11/1/2012 5:15 PM ET|
Where to buy a health plan in 2014
Under the Obamacare mandate, most Americans who don’t have coverage now will need to find health insurance soon. Here's where to look.
Starting in 2014, the federal government will require you to have health insurance. That's when the individual mandate goes into effect under the Affordable Care Act.
Upheld by the U.S. Supreme Court in June, the mandate requires everyone (with a bunch of exceptions) to have health insurance, whether it's through an employer-sponsored plan, a government-funded health insurance program (such as Medicare or Medicaid) or a private individual policy.
Worried about where you'll find a health plan? Here's where to look in 2014:
State health insurance exchanges
The Affordable Care Act requires states to set up competitive health insurance marketplaces called exchanges. The federal government will set up the exchanges in states that don't set up their own.
The exchanges will offer websites where you can compare health insurance plans and prices and buy coverage online. You'll also be able to see whether you qualify for government-funded insurance programs or government subsidies to help you afford health insurance premiums.
"It's a pretty impressive platform to set up," says Dan Maynard, the president of Connecture, a Milwaukee area-based software company that's designing the online-sales systems for exchanges in Maryland and Minnesota.
The websites will include self-service tools to guide you through the process of enrolling in government programs, if you're eligible, or choosing a private health plan based on your needs.
In most cases, exchanges will include call centers, where you can phone for help in choosing and enrolling in a plan, Maynard says. All exchanges will work with so-called "navigators." These are groups and professionals in the community who can help you enroll in a health insurance plan through a state exchange. Insurance brokers, consumer advocates and nonprofit groups could serve as navigators, and some state exchanges might have community outreach centers.
"Each state is going to approach it a little differently," Maynard says.
Health insurance companies and brokers
An estimated 30 million Americans are uninsured now. That's a lot of folks to hit the insurance market all at once, especially as new regulations go into effect, such as premium subsidies for people who meet certain low- and moderate-income requirements.
"Not everybody speaks insurance-ese," says Carol Taylor, the director of compliance and government affairs at Beacon Benefit Consulting in Jacksonville and Orlando, Fla. "It's going to be very, very complex. Agents are still going to have a consultative role."
Even though consumers will be able to shop for themselves through the exchanges, many will want some personal help from an insurance agent to sort through the options, she says.
Aetna, one of the largest health insurers, remains committed to brokers and will offer incentive programs to build stronger relationships and develop new technology to make it easier for brokers to work with the carrier, says Barbara DeMaio, the head of individual business for Aetna.
Health insurance companies will also sell plans directly to consumers through their own websites and call centers.
DeMaio says Aetna expects most of its business will continue to come through brokers and directly to the company in 2014. Sales through state exchanges will grow as the new marketplaces get established.
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Health insurance retail stores
Some health insurance companies are opening retail stores where you can shop for a policy, check on claims and get one-on-one health education coaching. For example:
- Highmark Blue Cross Blue Shield just opened its newest Highmark Direct store in Erie, Pa., the company's ninth retail outlet in the state.
- Blue Cross and Blue Shield of Florida has opened 10 Florida Blue Centers in the state.
- Last year, UnitedHealthcare opened a 16,000-square-foot center in New York, which the company says will serve as a model for future centers. The insurer operates several other smaller stores.
- Aetna continues to market high-deductible health plans through Costco, the members-only warehouse retailer, in nine states. Costco employees provide brochures that describe the health insurance program, and Costco members can go online or call to sign up for a plan. Aetna plans to expand this program to other states.
Private insurance exchanges
In addition to the state-sponsored exchanges, a variety of private exchanges will serve as marketplaces for comparing health plans and buying coverage.
Private exchanges have been around for decades. Nonprofits or companies, rather than the state or federal governments, own and run private exchanges. Some feature plans from a single health insurer. Others let you compare plans from competing health insurance companies. In some cases, your employer might contribute a certain amount of money for you to purchase insurance and then send you to a private exchange to pick out a plan.
Why have private exchanges when state-run exchanges will open in 2014? The private exchanges give health insurers another channel to market their products. In Massachusetts, where a government-run exchange has operated since the state reformed its health care system, health insurers have continued to market to groups and individuals through privately run exchanges.
Meanwhile, no matter where they're sold, all health plans will have to live up to minimum standards of coverage set by the Affordable Care Act. That means you will qualify for coverage even if you have a health condition, and plans must provide certain benefits.
