Health Insurance

Welcome to the Talking Total Farmer Health podcast from AgriSafe Network. At AgriSafe, we work to protect the people that feed the world by supporting the health and safety professionals, ensuring access to preventative services for farm families and the agriculture community. Welcome to the talking total farmer health podcast, I’m your host Carey Portell, and I want to remind you that open enrollment for the healthcare marketplace runs from November 1st through January 15th. In this episode, we’re going to cover some helpful tips on health insurance, and we’re going to speak with two wonderful guests, Florence and Maria. Would you both please introduce yourselves?

Hi everybody. My name is Florence Becot. I am a rural sociologist and research scientist at the National Farm Medicine Center. My research is really focused on the health, well-being, safety, and economic viability of farm families in the US. And one of the ways that I study these topics is by looking at health insurance.

And hi, everyone. I'm Maria Pippidis. I work with the University of Delaware Cooperative Extension. I'm an extension educator, and I focus primarily on financial well-being. And one of the things that really is important to support financial well-being is our own physical and mental health. And guess what? Healthcare and access to healthcare is part of that. So last ten years, I've been working on health insurance literacy and helping people better understand the complex nature of health insurance and access to health care.

All right. We are going to get right to it. Health insurance is a big topic. It can also be a very confusing barrier for farmers and ranchers because a lot of times it's private insurance. So in your work and research, are there any trends that you've seen?

What is so important about this that it needed to be researched to this length?

There are many reasons why. First, agriculture is one of the most dangerous occupations. It's also one of the most dangerous. And so it should come as no surprise that for farmers, health insurance is very important. And when we've asked them in the past, over three quarters of farmers say that it's an important risk management strategy. What we also know is that there are direct connections between the ability to offer health insurance and healthcare and the farm business. We actually have some evidence that high healthcare expenses and high health insurance can lead to bankruptcy and can lead to early farm exits. And so we also know, too, that the cost of health insurance and healthcare have direct implications on day-to-day decisions for the farm business. That's connected to what kind of farm investments can I make on the farm or do I make on the farm, including around income level, which Maria we talk about later, which have direct implications not only on the development of the farm business, farm viability, but also in the long term on potential retirement savings. So on and on, health insurance is really an issue that not only impacts farmers day-to-day ability to go see a doctor, but also that impacts the development of their farm business.

Yeah, I agree with all of that. And I've heard so much of what you just said. Now, how many people in the US that qualify for health insurance actually have it versus those that don't?

So when when farmers and ranchers decide, I'm going to go ahead and sign up for insurance, is there a certain time of year that that happens? Is there a deadline? And where would they go to sign up?

So I'm just going to back up one second, Carey, because there's lots of different ways farmers can get health insurance, right? So some of them are getting health insurance because their spouse is working for an employer who offers insurance through that place of employment. And so to answer your question then, when's enrollment? Well, that will be driven by the employer and that enrollment period. Right. So and then there's Medicare, right? So there may be farmers who are older or 65 or older and have access to Medicare. And so that enrollment period is the seven months around the month of their birthday. And so, for example, if my birthday is in March, I have kind of three months before my 65th birthday month and three months after to enroll in Medicare. And and then at the end of the year, there's the Medicare open enrollment period where people can identify or change the Medicare plan that they're on or the supplement that they might choose. There is a program in every state called the senior health insurance program, SHIP, for short. And they are trained volunteers who can sit down with you and help you better understand Medicare. And also Medicare Advantage plans and also the options for supplemental health insurance plans that are available in your community.

For the marketplace, so that is the marketplace is for people who are under 65, who want to access the marketplace plans that are offered either through their state or through the federal marketplace. And that enrollment period is November 1st through January 15th. Um, and then there's also programs like Medicaid and CHIP. So Medicaid is for really low income families. And CHIP is to cover the children in, in low income families. And really, that enrollment period is any time. And having said all of that, if you have an insurance plan and something changes, maybe you lose your job or you get married or you have a baby or there's some sort of life events that opens up the window to change your plan. So whether that's an employer plan, whether that's a health care marketplace plan, probably the Medicaid or the CHIP plans.

