Five Things to Know When Signing Up for State Health Plans

The state health exchanges where many people may purchase health insurance under the Affordable Care Act (ACA) have been open for a couple of weeks. Although the online process for finding and securing health insurance has been fraught with problems both technological and political, “Obamacare” is here to stay, and for a lot of people it’s long overdue.

If you are among those shopping for a health plan on these marketplaces-people whose employers don’t offer coverage, people who are unemployed, self-employed or employed part time-KaiserHealthNews.org (KHN) is an ongoing resource for shopping tips and general information about the ACA.

Remember, you have until Dec. 15 to sign up for coverage that is mandatory by January, and you have until March to shop on the exchange during the initial enrollment period. All plans offered on a state exchange meet legal standards for coverage-for example, no one can be excluded or charged more because of pre-existing conditions, there are no lifetime limits for coverage and certain common medical services must be covered.

Courtesy of KHN, here are five things to remember if you’re an exchange shopper interested in comparing the range of health plans online and whether you qualify for a federal subsidy of the cost.

1. Don’t wait until the last minute to look for a plan.

If you’re uninsured and want coverage to start on Jan. 1, you must sign up by Dec. 15. But don’t wait until the day before to shop. If you have questions, you’ll need time to ask them.

An estimated 7 million people are expected to buy coverage through the exchanges. Heavy website traffic might cause delays. It can take a while to compare plans, especially if you live in the larger urban areas that typically will offer more choices.

2. Look beyond the premium when figuring potential costs.

To evaluate a marketplace plan fully, consider more than the monthly premium. Determine the plan’s deductible, copayments or coinsurance, and the maximum out-of-pocket amount you could be responsible for every year.

Exchange plans in every state must cover a similar package of 10 “essential health benefits,” but what portion of those costs each consumer pays varies according the plan chosen. You pay 40% of costs in a bronze plan, 30% in a silver plan, 20% in gold and 10% in platinum.

This year only, some plans might have separate deductibles for some medical services and prescription drugs. If you or a family member in your health plan takes a lot of drugs or anticipates doing so, carefully examine the prescription drug coverage of each plan you’re considering. There can be significant variations in cost sharing. One study found 90% of bronze-level plans charged 40% coinsurance for drugs in tiers 3 and 4, which typically include expensive specialty drugs. Many silver-level plans charged flat copayments averaging $70 for drugs in those tiers.

3. Review provider networks.

One way insurers are keeping premiums more affordable for plans on the exchanges is by limiting their provider networks. That means fewer doctors, hospitals and other facilities will take your insurance than many employer-provided plans. If the providers you see under your current or former coverage are important for you to keep seeing, check to see if they’re included in the network of the plans you’re reviewing.

4. Estimate your income carefully.

It’s estimated that as many as 8 in 10 people who buy exchange plans will qualify for premium tax credits. The credits are available to people with lower incomes-$45,960 for an individual and $94,200 for a family of four for 2013 income. The credits will be based on your projected income for next year and may be sent directly to the insurer to reduce your monthly premium. But if you underestimate your income, you could have to repay at tax time any excess amounts you received.

So monitor your income during the year. Inform the exchange promptly if it changes and you realize your estimate was too high or too low so your tax credit can be adjusted. To calculate your estimated subsidy, see our blog of a couple of months ago.

5. Beware of fake health exchange websites.

In some states, people have encountered websites that look like official state marketplace sites but aren’t. “Some could be deceptive but fairly benign [sites] designed to sell legitimate insurance products,” James Quiggle of the Coalition Against Insurance Fraud told KHN. “Other sites could be malicious and intended to steal your identity.”

To be certain that you’re visiting the official health insurance marketplace for your state, visit the federal government’s site, healthcare.gov. Some states do not operate their own exchanges, ceding that authority to the federal government. Either way, healthcare.gov will direct you to information about how to get started choosing a plan in your state.

If you have questions about the ACA or the insurance exchanges, or suggestions about topics the organization should address, KHN welcomes your input. Email questions@kaiserhealthnews.org.

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