Insurance shopping on new marketplace requires game plan

jholleman@thestate.comSeptember 30, 2013 

  • thestate.com

    Download a one-page guide on how the Affordable Care Act will work in South Carolina at thestate.com/healthysc. There, you can also read previous stories about Obamacare.

    Insurance game plan A guide for shopping on the Health Insurance Marketplace

    1. Wait. The first real deadline to sign up is Dec. 15, and the first few days of the new system could be a mess.

    2. If can’t wait, go online to healthcare.gov to shop.

    3. If you have no online access, visit a public library or one of the designated sites for “Navigators.”

    3. Have your Social Security number, email address and income tax documents because you have to estimate your income to determine how much – if any – tax credit you will get.

    4. Start shopping by determining which level of insurance – catastrophic, bronze, silver, gold are your choices in S.C. – you want.

    5. Once you determine a level, decide which of the plans at that level fits your needs, based on factors such as deductibles, provider networks and procedures covered.

    6. There are four companies offering 32 different plans in many S.C. counties, including Lexington and Richland, and 27 plans in the other counties.

    7. Take a deep breath. You can log off the computer and come back another day to buy insurance.

    8. If you’re confused about details of the policies, contact an insurance-savvy friend or a private health insurance agent who can explain them and offer advice.

If you’re one of the hundreds of thousands in South Carolina who will be shopping on the new Health Insurance Marketplace that opens Tuesday, you need a game plan.

Some things to consider:

•  There is no rush. Prices won’t increase later in the shopping period. The true deadlines are Dec. 15 – the last day to buy and have insurance coverage by Jan. 1 – and March 15 – the last day to buy and have coverage in time to avoid penalties.

If you are Internet savvy and can’t wait, you can go to healthcare.gov on Tuesday. Be prepared for hiccups on the website. If you haven’t already, you can get a head start by going online to register for an account.

Tuesday will be like what businesses call a “soft opening,” according to Tim Liszewski, who is helping coordinate the S.C. Progressive Network’s registration effort. The Progressive Network is one of the Navigators and Certified Application Counselors who received federal grants to train employees in signing up citizens for insurance.

•  Most people don’t have to do anything. If you are on Medicare or Medicaid, you can sit this one out. If you have insurance through your work, you probably will not find a better deal on the new marketplace. Those covered by company plans aren’t eligible for tax credits unless the premiums for their company plan are more than 9.5 percent of their income.

•  Gather a few things. To shop for insurance, you’ll need your Social Security number, policy numbers for any current health insurance plans, and employer and income information for every member of your family who needs coverage. That means pay stubs or W-2 forms. You also will need an email address.

What about those with no internet access or who aren’t computer savvy? The easiest places to go might be local public libraries, which usually have multiple computer stations and staffers who can help you get started. Also, the Navigator and Certified Application Counselor groups can help. While they plan to have staffers in other places during the next six months, most groups expect to stick to their main offices in the first few days. In the Columbia area, try the Cooperative Ministry at 3821 W. Beltline Blvd., the S.C. Progressive Network at 2025 Marion St., the Greater Columbia Community Relations Council at 930 Richland St. and Eau Claire Cooperative Health Centers at 4605 Monticello Road.

•  Private insurance agents are another option. Some insurance agents also have gone through the training and licensing procedures. You do not have to pay them a commission because that expense is built into the insurance premiums. Make sure they are helping you shop on the federal Health Insurance Marketplace, not for private insurance. And don’t pay anything for the services. (Those credentialed to help on the marketplace can put their broker ID number on the forms to get paid by the feds.)

•  Ready to shop. When you get to the shopping level on the website, you need to go slowly and make sure you understand terms such as deductibles, out-of-pocket expenses and co-payments. If you’re unfamiliar with those terms, a Navigator or an insurance agent can help explain them. You’ll be able to chose among 32 different plans from three different companies – BlueCross BlueShield of S.C., BlueChoice Health Plan, Consumers’ Choice Health Plan and Coventry Health Care of the Carolinas. Consumers’ Choice is a new non-profit co-op set up to provide more competition in the marketplace.

•  Play the percentages. Most of you will chose between three levels of coverage. Bronze coverage pays 60 percent of most health care costs, which means you pay 40 percent. Silver plans cover 70 percent, gold plans 80 percent. People 29 and younger have another choice, catastrophic coverage, which pays for very limited coverage. Premiums for bronze plans will be much lower than those for gold plans. But those who go with bronze plans will have higher out-of-pocket expenses and are gambling they won’t need much medical care.

•  The devil is in the details. All of the plans cover 12 basic medical situations, including physician visits, prescription drugs and hospitalization. But many other aspects of the different plans won’t be revealed until the marketplace opens Tuesday. Some plans might pay for a smaller group of medical providers, meaning you have to pay more if you go to doctors or facilities that aren’t in that provider group. Some might pay a portion of gym membership to encourage better health. One plan might pay for many more visits to a physical therapist than another plan. Choosing a plan is the most difficult part of the process. Navigators and Certified Application Counselors can explain the terms to you, but they aren’t supposed to give an opinion on what’s the best plan for you.

•  Price, price, price. The website will show you how much tax credit you will get -- if any -- and will deduct it from your upfront cost. That’s also the way the payment system works. It’s what’s technically called an “advance premium tax credit,” and a twelfth of it will be deducted from each monthly premium payment. For example, if your annual cost for insurance is $2,400, you will be required to pay in monthly installments of $200. But if you qualify for a $600 annual tax credit, that would reduce your monthly bill by $50. In that case, you would owe $150 a month.

•  Go slowly. You can shut down the procedure and pick it back up at the same spot on another day. Like any other major purchase, it’s always a good idea to consider all options and then go home and sleep on it.

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