Healthcare Navigators Help Enrollees Steer Clear of Insurance Confusion

Copayments. Deductibles. Premiums. The complex world of health insurance coverage can be confusing for even the most informed patients. But for immigrants, refugees and other underserved populations, our country’s healthcare system is particularly daunting.

In a city where 10.5 percent of people lack health insurance coverage, United Way of Metro Chicago community partners are turning to healthcare navigators to help reduce barriers to healthcare access.

“Health insurance is just something completely different and complex,” said Dalia Galvan Morales, manager of Health Access and Immigration and Refugee Services at Heartland Health Centers, a United Way community partner.

“[It’s] very complicated for anyone, but our target population is immigrants and refugees. Coming from a different country and experimenting with this whole new system can add an additional layer of difficulty,” she said. “Having someone you can trust and identify with makes people a little bit more likely to seek services that they need.”

That’s where Zinah Kadhim, a 36-year-old from the suburbs, comes in. She’s one of a few navigators working for Heartland Health Centers on Chicago’s North Side. An immigrant from Iraq, Zinah seeks to help new communities – immigrants, refugees and asylees – understand America’s intricate healthcare system.  

“I like [my work] so much because we are helping many families that really need the help,” Zinah said. “They’ve got a lot of papers mailed to them and they don’t know what they mean. We are helping them and educating them about the health system here.”

On any given day, Zinah and her colleagues, including Stephanie Castrejon, respond to pressing healthcare questions, field client calls and facilitate up to 30 appointments at their office.

Their clients typically need help determining which health insurance plans they’re eligible for, researching details of insurance plans and applying for or renewing their insurance coverage. Since 2013, through state, federal and private grant funding, United Way of Metro Chicago has helped facilitate over 26,000 enrollments in health coverage.

Healthcare navigators continue to offer support every step of the way, helping with anything from reviewing enrollment paperwork to filing appeals with the federal Department of Health. Even after someone has health coverage, navigators work to ensure that they have access to care by assisting clients in finding providers within their plan, scheduling appointments and ensuring medical cards are issued. They also offer referrals to other agencies that address a client’s outstanding needs.

Like Zinah, Stephanie, a 24-year-old native Chicagoan, takes great pride in connecting families to the coverage necessary for them to live their healthiest lives and protect themselves from devastating healthcare costs.

“I love working with the communities around me, the underserved population,” Stephanie said. “Especially since I grew up in a neighborhood like Albany Park where there are a lot of different cultures and people come from a lot of different countries.”

These community members often have difficulty finding information in their native languages and may lack health literacy, making it difficult to understand healthcare terminology and concepts – a struggle that exists for many residents. 

To break down those barriers, the healthcare navigators, who receive extensive hands-on training, offer services in multiple languages, assess clients’ level of understanding and work diligently to explain terminology in words and phrases that are easily understood.

“I’ve definitely learned that the health coverage system is not very user friendly. A lot of our clients who come in, English is not their first language. They have that language barrier already, and then understanding health coverage lingo. It’s pretty difficult,” Stephanie, an English and Spanish speaker, said.

By resolving these difficulties and teaching community members how to navigate this system, Zinah, Stephanie and their colleagues directly improve the lives of enrollees who can finally access the care they deserve.

“It really makes me feel good once I see that I’m able to explain [the healthcare system] to them and they’re able to understand and reassure themselves that they understand what’s going on,” Stephanie said. “Doing one simple thing for them goes a long way.”

 

Suburban Coalition Relieves Families of High Healthcare Costs

When Dave and Jana Jenkins decided to return to the United States in 2012 following 19 years of missionary work in Africa, the pair expected to face challenges. What the parents of five didn’t foresee was healthcare being a costly barrier to their assimilation back into American life.

“Most of our professional lives we’ve been missionaries and were overseas,” Jana said. “So, it’s been a little harder to get our start here in the U.S. Because of that, we’ve kind of fallen into a low-income family.”

With their son Timothy requiring surgery and care for a pre-existing condition, Dave and Jana, in 2015, sought help navigating the complex task of finding affordable health insurance. That’s when they connected with the DuPage Health Coalition, a United Way of Metro Chicago community partner.

The coalition helped the family enroll in health insurance and, later, accepted them into its Silver Access Program to further reduce their healthcare costs.

“Our work is rooted in the belief that being poor should not be a barrier to being healthy,” said Karen Doyle, Director of Development & Communications for the DuPage Health Coalition.

 

The Jenkins Family

Dave and Timothy visiting Long Beach Island.

A family of seven, the Jenkins returned to America when their eldest daughter enrolled in college in Wheaton, Illinois. Wanting to live nearby, the family relocated to the Midwest and, eventually, settled in DuPage County.

The transition was challenging and, at times, required the parents to work numerous jobs to support their family.

“We did really well in Africa, and then we came to the States and we kind of fell into categories that made it difficult for us to find substantive employment,” Dave said. “At one point, between the two of us, we were doing four different jobs to pay the bills.”

In addition, it was nearly impossible for the family to find affordable health insurance that covered care related to Timothy’s cerebral palsy, a muscle condition that created nerve damage in his right hand.

“We fall into the category of self-employed, and I have a son with a disability. We would typically not be able to get insurance, or we would get insurance that was expensive and generally poor coverage,” Dave said.

In 2015, three years after their move, Dave connected to a healthcare navigator in DuPage County who walked him through the process of enrolling in health insurance. Together, they found a plan on the Affordable Care Act’s marketplace that covered the family for about $54 per month. “I remember when we got done, I was just stunned,” Dave said. ‘It was like ‘Wow, I’ve never had such good coverage for so little.’”

Timothy runs track for the Great Lakes Adaptive Sports Association.

The following year, that cost fluctuated, rising to $300. Dave inquired about the DuPage Health Coalition’s healthcare assistance program and was soon approved for its Silver Access program. It proved to be incredibly necessary, as Timothy would soon undergo a surgery that greatly improved his quality of life.

“The cerebral palsy created nerve damage and the worst part of it is in his hand,” Dave said. “Without being able to grip anything, he can’t use any of his other muscles.”

“They cut here to extend the tendons in my [forearm,] so they could get my arm to go more like this,” Timothy, an athletic high schooler, added, straightening his bent wrist with his other hand. “[With the help of a brace,] I can use it a lot easier now. I can go to the gym and lift weights and stuff.”

Without their enrollment in Silver Access, the costly surgery and aftercare could’ve devastated the family’s finances, Dave said.

“We had been one of those families who don’t go to the doctor and everything that comes up causes this emotional fear,” he added. “Sometimes, you’d end up with medical bills that would take you a couple of years to pay off, but, [with Silver Access], it has been a completely different world for us.”

 

A “Silver” Lifeline

A unique initiative in Illinois, the Silver Access program has provided a vital lifeline for more than 1,000 individuals and families in DuPage County.

Offered by the DuPage Health Coalition, a partnership of local health providers that strive to make it easier for low-income families to receive high quality healthcare, Silver Access enrollees receive help paying their insurance premiums, or monthly payments.

To qualify, enrollees must be legal residents of the United States and DuPage County and purchase health insurance from the Affordable Care Act marketplace. Once approved for Silver Access, applicants will pay their premiums for one or two months. Then, the program will cover the remaining premiums, up to $150 per family member each month.  

“Silver Access puts people in a place where they can actually use their insurance,” Karen said.

They encourage enrollees to do so through education classes that teach them how to use their coverage effectively, like prioritizing preventative care and using a primary doctor rather than relying on costly emergency room visits.

 

Paying it forward

Because of his hand surgery and access to braces that support his wrist, Timothy is able to lift weights with his dad.

For three years, the Jenkins family has utilized the Silver Access program, and though it hasn’t resolved all their financial woes, it’s freed up some of their energy to focus on their future and opportunities to serve others.

Today, Timothy keeps himself busy running track, competing in long jump and playing soccer. He recently travelled to San Diego to participate in a development camp with the USA National Paralympic Soccer team and became the proud owner of his first therapy dog, Bailey.

Dave and Jana serve as house parents for a DuPage County nonprofit that aids young mothers, while they work to build their own nonprofit to help East Africans who migrated to America navigate their new situations and life challenges.

 “When we’re not fighting for our basic survival, like healthcare, that gives us a lot of energy and resources to put into other people,” Dave said.