Adirondack Health Institute News

Free Health Insurance Enrollment Days! December 29 and 30

Adirondack Health Institute is hosting free health insurance open enrollment days.

Queensbury Indian Lake
When Monday, December 29 Tuesday, December 30
Where The Dome, 326 Upper Sherman Avenue, Queensbury Public Health Building, 139 White Burch Lane, Indian Lake
Time 1:00 to 7:00 p.m. 2:00 to 7:00 p.m.


Please call 1-855-650-0112 to arrange a no-cost appointment with one of Adirondack Health Institute’s certified navigators.  They will help enroll you in a free or low-cost health insurance plan through the NY State of Health Marketplace.

The navigator provides guidance through the health insurance enrollment process and helps find the plan that best meets your needs.  We also help determine if you qualify for financial assistance.

Vendor booths, snacks and refreshments and fun activities for kids will also be available.

NY State of Health Releases Demographic Health Insurance Enrollment Data

NY State of Health today released demographic enrollment data on the nearly 1 million New Yorkers who enrolled in health insurance plans during the first-year open enrollment period.  The report indicates that more than 80 percent of enrollees reported being uninsured at the time of application. From October 2013 through April 2014, 960,762 New Yorkers enrolled in a health plan through the NY State of Health Marketplace. To view the report, please follow the link below.



EASE Department Publishes Spring 2014 Newsletter

AHI’s Health Insurance Enrollment Assistance Services and Education (EASE) Department has published its Spring 2014 newsletter.  To read the newsletter, please click here:

EASE Newsletter — Spring 2014

Connecting Kids to Health Insurance Coverage

Don’t forget you can enroll your children in Child Health Plus all year long. Call us for an appointment with a certified navigator today at 1-866-872-3740.  And while you’re at it, check out this video from the Connecting Kids To Coverage national campaign.

Breaking News: Health Insurance Enrollment Deadline Extended For Individuals Unable to Complete Applications

The New York State Department of Health has announced that individuals who have taken steps to apply for health insurance but have been unable to complete the enrollment process by the March 31, 2014 deadline through no fault of their own, now have through 11:59 p.m. on April 15, 2014 to enroll.  Adirondack Health Institute (AHI) will provide assistance to those individuals who have taken steps to apply for coverage but have been unable to complete the enrollment process.  In-person, free-of-charge appointments are available by calling AHI at 1-866-872-3740.

Below is a list of acceptable reasons for not being able to complete enrollment by the March 31, 2014 deadline:

* Trouble with identity proofing
* Technological issues
* Customer Service Center delays
* Delay in getting an appointment with an assistor

To prove that you have a valid reason for needing additional time to enroll, you will be asked to agree to the statement below. It means that you are giving the Marketplace your word that you tried to enroll, but it wasn’t your fault that you weren’t able to complete enrollment.

I took steps to obtain health insurance through the NY State of Health Marketplace but, through no fault of my own, was not able to complete my application before the open enrollment period ended March 31, 2014.

What You Need to Know About Special Health Insurance Enrollment Periods

The last day for individuals and families to enroll in a Qualified Health Plan through NY State of Health was March 31, 2014.  If you missed the deadline, you will have to wait until November 15, 2014 to enroll in a plan that will become effective on January 1, 2015, and you may have to pay a federal tax penalty.  There are, however, a limited number of exceptions, called Qualifying Life Events, that allow you to enroll or make changes to your plan after March 31.  To qualify for a Special Enrollment Period, you must notify NY State of Health about your Qualifying Life Event within 60 days of the event.  You can do so yourself by visiting, or calling AHI at 1-866-872-3740 to make an appointment with one of our certified navigators.  Enrollment for programs such as Medicaid and Child Health Plus, as well as enrollment in the Small Business Marketplace continues all year.

Below is a list of Qualifying Life Events that would make you eligible for a Special Enrollment Period:

* Loss of minimum essential coverage due to: job loss; divorce; death of a spouse; becoming ineligible for Medicaid or Child Health Plus; expiration of COBRA; or health plan decertification
* Marriage, birth, adoption, or placement for adoption
* Gaining status as a citizen, national, or lawfully present individual
* Newly eligible, or ineligible for tax credits and/or cost sharing reductions
* Permanent move to an area that has different health plan options
* Marketplace staff or contractor enrollment error
* Qualified Health Plan violated a provision in its contract
* American Indians can enroll or change plans one time per month throughout the year
* Other exceptional circumstances.

Health Care Reform Hits Home

AHI Enrollment Specialist Renee Bazan was interviewed by the Hill Country Observer newspaper for an article titled, Health Care Reform Hits Home.  Renee shared her experiences helping individuals, families and small business owners shop for and enroll in health insurance through the New York State of Health Marketplace.  Please click here to read the article.

