GEP595_Eng_IP

0:01

S… Speaker 1 (GEP595_Eng_IP)

Okay. Perfect. Okay. So to start, please tell me your name and how long you've lived in Maryland. Alicia Kavanaugh, and this November will be 15 years. Oh, wow. Okay. All right. And can you describe your current health insurance situation? I'm self-employed, so I go through the marketplace. So I have Kaiser. Kaiser. Okay. Okay. And how long have you had it?

0:31

S… Speaker 2 (GEP595_Eng_IP)

For many years. There was like a short one or two years where I had Care First Blue Cross Blue Shield, but I would say more than five years. Okay. And why did you choose Kaiser in particular? They're the cheaper one. Okay. But also, as long as you're generally healthy, it seems like Kaiser works really well because everything's like...

0:56

S… Speaker 1 (GEP595_Eng_IP)

usually under one in one building it's when you have a specific issue or something and you have to go out of Kaiser then it's not good right okay okay um and have you ever faced any challenges in understanding how to enroll or confusion on how to enroll um yeah almost every year okay um on the marketplace I mean if I had it in front of me but I know like

1:24

S… Speaker 2 (GEP595_Eng_IP)

It takes me to the marketplace webpage and then it wants me to log in. Yeah. And then there's always some weird like green bar that says something like if you want to change your health plan, which you can't during the year, unless you have like one of four major things in your life. So it's like, if you don't click that, it looked like there wasn't really a place to go. I just remember every year, like having to go through this whole thing and figuring out how to log in and actually get to my,

1:55

S… Speaker 1 (GEP595_Eng_IP)

So it just doesn't seem very efficient. Okay. Okay. And were there any words or terms during the enrollment that you didn't understand?

2:06

S… Speaker 1 (GEP595_Eng_IP)

I mean, probably, but I wouldn't remember them right now, you know. Okay. And did you understand the differences between the plan options that you're choosing from? Yes. And I do like that you can click like the compare button so you can put them aside. Okay. All right. And would pictures or diagrams or examples have helped you to understand better? Probably. Okay. What do you think would be helpful in that respect? Well, I mean.

2:39

S… Speaker 2 (GEP595_Eng_IP)

You know, if I was choosing between like gold, silver or bronze plan, you click compare and it just kind of gives you a column of each. So I guess you don't really need pictures or diagrams of that. Okay. I think it would always be helpful. I just can't think of like a specific example right now. Okay, sure. Yeah, no worries. Okay. And did you seek any help when you enrolled or even after you started the application?

3:06

S… Speaker 2 (GEP595_Eng_IP)

A few years I have where they have a person that they assign you or you can be assigned. Okay. I don't know if it was that much more helpful than me doing it by myself. Not that they did a poor job or anything. It's just, I don't know. Okay. And do you know, were they a broker? I think that's what they were called. Yeah. Okay. Because I know one year.

3:32

S… Speaker 2 (GEP595_Eng_IP)

I think I called a number for help and they had said like oh well your person is this guy okay and I was like so I can only talk to him and I think they said you'd have to like cancel with him so then that person could help me and then when I did that like immediately I got a phone call from that first guy you know so I'm assuming they probably get some kind of like commission or kickback or something and he didn't like that you know he was losing it or something um and then actually that guy

4:00

S… Speaker 2 (GEP595_Eng_IP)

had another woman who was like who worked under him who was more familiar with the self-employed like marketplace version of the kaiser and so he kind of pushed me on to her so it wasn't even really him but you know i think maybe because i've been with kaiser for so many years and in the marketplace that i kind of start to get an idea of how it works okay sort of okay um and how many years have you been on the marketplace

4:30

S… Speaker 1 (GEP595_Eng_IP)

I mean, I've been self-employed the whole 15 years. So every time I would have been. Yeah. Okay. Okay. And have you ever faced challenges understanding your plan or health insurance communication about your plan, for example, like a letter or notice? Well, just one thing before I forget, like it's just probably an admin thing, but like I sign up for the e-statement.

5:00

S… Speaker 2 (GEP595_Eng_IP)

with kaiser and i still get like e-statements and the same statement in the mail so from an environmental standpoint it's a waste of paper it's a waste of time you're paying someone to literally stuff an envelope put in a stamp mail it and i keep mentioning that and on the phone they're like we'll handle that and i still keep getting the things in the mail um so not so much like not understanding it just like it's a excess um but yeah sometimes uh i'll get

5:30

S… Speaker 2 (GEP595_Eng_IP)

oh and the other thing is i'll get a letter in the mail after something's been fixed already so then if i don't remember that i've had that conversation and it's fixed now i'm worried there's a new problem and then i have to call and they're like you know no we've already taken care of that you know okay um that's helpful yeah but i mean if i don't have the people in front of me then i can't i just can't remember off hand like okay okay yeah no problem um and let's see

6:02

S… Speaker 1 (GEP595_Eng_IP)

Okay. How do you typically find information about how to pick the best plan that works for you? Well, there were a couple of years where I was doing an HSA plan. So I researched that a lot on my own and then I clicked the filter for just HSA. Okay. So, you know, that, that way I navigated through all of that. And then.

6:29

S… Speaker 2 (GEP595_Eng_IP)

then I switched back to like a regular plan so then I you know was looking at the different um monthly premiums versus um co-pays yeah all that kind of stuff so it's really just based on price I think because you know not good what I'm generally healthy so you know yeah absolutely okay um

6:57

S… Speaker 1 (GEP595_Eng_IP)

And let's see, what is the top one or two things or pieces of information that you look for in a plan? One is just the cost, right? Again, since I'm generally healthy, I would only have to go to the doctor once or twice a year. And a couple of those are...