Okay. That explains a lot. And I had never heard of the CHIP plan before. So that's something very new that I think our listeners will find out from you on this podcast. Now, I know that a lot of farmers are not great with that type of paperwork. Maybe there's the older generation that need help. Are there any kind of assistance programs that are available to these farmers and ranchers to help them fill out that paperwork?

So four kind of government supported programs. So by that I mean the health care marketplace, Medicare, Medicaid and the Children's Health Insurance Program. That's what CHIPS and stands for. Children's Health Insurance Program. Yes, the answer is yes. There are websites that can be accessed. There are what are called navigators in each state that are funded through the state health departments to help people enroll. There's even an 800 number that can be accessed to to to get help filling out applications or even or even be able to do the application over the phone with that helper.

Okay. We want our listeners to be totally prepared when they're going to apply for health insurance. So whether they're going in person or sitting down and looking at healthcare.gov, what do you think they should have readily available so they can just get right to it and get the application finished?

Okay. So grab a pencil and paper because here's the list. First off, this is an easy one. You need your address. You also need to know who is in your household. Most of these applications are about household, and especially if the application is for the health care marketplace, Medicaid or the CHIP program. They want to have a sense of who's in your household, so whether they may be covered or not by this plan, they want to know who's in the household. So information about the people who are in your household. So that could be family members, but it could also be non family members. It could also be a college student who's actually not in living in your household but is part of your family. And so there. So you need that list of people and typically you're going to need their Social Security numbers as well. And they may also ask some questions about whether or not those people smoke or not. And you might also need if someone is helping you fill out the application. So that's one of those navigators or assisters or someone over the phone. Then you would they they would have to identify themselves if you are an immigrant. You need information about your immigration documentation. Let's see what else you you may need to also share information about how you file your taxes. And by that I mean, are you filing as a single person, a married person, kind of a joint, separate? Right. And then who do you claim as dependents? Employment information, right. Where you work and any employer information there and your best estimate of household income. And so to do that, you might want to look back at tax records just so you have a sense of what is the typical total household income for your family.

Okay. Since you brought it income. Let's talk about that. Now, everybody knows that farmers and ranchers have a very inconsistent income. It fluctuates every year depending on whether economy, that kind of stuff. So do you have any tips for those type of people who are filling out that form?

So according to the healthcare.gov documentation, they're really looking towards having a best guess estimate. Clearly, if you are providing your Social Security number and you will, they'll be able to connect that to your tax return. Right. So and that is something that will happen. So you don't want to fib. Now, what happens if you do a best guess and for example, you end up earning more than than you thought? Well, then an adjustment is made. So and I'm talking about the health care marketplace plans. So with a health care marketplace plan, they're using information about your income and your number of dependents to determine how much of a tax credit or tax subsidy you would get to reduce the cost of your monthly premium. So they're using that information to offer that credit. And so. And so based on sort of based on that calculation of what's your income and the number of people in your household that you're trying to take care of and ensure the amount of that credit or credit or subsidy will go up or down. So your income is important in that calculation. If your income goes up during a year, right, then it's on you to contact healthcare.gov and say, gosh, I owe I overestimated or sorry, I underestimated. And so how do we need to adjust? And then what will happen is you'll be required to pay back some of that subsidy. Now, on the flip side, if you estimate your income and it's way less than you thought it was going to be best than you estimated, then at the end of the year, when you file your taxes, you'll get some of that money back.

Okay. You answered my next question because that's exactly what I was going to ask, because it's estimating. Boy, that's all you're doing is estimating. You just have no idea because it could rain really well. And boy, your crop is doing fantastic one year and then the next year it just absolutely horrible like the drought that we're having right now. Now, I've been on Marketplace before and I'm you know, there's lots of plans on there and you're trying to decide which one's going to fit you and your family. Are there any specific things that they should consider whenever they're looking at those plans?

