ROCHESTER, N.Y. — Navigating the world of health insurance can be an intimidating topic for many Americans this time of the year. Oct. 1 marked the start of the open enrollment period for Medicare customers, but other insurance providers begin on Nov. 1 across the state. New York has recently updated its navigator directory for to guide customers on the hunt for new health insurance resources near them. Mark Lane has been taking advantage for months.
“When I would get on the phone and try to take in and work out a plan, I would get kind of frustrated because I really didn't understand how this works,” Lane said. “I never expected to have to go through it. When I did get hit with it, it was like, having a math equation put in front of you and you've never done it before.”
A few years ago, Lane had a sudden major spinal surgery that left him on disability.
“A lot of it I don't understand, you know what I mean? And then, you know, with the surgery and stuff like that, like, I sometimes have problems remembering things and stuff like that,” he said. “I have the resource center doing stuff for me and my wife doing stuff for me, and that's what I mean. So it’s like, you know, insurance for dummies. That’s the only way I can put it, really.”
His health insurance became more important than ever, but he was left with less resources than before.
“Let's face it, I'm not a guy that can do a lot of copays or pay big prices on medicine and stuff like that. So, you know me, I'm on a budget, so I have to take in and, you know, dig into my resources. And like I said, this has been helpful,” Lane said.
Excellus Blue Cross Blue Shield has multiple resource centers across the state. They have plans to open another in Liverpool in coming months.
“Every time I get a letter I come here, you know what I mean?” Lane laughed.
“I've seen Mark at least 10 times. So we know we're on a first name basis and that kind of simplifies it. That is normal. Most of our customers, once we create that partnership and that trust with that customer, they want to come back,” said Gabrielle Davenport-Williams, one of Excellus Blue Cross Blue Shield’s two retail sales consultant at their Greece resource center.
There are many plans to choose from, so she understands the struggles Lane was faced with after his surgery.
“Right now, especially for under-65 members, it's very important to know the annual income, because that will determine what you actually are eligible for with the New York State of Health Exchange,” Davenport-Williams said. “And then for anyone over 65, just having a list of your plan of care, knowing what prescriptions you may need or may want to look into with that doctor, because it kind of helps us create the story to say what plan will work now and if you may need to change that plan later on.”
She’s been working with Lane to build his dual Medicare coverage plan.
“To be able to know that I can help guide them through all lines of business, whether it's through picking a plan or going over prescriptions, or even connecting them with a customer care representative to go over a bill. That’s huge,” she said. “It's very fulfilling to know that now there's a weight lifted off his shoulder. It's one less thing he has to worry about. As you can see, he's concerned about medication that he usually takes. When things change, that can cause frustration and panic, but there’s no need to panic because that’s what I’m here for: to make sure he has the best plan.”
Health insurance providers are entering busy season. Angel Alvarez, manager of retail sales and operation for Excellus Blue Cross Blue Shield, says they’ll see dozens of people at one location per day this time of year.
“I think the big thing is a lot of us have always had insurance through our employer. And then all of a sudden the switch turns off. And so now you need to start taking care of this on your own. And a lot of, ‘what do I do next?’ That's where the customers will come in and say, ‘I need help navigating these waters,’” Alvarez said. “We're going to ask those questions. What type of medications are you taking? What type of medical services are the most important to you that you're really looking for? Do you need to travel outside of the state? Do you need coverage outside of the network as well? So just making sure we're asking those right and relevant questions, to fit them with the right product that best fits their needs.”
“If I don't understand it or, you know, like, from my prescriptions, and I take a lot of a lot of medicines and stuff, so, I mean, sometimes something's not going to cover this, not going to cover that. So I have to find other options, you know what I mean? So it's nice to be able to come here, and they tell me, well, we can do this for you, or we can find, another source for you,” Lane said.
He appreciates the one-on-one FaceTime with his insurance providers to ask questions. Excellus Blue Cross Blue Shield is also preparing to launch its virtual pilot services to connect customers at a busy location with an available retail consultant from another one of their locations across the state.
“We are really excited to have it. You know, compared to, other insurance carriers, that's not being offered, but to be able to still have that personal experience, whether it's on a screen or face to face, that makes it great the actual interaction with the customer. So we’re excited for it,” Davenport-Williams smiled.
“Big weight off my shoulders. Big, big weight,” Lane laughed.
Medicare customers can start making changes to their plans starting on Oct. 15. For all health insurance providers, open enrollment begins on Nov. 1. The state recently announced an innovation waiver amendment in time for 2025 enrollment periods. The amendment is expected to cut an estimated $307 million in out-of-pocket costs every year, and allows new plans to take effect starting Jan. 1, rather than a month later from previous years. To find more resources near you, head to https://info.nystateofhealth.ny.gov/NavigatorDirectory.