7:24

S… Speaker 2 (GEP595_Eng_IP)

free by the government anyways like your well woman visit and whatever so that would be free across all the companies um i know like with care first i remember because i suffer from migraines i always have and they needed me to have like a certain amount of migraines per month in order to do anything they were much more um

7:48

S… Speaker 2 (GEP595_Eng_IP)

strict about stuff whereas Kaiser isn't um and so I've been able to get more access to like you know prescriptions and things that could help with um my migraines so

8:04

S… Speaker 2 (GEP595_Eng_IP)

In fact, this past year, past two years is probably the main reason why I stayed with Kaiser. Even though with care first, I like that I could go to a whole bunch of different doctors. I could get an appointment much faster. And they seem to be just more helpful overall. But since my main thing is migraines and headaches, I was like, oh, if I could just blend the two together, you know, it would help. But yeah. Okay.

8:30

S… Speaker 1 (GEP595_Eng_IP)

All right. And how do you decide if the information that you have found is trustworthy or accurate? You mean on the marketplace or the Kaiser website when I'm looking for insurance? Well, right. As far as looking for insurance, you know, like in terms of you mentioned that you were like looking at some things like online. And so was that on the Health Connection site or on Kaiser site?

8:59

S… Speaker 2 (GEP595_Eng_IP)

I think most, I think if I remember it, it'd be like if I, certain questions or things I'd look on Kaiser, it would then say, you know, it would have a link to take me to the marketplace. And I feel like that website is just a little bit strange. I remember there's only like a couple options on the very first page or something. And if you don't fall in those three categories, it's just like, well, where am I supposed to go? What am I supposed to do? Are you referring to the marketplace? Yeah. Okay. All right.

9:28

S… Speaker 1 (GEP595_Eng_IP)

But I honestly never thought anything that I would read or learn on Kaiser or Marketplace would not be trustworthy. I mean, I would assume what they're telling me is covered is covered. Right. Okay. All right. And are you aware of any upcoming changes to health insurance enrollment or coverage rules? I don't think so. Okay. Like automatic re-enrollment or...

10:00

S… Speaker 2 (GEP595_Eng_IP)

or subsidy changes? I mean, I've always remembered that every year they're like, if you don't make a change, you'll automatically be renewed in the plan that you have. And then if that plan isn't available anymore, then you'll be automatically renewed into the plan like they suggested for you because it's the closest to what you currently have. I know like...

10:23

S… Speaker 1 (GEP595_Eng_IP)

That MFA plan, there's some paperwork and stuff you have to go through and that's only good for like six months at a time. I don't know if there's any changes to that. Okay. Okay. All right. So now what I'm going to do is I'm going to show you this. So feel free to take a minute and just look through it. And then when you're ready, just let me know.

11:08

S… Speaker 1 (GEP595_Eng_IP)

First sentence sounds weird. You can't get to lower your monthly payment will continue to go down. I don't know. Sentence structure sounded weird. Okay, so there's changes. Yeah. And so how might these changes affect your enrollment decisions? My enrollment with staying with Kaiser, you mean? Forever. I mean, I'm assuming these, I mean.

11:51

S… Speaker 2 (GEP595_Eng_IP)

Or with any plan. I was going to say, I'm assuming all three of these are across the board with all the different companies. So there's really nothing I can do about it. Right. It's none of those are great. Although maybe the last one is because if I don't have an auto renewal, then chances are Kaiser or Marketplace will be constantly bugging me. You haven't chosen a plan yet. So it'll be a constant reminder that I'll need anyways.

12:22

S… Speaker 1 (GEP595_Eng_IP)

Yeah, but overall, none of those are good. Okay. And would they cause any hesitation or confusion or potential drop off? I mean, we get a penalty or a tax if we don't have health insurance. So, you know, to withdraw or not choose any health care plan means I have no health care and I'm going to have to pay money to not have anything. So.

12:55

S… Speaker 2 (GEP595_Eng_IP)

I just I don't know if there's there's no alternative to this. Like we have to have health insurance. So you have to pick a company and just unfortunately deal with, you know, your monthly cost being more expensive. I'm not an immigrant population, so the second one doesn't affect me specifically, but it's also just not great on the whole. And then auto renewal. I mean, like I said before, you know, it it would force me to have to really look.

13:26

S… Speaker 2 (GEP595_Eng_IP)

So I think the first one is probably the worst for me personally. Okay. Okay. And in your words, what does financial help mean here? Well, sort of like the MFA, you know, if you make a certain amount or less, then you can qualify for 50 or 100% coverage or reimbursement or whatever. I mean, that's the only one I know of personally.

13:55

S… Speaker 1 (GEP595_Eng_IP)

Maybe there's something with the state of Maryland that also helps. I'm not sure. Okay. And is there something other than financial help that you would call it? A tax credit? Is that what you're looking for? I don't know. That's, yeah, whatever you think. Something. Can you say again? Something else. Something other than financial help. Is there something else that you would call it instead? It's just a loss of.

14:38

S… Speaker 1 (GEP595_Eng_IP)

benefits, I guess. Okay. Okay. Yeah. And there's no right away. Yeah. So you're, you're fine. Okay. So I'm going to take that one back. We're going to do a lot of paper exchange here. Okay. So next we're going to show you a notice, but before we get to that phase, have you ever received financial help to lower your monthly health insurance?

15:00

S… Speaker 1 (GEP595_Eng_IP)

So in your words, what do you think an advanced premium tax credit or APTC is? I would assume it's something like the MFA, like you're getting a lowered monthly premium because you qualify for X, Y, or Z, whatever the requirements are. Okay. And what role, if any, does income play in how that financial help is calculated?