North Country Chamber Holds Informational Session on New Health Care Exchange

The North Country Chamber of Commerce hosted an informational forum on the upcoming changes in health insurance.

More than 150 business owners, managers and employees crowded into the meeting room to learn about changes occurring as health insurance marketplaces are due to begin enrollments.

Adirondack Health Institute Education and Outreach Specialist, Erika Walker, presented a PowerPoint overview of New York’s Marketplace.  To see more click here


Six Important Reminders About Medicare

From the Medicare Rights Center – Getting Medicare right

1.  Choose Wisely – Choose wisely when you decide what kind of Medicare coverage you want. There are two ways to get Medicare health benefits: through Original Medicare or Medicare Advantage.

Original Medicare – This is health insurance from the government. It’s what most people choose. Its lets you go to almost any doctor or hospital. Many people chose to buy supplemental insurance (Medigap plans) to help cover coinsurance and deductible costs.

Medicare Advantage - Private insurance companies sell Medicare Advantage plans. They’re often HMOs or PPOs. They cover Medicare benefits, but each plan has its own rules and costs. These rules may restrict which providers you can see and require you to get permission before you can receive certain services.

Most people must stay with their choice for the calendar year. Make sure it meets your needs and works with your other drug and health insurance.

2.  “B” Careful

Part B is the part of Medicare that covers outpatient services and doctor’s visits.

Generally, you should sign up for Part B when you first become eligible for Medicare. If you are working, check with the Social Security Administration to find out if your current employer insurance is primary to Medicare. If it is, you may consider delaying enrollment into Part B, but you must sign up as soon as you stop working.

If you don’t sign up for Part B when you should, you may have gaps in your coverage. You may also have to pay a penalty.

3.   Prescription for Health

You may want to sign up for a Part D drug plan to get coverage for prescription drugs. If  you have Medicare Advantage, drug coverage is usually included in your health plan. If you have Original Medicare, you must chooose a separate drug plan from a private insurance company. Important reminders:

When choosing a drug plan, make sure it covers the drugs you take.

Find out if the plan has any restrictions on the drugs you take — such as quantity limits, prior approval, or a requirement that you try other drugs first.

Learn how much the monthly premium is, and check how much the deductible and copays are before you sign  up for a plan.

4.   Don’t Take No for an Answer

Whether you are in Original Medicare, a Medicare Advantage plan, or a drug plan, you can appeal if any of them denies coverage.

An appeal is a formal request asking a plan to change its decision and provide you with coverage.

Many people win their appeals.  If you don’t win at first, you can continue to appeal to the next level.

There are a number of reasons you may appeal a drug plan’s decision. You can appeal if the plan is restricting the quantity of the drug you can get, making you get prior approval, having  you try other drugs first, or if your drug is not on its list of covered drugs (formulary).

5.    Save Money Now

Apply for programs that can help you pay your Medicare costs. If you are eligible, these programs can help pay your premiums, copays and deductibles for both health and drug coverage.

Apply even if your income and assets seem to be above the limits; some income and assets may not count towards the limit.

Programs include:  Extra Help, Medicare Savings Programs (MSPs), State Pharmaceutical Assistance Programs (SPAPs) and Medicaid.

Contact your local SHIP (State Health Insurance Assistance Program) to find out which programs are available in your state, if you are eligible, and how to apply.

6.   What’s Not Covered

Medicare does not cover all health care services and products.

Those that are not covered include:

Most dental care

Alternative medicine

Most personal or custodial care at home or in a nursing home

Hearing aids

Most cosmetic surgery

Most vision care

Most care received outside of U.S.

Most nonemergency transportation

Medicare Advantage plans may cover some of the above services.

For more information, visit

Medicare Interactive is an online resource that provides answers to all your Medicare questions.

Three Things to Know About the Health Insurance Marketplace

1.  It’s an easier way to shop for health insurance.  The Health Insurance Marketplace simplifies your search for health insurance by gathering all your options in one place. One application, one time, and you and your family can explore every qualified insurance plan in your area, along with any free or low-cost insurance programs you may qualify for.

2. Most people will be able to get a break on costs. Programs that lower costs are available for almost everyone. You may be eligible for a free or low cost plan, or a new kind of tax credit that lowers your monthly premiums right away. New rules and expanded programs mean that even working families can get help paying for health insurance at the Marketplace.

3. Gives you control over your options with clear, apples-to-apples comparisons. All health insurance plans in the Marketplace present their price and benefit information in simple terms you can understand, so you don’t have to guess about your costs. You get a clear picture of what you’re paying and what you are getting before you make a choice.

For more information visit: