Health insurance counseling

CVC’s health insurance counseling program offers direct assistance to eligible patients and their families as they navigate the complex health insurance benefits system. We help identify new or better sources of health coverage and make every effort to help you understand how they work.

Click on the headings below to learn more. To get started or ask questions, contact us today.

Our aim is to make quality health insurance feel more accessible and affordable regardless of a person’s resources or health insurance knowledge.

Whether you are starting from the beginning to simply explore, “What questions do I need to ask?,” transitioning from one coverage type to another, or asking more complex coverage questions, CVC’s health insurance counselors are here to help.

We want to erase the feeling of dread that washes over you when you think health insurance and replace it with a sense of empowerment—so you can take advantage of benefits available to you and improve your health outcomes.

A health insurance case manager can help you investigate, review and explain:

  • Original Medicare Parts A and/or B
  • Medicare Prescription Drug Plans (PDP, Part D)
  • Medicare Advantage Plans (MA, Medicare Complete)
  • Medicare Supplemental Plans (Medigap)
  • Medicaid
  • Employer-sponsored health insurance (group)
  • Coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • Private, commercial health insurance (self-purchased)
  • Affordable Care Act marketplace plans (the exchange, Obamacare, ACA, PPACA)
  • State-specific insurance, such as high-risk state pools

Case managers can also help as you consider the additional cost savings offered through state and federal health insurance consumer assistance programs such as:

  • Extra Help for Medicare Prescription Drugs (Low-Income Subsidy)
  • Medicare savings programs
  • State Pharmaceutical Assistance Programs (SPAP)
  • Cost-sharing and premium subsidies under the Affordable Care Act

First, a health insurance case manager will gather information from you and your family to assess current insurance information, determine new or improved coverage needs, and identify eligibility for health insurance or cost-savings programs in your area.

health insurance counselingYou can only enroll in coverage at certain times during the year—known as open enrollment periods. Outside of these times, you must qualify for a special enrollment period in order to receive coverage. Dates for open enrollment may change each year, so be sure to review them. The enrollment periods for 2019 coverage are currently scheduled for:

  • Original Medicare Parts A and B: General annual open enrollment period is Jan. 1–March 31.
  • Medicare prescription drug plans and/or Medicare Advantage: Annual open enrollment period is Oct. 15–Dec. 7.
  • Individual and ACA marketplace plans: Annual open enrollment period is Nov. 1–Dec. 15.
    • State-based marketplaces may offer extended enrollment periods.

Once you are eligible to enroll in coverage, CVC will ask you for a list of your prescribed medications and your treating doctors. This allows us to ensure the policies we recommend provide adequate coverage for prescription and medical needs.

Next, CVC will research plan options available to you in your area. Based on your specific needs, a health insurance case manager will prepare a side-by-side comparison of multiple plan options to send you.

The case manager will review the plan options provided with you directly to ensure you understand the benefits, rules and costs of each option. If alternate plan options need to be explored, the case manager will prepare a new side-by-side comparison and repeat the review process.

If any questions about a policy’s benefits, network or costs aren’t answered in available policy documents, CVC will contact the insurer with you, or on your behalf, to find the answers.

Once you choose the plan that best meets both your health and affordability needs, CVC will help you enroll. We will direct you to make your first premium payment so that your coverage activates.

Finally, several weeks after enrollment, a case manager will follow up with you to confirm that you received coverage documents and to offer tips and best practices for utilizing the new coverage and accessing needed medications and services.

Cost

There is no fee to use CVC’s health insurance counseling services.

Additionally, health insurance case managers are not affiliated with any health product or insurance provider organization and receive no compensation or commission for enrolling consumers into a particular health plan. No fees or payment are received from the federal government for the provision of our certified counselor services.

Eligibility

CVC is currently accepting new patients for health insurance counseling services.

To be eligible for assistance, you must be a U.S. resident diagnosed with one of these diseases:

  • Bile acid deficiency
  • Complex partial seizures
  • Cushing’s syndrome
  • Cutaneous lymphoma
  • Factor XIII deficiency
  • Gaucher disease
  • Huntington’s disease
  • Infantile Spasms
  • Lennox-Gastaut syndrome
  • Narcolepsy
  • Orthostatic hypotension
  • Pulmonary hypertension
  • Thalassemia syndromes

CVC is a Certified Application Counselor Designated Organization (CDO) under the Affordable Care Act as determined by the Center for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS). CVC first obtained approval as a CDO in 2013, prior to the launch of the health insurance marketplaces in January 2014, and has provided enrollment assistance to eligible consumers each year since.

All health insurance case managers are approved, under CVC’s CDO designation, as certified application counselors (CACs) and receive extensive training concerning marketplace insurance benefits. In addition to internal training received, federal law requires CACs to complete certification coursework each year, as determined and directed by CMS. You may view the current year certification certificates for active CACs below.

Case manager certifications:

View a PDF of CVC’s Notice of Privacy Practices.

Useful links:

  • Medicare
    The official U.S. government site for Medicare. Find information about eligibility, costs and coverage.
  • SHIP
    Each state offers a network of state health insurance assistance programs (SHIPs) which provide one-on-one health insurance counseling and assistance. SHIPs can help answer questions about Medicare and Medicaid and may offer other useful services.
  • Medicaid
    The official U.S. government site for Medicaid. The federal government regulates certain elements that all Medicaid plans must offer, but each state manages its own eligibility rules and applications. Visit the website for Medicaid in your state for more information.
  • HealthCare.gov
    The official site for health insurance plans under the Patient Protection and Affordable Care Act of 2010 (ACA). Individuals can find information about plans available, complete an application and enroll. Some states manage their own health insurance marketplace—visit the website for more information.
  • Veterans Health Administration
    The official U.S. government site for the Veterans Health Administration. Find information about eligibility, costs and coverage.
  • Foundation for Health Coverage Education
    The Foundation for Health Coverage Education (FHCE) was established in 2004 to simplify information about public and private health insurance eligibility. The site provides helpful resources and tools to better understand which programs and coverage you may be eligible for.

Download or print:

Also be sure to browse our articles about health insurance counseling to learn more about the process.

For more general and disease-specific resources, check out our helpful resources page.