15:32

S… Speaker 2 (GEP595_Eng_IP)

I mean, if you make a certain amount or less, depending on if you're single or married or have children or maybe you have some kind of medical, physical or mental disability or something like that, that's documented, then you'll get some kind of reduction. Okay. And how confident do you feel in terms of estimating what your income will be for the year?

15:59

S… Speaker 1 (GEP595_Eng_IP)

Me personally, not great at all because it's self-employed and it can change. Okay. So it varies. Okay. And so let's say your income changed during the year. So you like made more money or you lost some money. What would you need to tell the Maryland Health Connection about this? Or I'm sorry, would you need to tell the Maryland Health Connection about this change? I think so. Like probably.

16:30

S… Speaker 1 (GEP595_Eng_IP)

When you apply, if you apply again. Okay. All right. And how would you go about conveying that to them? I don't know. I'm assuming there's people log in and search for something. Yeah. Okay. And how soon would you need to report that?

16:49

S… Speaker 1 (GEP595_Eng_IP)

I don't know. Okay. That's fine. Yeah. Although it just seems kind of hard on the person. Cause what if you make like a thousand dollars less one month, but then a thousand dollars more in the next month, you know what I mean? So it's like, you've constantly changed. So I don't know, maybe it's just every six months they check in or something. Okay. Okay. And have you ever heard of the term reconciliation or reconcile your taxes as it relates to your health plan? No. Okay.

17:20

S… Speaker 1 (GEP595_Eng_IP)

All right. And so what do you think reconciliation or reconciling your taxes means in this context? I don't know. Maybe they're comparing your tax return to see what you qualify for. Okay. And what do you think happens if someone receives more financial help than they qualify for? I mean, I guess at some point somebody will notice it and then kind of let you know.

17:48

S… Speaker 1 (GEP595_Eng_IP)

I don't know what happened after that, though. Okay. And what do you think would happen if someone received less financial help than they qualified for? I think the same thing. In that case, I guess the Marketplace or Maryland Connection or whoever would apply it towards the future or something. Okay. All right. So now what we're going to do is we're going to take a look.

18:20

S… Speaker 1 (GEP595_Eng_IP)

at this notice here. But before, I'm sorry, before I do that, let me ask you just one thing, a few things here. So when you receive health insurance notice in the mail or through email, what do you usually do? The one that comes in the mail gets put in a pile on my desk of things to look at later when I have the time. Okay. And then the email probably.

18:47

S… Speaker 2 (GEP595_Eng_IP)

keep it as marked as unread and I'll flag it to remind me that I need to look at it when I can. Because usually these emails come in at a time when you're not able to give the attention to it that it needs. But that doesn't necessarily mean I follow up like I'm supposed to and, you know, read through everything. Is there a better time for them to come in? Okay. No, I mean, everybody's life is different every day. You never know what's going on, you know. Very true. Yeah. Yeah. Okay.

19:17

S… Speaker 1 (GEP595_Eng_IP)

And do you skim it initially or do you just kind of flag it and put it to the side? If it's something I got in the mail, I would skim it right away, like regular mail. But if it was email, I'd probably just flag it because.

19:34

S… Speaker 1 (GEP595_Eng_IP)

But the email is better because like if I'm, you know, at a doctor's office and my appointment, you know, I'm waiting there because their doctor's running late, I can pull it up and read it there. But if it's regular mail, I have to be home with it, you know. Right. Right. Okay. And then, okay. Can you describe a time when you received a notice from your health insurance plan?

20:00

S… Speaker 1 (GEP595_Eng_IP)

that you found particularly easy or difficult to understand? I mean, over the years, for sure. I don't know if I can recall like a specific one, but I know recently this.

20:14

S… Speaker 1 (GEP595_Eng_IP)

health year it said something like oh we miscalculated similar to what you're saying like we miscalculated something and your monthly premium is going to slight go up slightly and i was like oh but it didn't give me an answer like we're going from this price to this price and so i just waited until my you know auto pay started and and um

20:37

S… Speaker 1 (GEP595_Eng_IP)

on the kaiser website when i logged in i think it went up by like three dollars so it wasn't a big deal right it could have been right but all right okay um and is there anyone you typically turn to for help when you receive health insurance information like a family member or friend or navigator anybody else okay and has there ever been a time when you received a notice and were unsure what if anything you're supposed to do next well like that one when i said oh it might go up

21:08

S… Speaker 1 (GEP595_Eng_IP)

Or it is going up. It's like, so what do I do now? Nothing? Because, you know. Okay. Okay. And are there things about health insurance notices in general that make them harder for you to read or understand? I mean, there's a lot of stuff in the beginning that I'm sure they have to legally put there, but it just doesn't really pertain to me or maybe it does, but it's not.

21:38

S… Speaker 1 (GEP595_Eng_IP)

I don't know. It's not important to what the subject is of the letter. So, yeah. Is there a way that they could maybe reorganize that or are there changes that they could make to improve that? I mean, sure. But I think it's just like any company. They have this whole first paragraph.

22:03

S… Speaker 1 (GEP595_Eng_IP)

trying to pleasantries and but the meat and potatoes of the email is like down here the letter is down here and yeah you know and then they also which I understand why that they have like two another whole page and a half of explained in different languages which I understand why it's just it's ad paper so you know when you open it up and you know your your letter is like four pages long you're just like oh my god but then you realize really only one page is actually pertinent to you yeah

22:32

S… Speaker 1 (GEP595_Eng_IP)

The rest of it is stuff they have to put in there because they have to or something. Right. Okay. So I don't know that they can actually change that. Okay. How about the length or layout or anything else? Well, kind of what I just said. Yeah. Okay. All right. Okay. Now we're finally going to get to this. I keep trying. All right. Grab these two pages.

