Insurance? Exchanges? Metallic Choices? You are not on your own to sort out the new era of Healthcare Reform! You do have options and even more choices than you have seen advertised with huge marketing campaigns. Yes, you may be eligible for tax credits to help pay premiums or cost sharing to help pay for healthcare expenses, and almost everyone will need to be compliant or eventually face a penalty. But, there is much more to deciding the medical coverage that is best for you and your family. First, here are 3 ways to obtain coverage under Healthcare Reform:
1. The government Exchange website. Today, the website is not complete, and is giving consumers quite a challenge in completing the process from start to finish. In addition, a call center is available and local community centers are staffed with Navigators who can provide assistance (solely in filling out forms, since they are neither licensed nor trained to offer assistance with healthcare plans). Important! This Exchange website avenue does not provide information on any policies that can be purchased privately (outside the exchange). So you will only be looking at a portion of the medical coverage choices.
2. Direct sales departments for each Insurance Company. You can use a website or call a licensed insurance company employee to help you. If that insurance company sells policies ON and OFF the exchange, they will tell you about both types. Keep in mind that each insurance company will provide information solely about its own policies, so you will need to contact each competing company to see your full range of choices.
3. An Independent, Licensed and Insured Agent. An agent can do it all. If they are certified to use the Exchange, they can tell you about policies ON the exchange and also OFF the exchange in the Private Market. They can tell you about policies from all the major health insurers in your area. They can help you select a plan (Navigators are not permitted to help with this). They can tell you about Doctor Networks, check to see if your prescription is on the formulary and they can help you pick the plan that fits your budget and your needs. They can talk to you about subsidies and what your net cost would be. Agents can help with the Exchange application process, too. For many years, insurance agents have been doing side-by-side comparisons online, which is a feature the Exchange is now trying to duplicate. Yes, the Agents’ websites already work and have allowed individuals to see plan comparisons and complete enrollments on-line for years!
Using an Independent Licensed Agent/Brokers comes at no extra charge to you. If you think about it, all 3 of these avenues to coverage have consumer assistance built into the premium, so going it alone does not have the effect of a lower premium in any case. Why pass up the opportunity to get the most out of your options?
Whichever avenue you chose, start by making a list of what is important to you and what questions you have about deductibles, co-pays, prescriptions, out-of-pocket maximums and doctor and hospital networks. An agent can make suggestions if you don’t know what considerations you might have for you and your family. You can also check back on our News Blog for more information about choosing policies.
Have More Questions? We invite you to Comment or call us with your healthcare reform questions. Click on “Contact Us”. See more blogs for answers to your questions in our Archive (to the right of this page).
And, as always you can Follow us on Twitter and Facebook by clicking on the links at the top of our blog.
Patient Protection & Affordable Care Act (PPACA) information discussed in communications is most accurate as of this date. The Department of Health & Human Services may amend or change federal regulations at any time.