Virginia Office of the Insurance Commission, held an event for residents who need to buy their insurance off the marketplace in 40 walk-in locations state wide. The Marion County location was held at the MVA Health Center on Locust Avenue. The event provided uninsured state residents with the opportunity to learn about health coverage options and access free enrollment assistance.
More than 100,000 West Virginia residents are uninsured.
Smith said some residents are uninsured because they don’t qualify for health insurance through their employment, or their employment doesn’t provide health insurance. Residents who are self employed and make more money than allowed for Medicaid also rely on the health care marketplaces for insurance.
Smith said it’s a select part of the population that qualifies for this type of insurance, and unlike the yearly health care signup process offered by employers who provide health insurance, there are a lot of hoops to jump through to figure out if one qualifies. The federal government also provides subsidies so people can afford paying for insurance off of the marketplace, but that also requires a fairly involved process.
Smith said the Navigators guide their clients through the process, ensuring people can afford their copays and that their doctors are in-network. They also check to make sure prescription medications are covered by the plans.
Raymond Alvarez, president and CEO of MVA Health Center in Fairmont, said the clinic was a good place to host the event because the clinic has operated as an independent nonprofit community health center since 1958. Alvarez said one of the most prominent challenges facing health care in the state is ensuring every resident has access to it. However, the Trump administration made a 90% cut to the program that funds the West Virginia Navigators. As a result, the program has had to close its in-person offices and resort to offering help by phone or virtually.
Alvarez expects there to be an increase in the uninsured population as a result, which will impact the clinic’s bottom line.
“It increases your accounts receivable,” Alvarez said. “You’re going to be sending out a lot of bills you’ll never collect on these accounts, so that becomes, not a financial burden, but you’ll see it as an increase in your reimbursement. You have more accounts that aren’t going to be paid than accounts that are paying.”
Alvarez said the clinic will adapt as necessary to the new reality. While he doesn’t predict a loss of services, it’s still going to be important to have an effective financial management strategy, he said.
Smith said the cuts to the program have made it more difficult to provide enrollment help throughout the state. He said the cuts have also made it difficult to market and raise awareness about health insurance options. As a result, Cover West Virginia Day has become more important to filling that gap. There’s also the news about increasing premiums due to the fight over expiring subsidies for health insurance on the marketplace. Smith said he doesn’t want to see people get scared off by the news, and to still check into what’s available this year.
Open enrollment for health coverage ends Jan. 15, after which individuals will have to wait till 2027 to enroll. But even if in-person help is no longer available outside special events, help is always available by phone, Smith said.
“Health insurance can feel overwhelming, but no one has to navigate it alone,” Megan Diehl, director of Communications & Engagement for the WVPCA, said. “With experts available at dozens of locations statewide, we want every West Virginian to know that help is here, it’s free, and it can truly change lives.”
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