23:03

S… Speaker 2 (GEP595_Eng_IP)

Okay, so go ahead and take a look at those pages. Note that this is a draft, not a final. Yeah, this looks similar to what I've received before. Yeah, I mean, this is helpful information, and I like how it's kind of...

24:20

S… Speaker 1 (GEP595_Eng_IP)

You know, the green, like these are the topics and then helpful tips on there. Okay. Yeah. And so in your own words, what is this notice telling you? It's telling me that my coverage may change and that I would be automatically renewed if I don't do anything. So like I could literally do nothing and it'll just do it itself. Unless that same plan isn't available, then they'll choose one that's similar to it. And then.

24:50

S… Speaker 1 (GEP595_Eng_IP)

The second one talks about like how the open enrollment timeframe and what you can do during that timeframe.

25:00

S… Speaker 1 (GEP595_Eng_IP)

and, you know, update things like auto pay and stuff like that. The tax credit thing, I believe is new. I don't think that this was here last year. So this is helpful. Maybe if they put like in parentheses, new, never available before or something, you know.

25:27

S… Speaker 2 (GEP595_Eng_IP)

And then just telling you what you're eligible for. Yeah. Would you recommend like the same font? Yep. Okay. Okay. All right. And you've mentioned what this notice wants you to do, but is there any other things that are like confusing or unclear or missing or any steps that need to be broken down further? I'm assuming if this was online, you could click things to get more details about the program. This is just sort of like.

25:58

S… Speaker 2 (GEP595_Eng_IP)

a summary or maybe that's what this is so under your plan and um information yeah yeah because it doesn't really explain like it does show what your co-pays would cost or you know prescriptions and all that kind of stuff um and then

26:20

S… Speaker 1 (GEP595_Eng_IP)

these two things it's saying based on your last income but maybe it's changed so it hasn't I don't think it said anything in here about like if it's changed or says you should report a change but it oh I'm assuming this would be a link how do I change plans or report a change in my information or maybe this bar I don't know but if it's just a letter in the mail like this I mean

26:48

S… Speaker 1 (GEP595_Eng_IP)

It says using the steps below, but there are no steps. So I'm assuming that's coming. So then I have to wait for that. Maybe it'd be helpful if there was like a phone number too that you could just call because some people just aren't text savvy. So under the eligibility for... Yeah, and probably this one too, because it's...

27:10

S… Speaker 2 (GEP595_Eng_IP)

Probably the same thing. Okay. So the eligibility for the tax credit and also the eligibility for the state premium assessment. Yeah. Yeah. Because, you know, some people just don't want to use or can't, whatever. They need to talk to a person. Yeah. Okay. Okay. And were there any words or phrases that were unfamiliar or hard to understand?

27:40

S… Speaker 2 (GEP595_Eng_IP)

No, I think it's the opposite. I like how it's like, why am I getting this letter? Because this is literally the first people are going to be like, why did I get this letter? And green sort of indicates like positive. It's not like red, like bad news. So I like that too. Okay, great. And what terms would need explanation for somebody who is unfamiliar with health care?

28:06

S… Speaker 1 (GEP595_Eng_IP)

um i mean if they're unfamiliar with everything just open enrollment obviously because they're probably like why do i need to enroll or change and um and but then you know it kind of helps explain some of that down here but probably these two things since they're relatively new or new to that person um i know like in the past if you updated your insurance before

28:40

S… Speaker 1 (GEP595_Eng_IP)

December 15th or by December 15th then it would automatically start on January 1st but if you waited until January 15th it wouldn't start till February 1st so I guess I would I would wonder if you need to update this by January 15th well what happens between January 1 and 15 because you're in the new year and your current plan will end December 31st so I guess I would think like if I haven't made a choice I haven't

29:09

S… Speaker 1 (GEP595_Eng_IP)

clicked a box to pick an insurance January 1st, it's going to automatically renew. I've actually been through this situation before where you do have like those 15 days to change plans. It's like that small little window, but man, does it screw everything up? Because, you know, if you, in the past, if you, this might answer some question down the line, maybe it's what you're getting to, but like, if you,

29:35

S… Speaker 1 (GEP595_Eng_IP)

choose to change your plan on say December 14th I can't call to make appointments for January because they're like we don't have you in that health care plan and then even when January 1st comes that's a holiday so January 2nd you call and that health insurance is you know Kaiser's like well we don't

30:00

S… Speaker 2 (GEP595_Eng_IP)

have you in that or um you know then you call health connection and they're like well just give it a couple more days because you know you switch towards the end like december 14th okay but you set the deadline you know yeah so like if you're telling people that they can choose their health care plan by december 15th in order for it to be active january 1st then you really need to say

30:24

S… Speaker 2 (GEP595_Eng_IP)

actually you need to pick it by december 10th in order to you know so and then you i remember one of the years i tried to like do like a a free trial not not free i paid but like i did the really good plan that covered everything for those first two weeks and i wanted to try to book appointments yeah but i couldn't

30:48

S… Speaker 2 (GEP595_Eng_IP)

And then by the time I was able to book the appointments, oh, then they can't actually get me in until after the 15th. Well, by the 15th, I was going to switch to the lower plan. And so I got caught in the middle of the system twice. So it was really confusing and frustrating. But ideally, if you set those deadlines and we follow the deadlines, then.

