Shopping for Coverage for 2014

As everyone has heard, the Healthcare.gov website experienced many problems when it launched in October. The administration has stated operations should be smoother by late November. In most states, residents are relying on Healthcare.gov, the federal website, to shop for insurance coverage for 2014. The following states and DC are not relying on Healthcare.gov. These states are operating state exchanges for their residents:

These state-based marketplaces connect with the Federal data hub in order to verify one’s identity and income but are run independently and in many cases are not having the extent of problems the Federal website is. There are exceptions of course. Oregon, for example, opted not to open its insurance marketplace on October 1st and to rely on assistance from navigators (staff hired specifically to help individuals enroll) due to the technical problems anticipated with the site.

How Does the President’s November 14th Announcement Regarding Cancelled Plans Affect Me?

Millions of Americans with individual or small group coverage received cancellation notices because their existing policies do not meet Affordable Care Act requirements for 2014. Many are justifiably upset because they expected to be able to keep their policies. President Obama, in an attempt at damage control as a result of his statement, “If you like your coverage, you can keep it,” announced on November 14th that state Insurance Commissioners could consider letting those with cancelled plans keep them for a year. As a practical matter, the Insurance Commissioner in every state will have to decide whether to allow insurers to rescind their cancellations and then presumably, individual insurers will also decide whether they will reinstate cancelled policies. Complicating the situation is the fact that for those who require coverage for January 1, 2014, the deadline for enrollment is December 15, 2013.

Who should shop for coverage through the Exchange or Marketplace?

People who will qualify for a tax credit, meaning their income is between 138% and 400% of Federal poverty guidelines, MUST purchase coverage through the marketplace in order to receive those tax credits. In addition, if there is any possibility that your employment or income situation could change and result in your meeting those guidelines in the future, by all means, buy on the Exchange. There are also staff available via telephone, navigators available for in-person meetings with applicants and in some cases, retail stores one can visit.

However, those who won’t qualify for a tax credit might want to browse on the exchange but can purchase coverage in other ways.

Buying Insurance Off the Exchange</b

Considering the significant changes occurring in the marketplace, everyone who needs to have new individual or small group coverage should do as much research and due diligence as possible to understand their options. However, a common misunderstanding today is that one must shop on the Exchange or Marketplace to obtain coverage which is incorrect.  

If you are looking for private individual insurance for yourself and/or your family, you have all the means available that one has historically had to use to shop for insurance. You can use an insurance company website, ehealthinsurance, or gohealth.com or you can contact a local insurance broker. If you don’t know one, you might contact the Chamber of Commerce, or go to the National Association of Health Underwriters (NAHU) website and enter your zipcode to find someone.

Our organization provides a more comprehensive approach for individuals and families looking for health insurance. Our fee-based service uses information including your doctors, medications and preferred hospitals in the event of serious illness to make a recommendation regarding coverage.

Please note that some Exchange plans have more limited provider networks than products off the exchange and some may have more limited formularies (approved prescription drug list). Some plans will require a referral and many are eliminating out-of-network benefits. Determine your priorities and shop accordingly.

It is a confusing time to be shopping for health care coverage, but it should get better over the coming weeks. Of course, given the controversy surrounding those who have had their coverage terminated combined with the poor roll-out of Healthcare.gov, it is possible that more changes will be made affecting those who need to purchase individual coverage for 2014. Don’t count on changes, however. Be prepared.

Worst case? If you have buyer’s remorse for a product you have chosen for January 1st, you have until the end of the initial enrollment period to change. However, you want to do your very best to make as good a decision as you can the first time, because to get new coverage for January 1 and then repeat the process for February or March will mean deductibles will reset. Also, most individuals with individual coverage will be locked in until next year’s open enrollment unless you have some qualifying event like moving, which will provide you with the opportunity to buy insurance off-cycle from the annual enrollment period.