This report from the California HealthCare Foundation summarizes some of the experiences of consumers and enrollment counselors with enrollment for health insurance coverage through Covered California, the state-based health insurance marketplace established under the Patient Protection and Affordable Care Act. Numerically, Covered California has been the most successful of the state-based marketplaces, enrolling over 3 million of the 8 million individuals who obtained health insurance coverage during the first open enrollment period (October 2013 – March 2014) through the federally-facilitated and all the other state-based marketplaces. The report was prepared by PerryUndem Research/Communication and is based on focus groups and interviews conducted in February 2014 with 71 diverse consumers who had applied for health coverage through Covered California, 32 Certified Enrollment Counselors (CECs), and two Certified Insurance Agents.

While many were thankful to have health insurance, many still did not understand all the details about what types of health insurance coverage they were eligible for, and what types of assistance, both with enrollment and with payment of premiums and co-payments, were available. Consumers had difficulty understanding and calculating their incomes for eligibility purposes, meeting documentation requirements, and choosing a health plan. Many consumers reported frustration with the Covered California call center, and with receiving timely responses from MediCal, California’s Medicaid program. Latino consumers expressed confusion and fear about immigration-status concerns, and Mandarin and Vietnamese consumers reported gaps in language access.

Among the ideas for improvement:

+ Open the door wider. Consumers wanted Covered California to reduce call center wait times; to educate Californians that in-person enrollment help is avail- able; and to translate the Covered California online application into other languages. They also wanted the Medi-Cal processing time to be shortened.
+ Improve communications with consumers. Consumers wanted Covered California and Medi-Cal to be clearer upfront about the documentation required for enrollment and to clearly explain the Medi-Cal enrollment process.
+ Enhance the Covered California website. Consumers wanted Covered California to improve the online chat function, update the provider search function, and offer clearer guidance on how to calcu- late their incomes.
+ Conduct more outreach and education. Latinos wanted Covered California to address their specific enrollment concerns (i.e., immigration worries, fear of losing their home to Medi-Cal). Mandarin-speaking and Vietnamese-speaking consumers also suggested going deeper into their communities with outreach. Many consumers wanted more resources that explain how insurance works, particularly the various costs involved.
+ Offer more support to CECs and insurance agents. CECs and agents wanted a refresher training course to address real-life scenarios and complex cases. Some also suggested a feedback loop so CECs could share what they learned. Finally, agents wanted their own dedicated help line as the CECs have.

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