31:09

S… Speaker 2 (GEP595_Eng_IP)

The Health Connection or Kaiser or Blue Cross, whoever, has to follow through and have that plan not only start on January 1st, but have those doctor's offices have all your information by January 1st. I mean, you are giving them two weeks to get their act together. So if they need to, like, push the date up earlier, so be it. But, you know, it gets really frustrating. Okay. That's very, very helpful to know. So thank you for all of that information. No, that's really helpful.

31:39

S… Speaker 1 (GEP595_Eng_IP)

So after reading this, how likely would you be to take action related to your health insurance? I mean, if this was me, I would...

31:57

S… Speaker 2 (GEP595_Eng_IP)

Every year I tell myself I'm going to look into this right at the beginning of the open enrollment. A lot of times I'm ready to, I have time or it's the right mind frame for me in like September, but it's not open. And I call and they're like, we don't have any info. So it's annoying that you have to wait November 1st to December 15th for a couple of reasons. One, you're at the end of the year. So especially as self-employed, you got to.

32:24

S… Speaker 2 (GEP595_Eng_IP)

scramble with all your last minute things and a lot of times like you're talking you know i don't have consistent income so i have to really figure out all that stuff at the end of the year plus it's like so many holidays during that time frame you're picking the worst time of the year third it's like where seasonal depression comes in because it's cold and grumpy and winter and so it's just like to me it's the worst six weeks to make us have to focus on this yeah um

32:54

S… Speaker 2 (GEP595_Eng_IP)

And honestly, like, I don't understand why they can't, you know, have this ready earlier for us, like September or October. Maybe people with kids be like, oh, that's when school starts and we don't, whatever. But like, have it be a big open time because I'm not really sure.

33:13

S… Speaker 2 (GEP595_Eng_IP)

you know, what's going to change so much in what's covered and what's not between September to November 1st. You know, I know this particular year, there was like something going on in the politics where, I don't know, whatever ended up happening, but like we were going to, we were going to lose some kind of tax credit. The Republicans and Democrats were fighting about it. And then people were like, you're getting too close to the deadline. There was like a shutdown or whatever. So it was just us citizens were losing out on

33:43

S… Speaker 2 (GEP595_Eng_IP)

Whether we get this credit or not. And I don't know whatever happened in the end. I think we're still fighting on that. Who knows? But, you know, pushing that till the deadline. Yeah. Also made it even harder for citizens because we didn't know what we were going to get. Yeah. These things. Yeah. That makes sense. So it's just a really bad time of the year to. And then it pushes them to just two weeks to get their act together. Yeah.

34:14

S… Speaker 1 (GEP595_Eng_IP)

Yeah. So I'll be shifted up by like two months. Okay. Okay. That's super helpful too. Is there any information that's missing or that you feel like you would need?

34:31

S… Speaker 2 (GEP595_Eng_IP)

I mean, as far as these two things, especially like this one, it'd be nice. I think somewhere at some point over the years, I saw like a breakdown of if you're a household of four, then if you have to make this amount or less or whatever. But it seems I have to go kind of research that stuff on my own. So the eligibility for a tax credit and then the state premium assessment. Okay. And what would be helpful to have in those two sections?

35:02

S… Speaker 2 (GEP595_Eng_IP)

well i mean i guess if this is a link that gives more information then maybe you know that would be in that information how do i change you know using the steps below okay which so creating a link for that i mean a link but as long as it has the information okay you know got it got it got it okay we don't want to go chasing rabbit holes of links and then it doesn't you know true that yeah okay

35:27

S… Speaker 1 (GEP595_Eng_IP)

Okay. And how about like the bullets and the headings? You mentioned that you like the color, but the font size. Color's fine. And the font stuff is fine. I'm not sure what...

35:40

S… Speaker 2 (GEP595_Eng_IP)

eligible for cost sharing reduction no or no i'm not sure where oh is that the end of this i think so if that was just kind of formatted a little bit better because i thought that was a totally separate thing but now i see it similar to this so okay yeah that should all be in one one page okay okay how about spacing uh yeah no i think it's pretty good because it's not like major um

36:08

S… Speaker 1 (GEP595_Eng_IP)

There are some breaks in things. Right. And the paragraphs kind of explain better. Okay. And now we're going to focus on the section that is talking about the APTC on the second page. Do you see that? The advanced. Let's see. The tax credit. It's on here.

36:41

S… Speaker 1 (GEP595_Eng_IP)

Hold on. APT? Yeah, it should be on page two. I see QHP. Oh, here. Advanced tax credit. Yeah. Okay. Okay. I was like, I know it's on there. I just couldn't hear from above here. Okay. All right. So after reviewing the explanation about APTCs, what information is used to decide how much an APTC someone can receive?

37:09

S… Speaker 2 (GEP595_Eng_IP)

Well, it says you can choose. So you can choose to apply anywhere from zero to the full monthly amount toward your insurance bills now or take the credit when you file your federal income taxes. So, sorry, ask me the question again? Sure. So after reviewing that, what information is used to decide how much APTC someone can receive?

37:36

S… Speaker 1 (GEP595_Eng_IP)

um your last incomes like your last tax return yeah and are there any words or terms in that um abtc explanation that are unfamiliar or confusing to you uh no i don't think so okay how about anything that um with how abtc's work that you would want to know more about i mean it might be more of like an accountant thing but like what's the benefit to putting zero

38:07

S… Speaker 2 (GEP595_Eng_IP)

per month and then putting a big amount at the end of the year or putting like i don't know 25 every month um you're like evening it out through the year you're trying to take the credit when you file oh you would get the credit every month versus taking one big credit at the end i guess it just depends on the person okay um and is there anything um

38:41

S… Speaker 1 (GEP595_Eng_IP)

If you have any understanding or perhaps not understanding of APTs that have ever affected a decision that you have made about your health insurance and taxes? No. Okay. And are there barriers that might prevent someone from following these instructions or understanding this information? I mean, I think just because it doesn't, this particular paper.

39:11

S… Speaker 2 (GEP595_Eng_IP)

It doesn't have links. I mean, I'm assuming this is the only link on this page. So if there's no link to help me with more info or answer some questions, then that might block me. And there's no phone number.

39:25

S… Speaker 1 (GEP595_Eng_IP)

Okay, so we've talked about including a phone number in the eligible for tax credits and then also in the premium assistance area, and then also including links to explain those terms. Yeah, I mean, again, maybe you're going to show me something in a minute, but it says the steps below, and I don't know what's coming below. So maybe that'll be answered in a minute. I don't know. Okay, okay.

39:52

S… Speaker 1 (GEP595_Eng_IP)

All right, and if you needed this in another language format, would you know how to ask for that?

40:01

S… Speaker 1 (GEP595_Eng_IP)

I mean, I wouldn't because English is my first language, so I wouldn't have thought that. But I would assume if it wasn't and I was used to doing that, then I would maybe call like this number. The reach out for assistance and help. Yeah. Or maybe online there might be a little button up here that's like English or Spanish or French or German or whatever. Okay.

40:30

S… Speaker 1 (GEP595_Eng_IP)

All right. So now I'm going to take those back. And what I'd like for you to do is take a look at this page. And then just let me know. And particularly considering the things when choosing a plan. That section's the alerts. The arrow? Yes.

41:16

S… Speaker 2 (GEP595_Eng_IP)

Oh, I, when, when I couldn't remember something on the, this reminded me, which is what if I want to end my health insurance coverage through Maryland health connection? So I know, um, there was like a button on the Maryland health connection. Like it was like this or end. And I was like, I, I forgot what that was, but it was nothing that I needed. So if you clicked and it was like going to end it that day. Oh.

41:46

S… Speaker 2 (GEP595_Eng_IP)

You know, I was telling you like this will end, you know, at midnight or 1201 tomorrow morning. And I'm like, no, I, I, it says, you know, select end my coverage and then select 2026 coverage, which sounds good. But I know a couple of years, it's like, it will literally say something unless I interpret it incorrectly that it will.

42:10

S… Speaker 2 (GEP595_Eng_IP)

and that day and then you know you might get a penalty on your taxes for not having insurance and then you're not supposed to change your insurance if it's not in that open market window or whatever open enrollment so then I wasn't in that open enrollment time and so I was like no I don't want to end what I have but how can I

42:29

S… Speaker 1 (GEP595_Eng_IP)

pick a new one if i did so um i remembered this part being kind of weird on the website a couple years in a row um so it wasn't clear how to pick a new website or pick a new they're just the first page like it was very strange every time i can't remember exactly but there was something with that okay um

42:56

S… Speaker 2 (GEP595_Eng_IP)

And I know when I was with Kaiser and switched to care first, I did cancel my plan. Okay. And, you know, I like went, I got like, I think I got a confirmation email and then, you know, I went to book appointments with care first and they were like, we're showing that you still have insurance with Kaiser and you can't have insurance with two different companies at the same time. And I'm like, no, it's, it's canceled.

43:25

S… Speaker 2 (GEP595_Eng_IP)

And so then they would call Health Connect. I think I called Kaiser and they're like, you need to call Health Connection. I called them and they're like, yeah, it's it's in the system. It just hasn't like worked itself through the system. And I'm like, well, that's not OK either. You know, like if I'm ending the plan on this day.

43:41

S… Speaker 2 (GEP595_Eng_IP)

And you tell me that and you give me a confirmation and then I go to start booking with a new company like I'm paying for a plan, you know, and I think in one case my auto payment was still going through. So even though I had canceled the plan, you would think that would stop the auto payment because they're not going to bill me for something unless I'm.

44:01

S… Speaker 2 (GEP595_Eng_IP)

using it and I still got billed and so then I had to like go a couple months through before they you know refunded that so that was frustrating um so it's like it just didn't I think it was like a misconnection between Maryland Health Connection and Kaiser yeah um meanwhile Care First is like well we can't have somebody with two health insurance plans at the same time so I was like stuck waiting

44:28

S… Speaker 1 (GEP595_Eng_IP)

So that was frustrating. So it almost makes it like you don't want to leave Kaiser because you don't want to go through all that hassle or fear that you are. So, yeah. Okay. That makes a lot of sense. So are there any words or phrases that are unfamiliar or hard to understand in that area, in that section? I mean, I'm still not completely sure about coinsurance.

45:00

S… Speaker 2 (GEP595_Eng_IP)

And that seems strange to me. So I sort of just ignore that part, no matter what health insurance company I have. Okay. But benefits, co-pays, deductibles, that stuff is all pretty standard. You know, cost sharing and advanced tax credit, it's making sense. We've already talked about the open enrollment, how it can be annoying when it doesn't.

45:30

S… Speaker 1 (GEP595_Eng_IP)

follow the schedule it says it will um yeah no i think i mean it does say up here you should stop automatic payments from your bank after you pay your december 2025 bill um maybe it said that before i don't i don't um it was definitely a hassle um no i think

46:09

S… Speaker 1 (GEP595_Eng_IP)

Okay. And after reading this, how likely would you be to take action related to your health insurance? I mean, I would have to take action no matter what, right? Because if I don't, it's just going to renew on... I know one year...

