Health Exchange shopping tips
The Savvy SeniorSeptember 4, 2013 | 1,749 views | Post a comment
Dear Savvy Senior,
At age 62, I will be retiring at the end of the year and plan to enroll in Obamacare until my Medicare kicks in. Can you offer me any advice on choosing a plan?
The new health insurance exchanges -- also known as Obamacare -- that begin in 2014 will have a significant impact on millions of Americans who need health insurance, especially pre-Medicare retirees and uninsured baby boomers who often have a difficult time finding affordable coverage.
To help ensure you get the best health insurance coverage that fits your needs, here are some things you should know.
Health Exchange Overview
Starting Oct. 1, you will be able to shop for health insurance policies, and enroll in one directly through your state’s Health Insurance Marketplace website, over the phone, via mail, or in person at a designated center. The coverage will go into effect on Jan. 1, 2014.
You can also be reassured to know that federal law prohibits Marketplace insurers from denying you coverage or charging you higher rates if you have a pre-existing health condition. But they are permitted to set premiums up to three times higher for applicants over the age of 50, and smokers may be charged up to 50 percent more than nonsmokers.
To help make coverage affordable, sliding scale tax-credits will be available if you earn less than 400 percent of the poverty level -- that’s $45,960 for a single person and $62,040 for couples. These tax-credit subsidies will provide immediate savings off your monthly premiums. See the Kaiser Family Foundation online calculator (kff.org/interactive/subsidy-calculator) for a premium estimate.
Every state will have a Marketplace, but each state can choose how it will operate. Seventeen states and the District of Columbia will run their own state-based Marketplace, seven states will partner with the federal government, and 26 states will offer federal Marketplaces. The differences between federal and state programs will be subtle. You will be able to access your state’s marketplace at Healthcare.gov.
To make shopping and comparing a little easier, the health plans will be divided into four different levels -- bronze, silver, gold, and platinum. The bronze plan will have the lowest monthly premiums but the highest out-of-pocket costs when you need care, while the platinum plans will have the highest premiums with the lowest out-of-pocket costs.
You will also have a variety of health insurance companies to select from. To help you evaluate insurers, the nonprofit National Committee for Quality Assurance offers online “report cards” at ncqa.org that can help you narrow your choices.
Because most plans will be managed-care policies such as HMOs or PPOs that require you to get your care within a network of providers, you’ll want to make sure that the doctors and hospitals you typically use are covered in the plans you’re considering. The new Marketplace plans are expected to offer fewer choices of health-care providers, and who’s included may vary quite a bit.
You also need to find out what happens if you want to use a doctor or hospital outside a plan’s network. Will you have to get a referral or pay more to get these services, or will it even be covered at all?
Also check the plan’s formulary, which is the list of prescription drugs they cover, to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.
For assistance, contact the Marketplace Help Center helpline at 1-800-318-2596. Or, if you’d rather get face-to-face assistance, there will be designated centers set up with trained and certified navigators, counselors, and application assistors to help you, along with insurance agents and brokers. Call the Marketplace Help Center after Oct. 1 for a referral to help in your area.
Jim Miller is a contributor to the NBC “Today” show and author of The Savvy Senior. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org.
Your Opinions and Comments
Be the first to comment on this story!
You must be logged in to post a comment.
South Texas Living Archives
Apple Pie readers help Julia fill in the blanks (September 21, 2016)
Cheap cell phone plans for seniors (September 21, 2016)
Come And Take It starts Sept. 30 (September 21, 2016)
Disc water pitcher (September 21, 2016)
DRT chapter plans meeting, new member class (September 21, 2016)
Get ready to grill at show barn’s barbecue cook-off (September 21, 2016)
Old Town Day seeks vendors (September 21, 2016)
Poth VFD to serve up barbecued chicken (September 21, 2016)
Run and shine at Neon Sizzle 5K (September 21, 2016)
Spots open for Community Yard Sale (September 21, 2016)
St. Mary’s Fall Festival Sept. 25 (September 21, 2016)
Support FUMC youth at barbecue ‘fun’ raiser (September 21, 2016)
Teen MOPS plans upcoming meetings (September 21, 2016)
The root of many evils (September 21, 2016)
Uncovering local legends: The grave in the middle of the road (September 21, 2016)
URBAN-15 seeks dancers, drummers (September 21, 2016)
Chicago Cub yearbooks (September 14, 2016)
Enjoy Country Music Show Sept. 20 (September 14, 2016)
How to prevent falls at home (September 14, 2016)
Krawietz family reunion (September 14, 2016)
La Vernia EMS plans Car Show (September 14, 2016)
Labatt Club donates to library, children (September 14, 2016)
Low voices and high hopes (September 14, 2016)
Lutheran Church plans Sausage Dinner (September 14, 2016)
Medicaid covers mosquito repellent to fight Zika (September 14, 2016)
Metting family plans reunion (September 14, 2016)
Non-prescription drugs — the forgotten solution to rising health-care costs (September 14, 2016)
Relay For Life meeting is Sept. 15 (September 14, 2016)
Seguin Cowboy Gathering is Sept. 17 (September 14, 2016)
Smith Gas celebrates 88 years in business (September 14, 2016)
The life of Doris Billimek Moczygemba (September 14, 2016)
Trail ride donations surpass $1M (September 14, 2016)
Visit Remembering Our Fallen exhibit in Seguin (September 14, 2016)
Who will take care of you? (September 14, 2016)
A life shaped by hard work and hunting (September 7, 2016)
After-Dinner Chocolates (September 7, 2016)
Cajun music Sept. 10 (September 7, 2016)
Donate hearing aids, glasses, equipment (September 7, 2016)
Earn a certification in native landscaping (September 7, 2016)
Enjoy EquestFest 2016 (September 7, 2016)
Getting Engaged? How to spend wisely (September 7, 2016)
Mystery box (September 7, 2016)
Nominate a nonprofit for Literacy Award (September 7, 2016)
Old medicine chest dates back to 1821 (September 7, 2016)
Professional bull riding returns to Fredericksburg (September 7, 2016)
Register to run for tacos Oct. 1 (September 7, 2016)
Road Runners plan September outings (September 7, 2016)
Still time to buy tickets for Wild Game Dinner (September 7, 2016)
Take a tour of SS museum Sept. 17 (September 7, 2016)
Take the H-E-B Slim Down challenge (September 7, 2016)
Vote for top flick at Manhattan Short Film Festival (September 7, 2016)
Welcome to The Greenline, a 43-acre linear park (September 7, 2016)
‘Cupping’ long before Phelps did it (September 7, 2016)