Absolutely. The first thing that I always do in my educational programs is to get people to think about how do they use or would use health care resources. So how often do you go to the doctor? What kinds of specialists do you need to need to see for yourself, as well as all the members of your family? And so figuring out what are your health care needs, that's really important because you want to be sure that the plans that you pick offer those important services. The next thing to think about is total cost. And one of the things that I see a lot is people choose a plan based on premium alone. And so there's this interesting kind of balance, right? Oftentimes, if you pick something with a really low premium, then there will be other out-of-pocket costs, like the deductible will be really high. And remember, you have to pay the deductible before the insurance kicks in. So there's that weird tradeoff between low premium and high deductible amounts.

And if I can add, this is really an area where we found that farmers were struggling. Was that high out-of-pocket expenses and high deductible, that really having the shorter premium in the short term might help a lot. But when it comes to dealing with a major health consequence, that's when things got trickier.

Right. Right. So there are I mean, cost is always going to be a factor in a farmer ranchers life. But even though they're thinking, you know, I'm never sick, nothing never happens to me. It's that one time whenever they come down with an illness or I mean, gosh, look at COVID, for example. You never know how you're going to react to it or you've got that farm accident that happens. Of course, you can't predict that. And then that that deductible comes out of pocket. So that's that's something I can see that is such a hard choice for our farmers and ranchers.

So one of the things I really encourage people to do is, is, is map it out like look at last year's calendar. Which doctors did you see? What were those co-payments? And kind of do the math. If I went to the doctor four times and there's a $20 copay, well, that's $80. Right. And my kid had to whatever. And had to go to the dentist. And that was, you know, six times with all the family members. So there's, you know, add it up because that's going to be an out-of-pocket costs, you know, in order to use your, your insurance plans. So if you kind of compare that with what would that out-of-pocket costs to pay those deductibles be, you kind of come to this notion of like man having a high deductible really doesn't work because I want to be able to go to the doctor when I need to go to the doctor. So I really encourage people to look at last year or what you should have done because there's so many people who don't go because of the cost. Right. But you should have gone. So do the math and compare that with your plans. And there's some really great resources on our University of Maryland extension health insurance literacy page that. Can help you crunch those numbers. We've got a really great publication called Estimating Your Health Care Costs, and it will allow you to kind of comparison shop. Right. Put in a couple of plans. Let's crunch the numbers, see which works. And and that will help you pick the right plan. I'm just going to circle back around because your original question was, what are some things to look at when you're trying to decide? And one of the things that Lawrence and I talked about was looking at what's the network of physicians that are available to you if you choose the plan? Some some networks are really small.

And if something big and huge happens and you have to go out of network, right, then the cost of health care gets really expensive because it's all on you. The insurance coverage. The insurance plan won't cover it. I think another thing to pay attention to is what kind of plan is it? Is it a preferred provider organization plan - PPO oftentimes - and oftentimes there are rates in those plans that are for in-network and for out-of-network. And it gives you that option as opposed to a HMO, which often limits, right, to only in-network doctors. And again, the insurance provider will not cover you if you go out of network. And then there's, they're called EPO's and they're sort of a hybrid. And so they have a a larger network. But again, if you go out of network, they don't cover the cost. So you have to look at those little acronyms that they use as you're comparing the plans. And then last thing to think about is, you know, farmers are so stressed and there's lots of lots of mental well-being issues that are happening in farming these days. And so you want to be sure that that a plan covers behavioral health, access to mental health resources, access to I mean, I hate to even say this, but like recovery, drug addiction and alcohol addiction recovery resources because. Things are tough out there.

Yeah. In our study, when we asked farmers if they were covered for behavioral health, we had about a third that who said they did not know their plan covered that because it's not systematic that a plan would cover.