46:26

S… Speaker 2 (GEP595_Eng_IP)

it said if you don't do anything it'll renew but since this plan doesn't exist anymore this is the similar one we chose for you and it was way more expensive and i was like no no no no so you do still have to pay attention because it may be the closest one to what you currently have but it could be completely different yeah i think that was one of the things with the

46:48

S… Speaker 2 (GEP595_Eng_IP)

politics fighting over like $700 more a month or something like that so people were just going to be shocked when that came through so I guess I would have to take advantage I would have to make some kind of move no matter what it does sort of make me want to stay with Kaiser because one I'm generally healthy so far and two it's a pain in the butt to have to switch yeah so

47:20

S… Speaker 2 (GEP595_Eng_IP)

I don't know if they make it like that on purpose or not. So what's the most painful part of switching that is? It's just trying to book appointments for after the new year. Because that's the other thing is that a lot of the, even Kaiser, they're like, well, we don't have a calendar open for 2026 yet.

47:46

S… Speaker 2 (GEP595_Eng_IP)

So I'm like, you want me to wait till January 2nd to call you to make appointments for January? You know, so and I've noticed like a lot of their doctors are leaving. So then I get an email like, oh, we've chosen this new doctor for you. Here's a little blurb about him or her. But they don't have a lot of openings. Whereas the other.

48:10

S… Speaker 2 (GEP595_Eng_IP)

like care first you can go to pretty much anybody and they have way more openings um and one of them the foot doctor was kind of like behind my condo building so i was like i just walk there um so if it wasn't so hard to switch i would switch okay i mean that's one of the factors depends on what the cost would be and what they cover and stuff

48:35

S… Speaker 1 (GEP595_Eng_IP)

Sure. Sure. That makes sense. And is there anything missing from that that you think that you would need? It tells me about monthly billing when it starts. I don't report a change. I like how it's telling you how I change plans or report a change. It's like log into this and select this. You know, that's good.

49:12

S… Speaker 1 (GEP595_Eng_IP)

No, I think it's playful. Okay. Okay. So I'm going to take that back. And I'm going to give you a last piece of food right now. Okay. Oops. There we go. All right. I want to take a minute to look at that. Okay. So this tax credit, maybe I didn't understand what it was because it's saying...

49:51

S… Speaker 2 (GEP595_Eng_IP)

The premium tax credit you used in advance during the year and the amount of tax credit you qualify for based on your final income.

50:00

S… Speaker 3 (GEP595_Eng_IP)

I don't know what the final income is. Does that mean like at the end of the year, how much I made? Yeah. So you're kind of rolling the dice. Like you don't really know. So you could end up, this could end up hurting a lot of people because they could end up owing more money.

50:25

S… Speaker 1 (GEP595_Eng_IP)

yeah i don't like this at all okay it kind of reminds me of you know regular taxes you don't people are so happy oh i'm getting a refund yeah you gave the government a free loan right so you if you don't use enough of it you gave the government a free loan if you do use too much of it then you penalized yourself and this is supposed to save you money so you end up you know and like

50:55

S… Speaker 2 (GEP595_Eng_IP)

we don't do this for a living the tax people do so it's hard to say that it's our fault if we screw it up especially someone who's self-employed where the income is different right you know right that makes sense so i'm not a fan of this okay so now you've had a chance to read about it um what about this information still confuses you or is unclear if anything um well come

51:30

S… Speaker 1 (GEP595_Eng_IP)

Pair the two amounts, the premium tax credit you used in advance during the year and the amount of tax credit you qualify for based on your final income. Technically, you're not going to have a final income if you're self-employed until after the end of the year into the beginning of the next year.

51:52

S… Speaker 1 (GEP595_Eng_IP)

it's too late to like even adjust like if you know if i figured out i used too much in november i could just take no tax credit in december and try to even it out or something maybe i'm not sure but i can't do do that once again it just seems like self-employed 1099 gig worker people we get the short end of the stick on everything so um it seems like unless you know exactly what you're doing and exactly how much money you're going to make

52:23

S… Speaker 2 (GEP595_Eng_IP)

there's a big chance you're going to screw this up and you're going to lose both ways the government will win both ways okay free loan or you have to pay them more money now okay and can you explain in your own words why you think updating your income might matter um well for this to try to you know not have this get so out of swing one way or the other yeah but again like what if you

52:56

S… Speaker 1 (GEP595_Eng_IP)

you know, God forbid break your leg and you're not working and you don't have workman's comp. Now you're making zero income for the month of October and November. But in September, you just reported that you made $500 more every week than you normally do. And based on my past experience, it takes a long time for them to catch up with the paperwork. So I could end up paying like higher.

53:24

S… Speaker 1 (GEP595_Eng_IP)

deductibles or not qualifying for that credit. But then when I really needed the most in November, October and November and December, when I'm broken leg, can't make any money, I'm going to have a higher premium or deductible or whatever it is due. That's actually overinflated because now, so I think, I think personally, I think it should always work towards the citizen, the customer.

53:54

S… Speaker 1 (GEP595_Eng_IP)

you update it once or twice a year like i don't know one time and then six months later and if you got like this five thousand dollar a month in reward or pay raise good for you but if it doesn't happen within those six months yeah so be it right people can't spend their whole lives keeping track every single day every single month just for the government yeah however

54:19

S… Speaker 2 (GEP595_Eng_IP)

I also feel like if you made less money and they find that, then that should be brought to you back as a credit. So it should always work in favor of the person, the customer, not the government. But of course, I'm biased. Okay. And has anyone ever told you what could happen if you don't update your income?

54:43

S… Speaker 2 (GEP595_Eng_IP)

I don't know. I'm assuming at some point they'll send you a letter saying like, hey, you know, your income changed. So now you owe us, you know, this amount of money. But you haven't had that situation or nobody's told you? I don't think so. Okay. And how concerned would you be about potential?

55:00

S… Speaker 1 (GEP595_Eng_IP)

having to repay excess premium tax credits? I mean...

55:06

S… Speaker 2 (GEP595_Eng_IP)

Again, I hope there'd be like some links to try to figure out stuff. And then if it's a really big amount, I mean, that depends on each individual case, but have some kind of payment plan set up. You can't just be like, you owe us $5,000 by the end of the month. Yeah. You know? Yeah. So, you know, government can take as long as they want to give us our money, then they're going to have to wait to get that money back. I guess it'd be different if you could, if the government could prove that.

55:35

S… Speaker 2 (GEP595_Eng_IP)

the person blatantly like lied like they made like a million dollars and said they only made like 30 000 something crazy but otherwise like okay people didn't exercise the amount right but now we have and this is the correction we need to do and like let's work out a way that works out for both of us then that would be okay okay

55:59

S… Speaker 1 (GEP595_Eng_IP)

And what factors might prevent you from reporting income changes during the year, like confusion, loss of coverage, fear of losing coverage, not knowing how to, or believing it won't matter? Probably two out of the four you just said.

56:16

S… Speaker 2 (GEP595_Eng_IP)

worry that you'll lose coverage or qualify for it and then also that you know you're confused because again what if your salary goes back to the way it was a month later or two months later yeah you know especially if it says you only have you can only update it every six months so if you update it six months but then the seven month it's a big difference again you're out of luck right you know

56:41

S… Speaker 2 (GEP595_Eng_IP)

And even if there's a way to like at the 12 month mark, go back and it's going to take a long time before you get that money and that money need, you need it at that moment, not six, seven, nine months from now or more. Right. So what might motivate you to report proactively or quickly? Probably nothing. Okay. Okay.

57:05

S… Speaker 1 (GEP595_Eng_IP)

And if repayment rules become stricter and more consumers may owe money back, how would you want that information to be communicated to you? Well, like I just said, that there's a payment plan or whatever. But I think.

57:21

S… Speaker 2 (GEP595_Eng_IP)

It should not go that route. I think it should not be more strict because especially just everything is going up, costing more and more and our incomes are not going up with it in general. So to make a tax credit reduction kind of thing, it's supposed to help us be more strict at a time when everything is so much more expensive. It's going to create a lot more problems. So I would hope it doesn't happen to begin with.

57:47

S… Speaker 1 (GEP595_Eng_IP)

What tone do you believe is going to be the most effective to receive this type of information, like educational, warm focus, step-by-step guidance, or also emphasis on avoiding penalties?

58:01

S… Speaker 1 (GEP595_Eng_IP)

Probably those two, like step by step and here's how to avoid penalties. OK, so I want to thank you so much for sharing your thoughts and everything you've told me has been very helpful and will be used for research purposes to help improve services for members like you. But before we wrap, what else would you like to tell me about your experience with enrollment? Something or something that we might not have talked about, but is important to you.

58:31

S… Speaker 2 (GEP595_Eng_IP)

kaiser specifically their website's terrible okay um and i just had this like i had an appointment with my neurologist and i wanted to get a message to her the night before and when i went onto the website logged into my account i could not

58:48

S… Speaker 2 (GEP595_Eng_IP)

like it had a list of doctors of mine that I could talk to I could send a message but she wasn't listed in there I had to go back into like an old message she sent me to reply to it but then it said this message is too old you can't reply to it anymore so at that point I had no way to contact my neurologist who I had an appointment with the next morning so when I went into the appointment and I explained that to her she was like oh really like because she said her name was in there so so

59:15

S… Speaker 2 (GEP595_Eng_IP)

I was on the app because I was on my phone in the doctor's office. In the app, I could see her name listed as an option to send a message, but not on the actual website. Interesting. And many times the website crashes or it takes a long time to load. Same with the app.

59:33

S… Speaker 2 (GEP595_Eng_IP)

So I just think like whatever software system company they have a contract with, it's just not good. I didn't experience any of that with Care First. And then the Maryland Health Connection, I don't know if it's also a problem with the other companies, Aetna, Care First, whoever, but it's definitely like there's something where their signals aren't talking to each other because...

1:00:00

S… Speaker 1 (GEP595_Eng_IP)

it you go over there and it just doesn't the marketplace is just very I feel like they don't have enough buttons they don't have enough options okay um and I don't know if that falls on because I'm a 1099 person and the majority of the world isn't but even still like there's a lot of us out there yeah and most likely more of us are on marketplace yeah so it's probably should be geared towards us

1:00:26

S… Speaker 1 (GEP595_Eng_IP)

So I think I think that's that's it. Just making sure that they all talk to each other. And I did notice I think this is just in general across the board with everything, but like some people.

1:00:39

S… Speaker 1 (GEP595_Eng_IP)

um have trouble signing in when they've done a software update like when Maryland Connection has or Kaiser has if they have a MacBook or they use a an Apple type software like Safari and then they have to go and use like Google Chrome or something yeah um and then it turns out that like later on it will work in Safari just to work the kinks out but I mean yeah

1:01:06

S… Speaker 2 (GEP595_Eng_IP)

Apple and Safari are such well-known, popular companies out there. They need to make it adaptable to both. Yeah. Okay. That's very, very helpful. Yeah. So thank you again for your time and your ideas and your feedback is definitely going to make a big difference. So we're going to stop the recording now.

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