Health Exchange shopping tips
The Savvy SeniorSeptember 4, 2013 | 1,758 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
A creepy Halloween party appetizer (October 19, 2016)
Applying for Social Security (October 19, 2016)
Chili Cook-off to benefit Wilson County youth (October 19, 2016)
DRT joins Heritage Music Festival (October 19, 2016)
DRT to meet Oct. 24 in Kerrville (October 19, 2016)
Enjoy Harvest Festival in Marion (October 19, 2016)
Enter Pecan Bake Show (October 19, 2016)
Little Golden Books (October 19, 2016)
Make plans for Halloween fun and fall fests (October 19, 2016)
Meeting the needs of the community: St. Vincent de Paul (October 19, 2016)
R&B legend opens Carver season Oct. 29 (October 19, 2016)
Readers share their spooky tales, part two (October 19, 2016)
Road Runners plan Oct. 22 group run (October 19, 2016)
See country legends Oct. 22 (October 19, 2016)
Try your hand at square dancing (October 19, 2016)
Turn yard waste into gardener’s gold (October 19, 2016)
Baptist church to ring in 100 years (October 12, 2016)
Church plans Junk and Treasure Sale (October 12, 2016)
Comal Country Music Show is Oct. 18 (October 12, 2016)
Davy Crockett (October 12, 2016)
Enjoy fried chicken in Poth Oct. 23 (October 12, 2016)
Enjoy this flashy winter resident (October 12, 2016)
Join in the 2016 Rosary Crusade (October 12, 2016)
National Charity League plans celebration (October 12, 2016)
New program increases student knowledge of E-cigarette dangers (October 12, 2016)
Play bunco in La Vernia Oct. 22 (October 12, 2016)
Pondering a poignant letter from the past (October 12, 2016)
Save the date for Oct. 22 March for Life (October 12, 2016)
Should you redeem old savings bonds? (October 12, 2016)
Show Barn Cook-off approaching (October 12, 2016)
Sutherland Springs Old Town Day (October 12, 2016)
The business of aging grows more complex (October 12, 2016)
Try your luck at China Grove Lions Club Casino Night (October 12, 2016)
Atascosa County Craft Show seeks vendors (October 5, 2016)
Beautify your landscape with cacti (October 5, 2016)
Experience Oktoberfest in San Antonio (October 5, 2016)
Gilded peanuts and golden memories — recalling past Floresville Peanut Festivals (October 5, 2016)
Japan Fest set for Oct. 16 (October 5, 2016)
Meal service delivery options for seniors who don’t cook (October 5, 2016)
Oktoberfest comes to Floresville Oct. 15 (October 5, 2016)
Past Pirate champions will never be forgotten (October 5, 2016)
Readers share their ‘spooky’ tales (October 5, 2016)
Sacred Springs PowWow (October 5, 2016)
Shorter teapot (October 5, 2016)
Sinatra tribute comes to Kerrville (October 5, 2016)
Stockdale librarian updates Blue Bonnet Club members (October 5, 2016)
Sunnyside 4-H Bake Sale (October 5, 2016)
Time for turkey in Cestohowa (October 5, 2016)