Questions Part II: Permissible Guidance
- Return to the main webinar page.
- Questions Part I: Training
- Questions Part II: Permissible Guidance Questions
- Questions Part III: Affordable Care Act and Families
- Questions Part IV: Penalties
- Questions Part V: Premium Tax Credits
- Questions Part VI: Other General Questions
Is it appropriate that VITA sites offer insurance advice without completely understanding health insurance?
Volunteers shouldn’t offer more assistance than they’re comfortable with. Much of the health insurance application is about determining modified adjusted gross income, filing status and dependency to find out if an individual or family is income-eligible for either Medicaid or tax credits that reduce their health insurance premiums (Premium Tax Credits). VITA volunteers are already well trained for helping families with that portion of the application. Assisting with the health insurance plan section of the application requires additional training. However, since the processes of eligibility determination and plan selection are separate and since most people will not or cannot complete them in the same day, experienced tax preparers shouldn’t feel pressured to know both elements in order to provide some assistance. A good referral to a Certified Application Counselor or Navigator could be very helpful to consumers seeking guidance on plan selection. In addition, remember that even CACs cannot give insurance advice. A CAC’s role is to present the options and provide – or direct people to – the information they need to make their own insurance plan selection.
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A librarian told me it was illegal to help people with insurance applications if you’re not a Certified Applications Counselor. Is that true?
False. Anyone can help people apply but someone who is not a CAC cannot call themselves a CAC. In fact, there are a lot of librarians providing this type of assistance.
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If you’re a Certified Application Counselor, is it inadvisable that you make recommendations regarding specific plans to clients?
Certified Application Counselors are not selling insurance plans. The most you can do as a Certified Application Counselor is point out pluses and minuses and point out things to look for in selecting an insurance plan. For instance, you might have a conversation with someone for whom a low premium is most important. Then you would be able to provide them with a list of plans with low premiums, show the “summary of benefits” for those plans and ask what other things are important to that client. You can help them figure out what their priorities are and explain the different insurance terms (deductible, co-pay, coinsurance, etc.), but you wouldn’t make a specific recommendation for which insurance company or plan they should use. The selection should be the individual’s decision, whether they are being helped by a Navigator, a CAC, or another party, like a VITA volunteer.
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As a VITA volunteer, we should not be discussing plan details – just what they need for the application and tax credit, as far as the income and filing status, etc. Is this correct?
As a VITA volunteer, you are certainly equipped to help with the majority of the application because it uses your existing knowledge about filing status, dependency and income. When it comes to plan selection, if you haven’t been trained as a CAC, proceed as far as you feel comfortable, based on your knowledge of insurance. If you have completed the online CAC training (whether or not you’re affiliated with a CAC organization), you will have the same amount of information as the CACs and should feel comfortable discussing plan selection. You don’t need to be an insurance expert to provide useful information. Helping people understand basic information like the difference between premiums and deductibles is very valuable assistance, especially if it is their first time ever having insurance. No matter your level of training, at the end of the day it’s the client, not the assistor, who ultimately chooses a health plan.
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