Yeah. I know the farmer and rancher who are listening to this right now is thinking, man, I'm already short on time. I really don't have the time to like research all of this. But it sounds like if they just do their prep work beforehand, the decisions and everything will be much easier in the long run.

Yes. I think that's great. And and also, all plans are required to have kind of a like an eight page summary document. And so that includes things like what's the what's the the premium, what's the co pay, what's the deductible, what services does it provide? And that can help a lot to just sort through. What does this plan really cover?

Yeah.

It's the importance, too, of talking to the health insurance navigators. There is also going to insurance agents who are certified for marketplace plans who can take the time and work individually with farmers to look at what options are out there in the area and what makes the most sense for their current situations.

Now, you spoke a little bit earlier about some resources. Are there any specific resources that people, in fact, should be looking for?

So two really good websites, right? Healthcare.gov has done a really nice job of helping people understand health care, health insurance and also kind of how to connect in with the marketplace. So there's a place there where you can say, hey, I'm from Delaware, right? And up will come the information about Delaware. And so it helps kind of focus in and sort through as well as does a really nice job of explaining the language, explaining the terms in plain language. Another great resource is HiredInAg and that is a project that Florence has worked on with some colleagues and that does a really nice job of kind of talking about what, y’know what is the issue, what are some options available for farmers and connects to other resources. And Florence, do you want to say anything else about that one?

What I would add as well is that that's where we have been adding a lot of the research findings about why is health insurance such an important topic for farmers and what does it mean in terms of impacting the business and rural economic development?

And then from a practical side, the University of Maryland extension, they have a health insurance literacy web page. So if you just put in University of Maryland extension health insurance, it will come up. And there resources for consumers, resources for farmers, resources for educators. There's little tabs across the top. You can like press on the one, but there are some worksheets, there's some calculators and resources like that that can really make it practical. Right. Help you make the decisions?

Yeah. We love to pass on resources to our audience. It's just you can listen to a podcast, but then you're like, What do I do afterwards? So when we have those resources to give. Boy, that helps them out a lot. Now, why is it important to continue this or this type of conversation within our agriculture community?

I think there are a couple of reasons. First. Navigating health insurance landscape is hard and confusing. And we've talked to many farmers who explain to us their frustration with even not understanding how it works at the time it takes to navigate. And so it's important to really continue the conversation around what could be done to make it easier for people to sign up for health insurance and what could be done to to make it easier in terms and less expensive as well in terms of signing up for insurance. The other thing, too, is what we found through our research is really the connections between health insurance and farm business. We've talked to countless farmers who tell us the thing that will make the biggest difference is if I don't have to spend $20,000 on health insurance a year. And so I think it is health insurance is one of those things that as individuals, there's not much that we can do. But really talking continuing to talk to their farm organizations, commodity groups, really talking about what kind of solutions could be deployed by commodity groups and farm organizations, but also really connecting with policymakers and talking to them about what will make it easier to have a vibrant and resilient farm business.

Yeah. I love all the knowledge that you have shared with our audience today, and I have learned things myself. Before we end, is there anything else that you would like to share with our audience?

And I have a few farmers in mind that would much rather call that phone number than get online and try to figure it out themselves. Ladies, I thank you so much for letting us just glean a little bit of the knowledge that is inside your heads today. I thank you for being guest on our Talking Total Farmer Health podcast until next time.

Thanks so much for having us, and thank you for making the time to talk about this important topic.

Thank you.

All right, everybody, that’s all for today. Thank you again for tuning in to another episode. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. If you’d like to suggest topics, or have a story you’d like to share, contact us by email at INFO AT AGRISAFE DOT ORG, and title your email “T T F H Podcast.” To see more from AgriSafe, including webinars and our newsletter, visit w w w dot agrisafe dot org. This episode was created by AgriSafe Network. Script arranged by Laura Siegel, hosted by Carey Portell, edited by Joel Sharpton, with special guests Florence Becot and Maria Pippidis.