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I found out first hand what an awful mess the American healthcare system is in when I suffered an industrial accident which landed me in a burn ward for three months, crippled my right foot and took me out of the work force. Healthcare is pretty nice when your company qualifies for group rates, handles all the paperwork, and sees that you cannot be excluded for pre-existing conditions; but it is a living nightmare out there should you ever lose your job through sickness, injury, or other reasons and must scrounge for coverage in the private market.
In my case, my injury (though covered by workers comp) disqualifies me from obtaining general coverage in the private market At ANY PRICE. I am deemed too great an unknown liability and there is no place for a person like me on their for-profit spread-sheets. Fortunately I had no family to support and I had my life's savings to fall back on. It was only by drawing deeply on these reserves that I was able to find and keep any sort of coverage at all, just not through the private market.
The only way I could get insured was through the State's (yes, there is that hated 'nanny-state' again! Meddling in business affairs and trying to look out for people), I say the only way I could get insured was through the state's HIPAA program of guaranteed coverage, but even that was a touch and go proposition. One mistake, one returned letter and I would have been SOL. To qualify, you MUST exhaust your COBRA coverage without a lapse, beat the narrow window of qualification (thanks Nixon.) and squirm through all the other pit-falls and hoops in the way of obtaining coverage.
And even then, although the insurance company cannot refuse to cover you, they DO get to set the premiums; and in my case HumanOne jacked my rates up after the first year from $440 a month to $650 a month, an increase of 67% in a single year! In an effort, I suspect, to price undesirable clients out of the market before the first of the ObamaCare reforms hit. And indeed, after the mandate came on line that 80% of all premiums collected must be spent on actual health-care rather than profits, my health insurance rates fell back down to under $400 a month and I received a nice letter informing me that I may have a refund on the way.
The truth is that good people through no fault of their own are being slaughtered financially by the healthcare system in America every day. Indeed, one of the greatest cause of bankruptcy in America is when a family is stricken by serious illness and exhausts or losses coverage. That is you and me, my friend.
But while the GOP sought to stone-wall, dig in their heals and do everything in their power to see that no reforms were made, only the Democrats under Obama had the grit to tackle the issue and forge ahead.
And now that reform is a defacto reality, even the GOP (when not vowing to repeal ObamaCare), is actually talking about reform, about allowing the 25,000 dependents to stay on their parents plans, and not allowing the worst offenses of the Insurance Companies past such as revoking coverage on the feeblest of pretenses once someone gets seriously ill. This is progress friend. It is a place to start and a place from which we can proceed. No matter how the election turns out,this is a good thing and Obama deserves the credit.
The moral of the story is - an ounce of prevention can not only save lives but a lot of money ($1,000 prescription vs Thousands of $ a day for a week in the hospital with a blood clot in the lung)
I didn't pay the thousands of $ a day - our insurance did (trust me we had more than fulfilled our $5,000 deductible at that point) but the fact that my husband COULD HAVE DIED because the health insurance vs prescription company didn't see the worth in some prevention.
I know there are many people against "Obama Care" but for all the yelling about repealing it I haven't heard any other ideas. There is something seriously wrong with the health care system in our coutry. I don't know if Obama Care is the answer - but it least it is something - the beginning of a step in the right direction.
who doesn't have 12 grand plus deductable to pay insurance companies every year...so I make 30 grand a year and must pay 8 grand in taxes plus 12 grand for health care... thank goodness for welfare
"Starting in 2014, the federal government will require you to have health insurance. That's when the individual mandate goes into effect under the Affordable Care Act."
So those who can't afford it now at any cost are required to buy it or pay a fine and go further in debt? Hey Obama, how is this going to help these folks? Maybe you could just pass a law saying no one can be poor anymore and problem solved.
If you think you will get affordable health care, then think agian. The switch and bait rates are now in affect for a few, but after everyone is locked in, the rates will rise as insurance companies are already asking for rate hikes. You who have your company paying most of your costs, will soon have your plans dropped, thus you will pay 100% of the costs. Not cheaper.
Government run health care will never be cheaper, better quality, nor more efficient. Don't think so? All I can say is DMV, TAS, IRS, FEMA, INS, Welfare...etc.
I am not being critical of insurance, especially health insurance. But, I am being crititcal of insurance as it seems to be in America now. When you get close to 65, you will get almost daily one, two or more letters offering you the best insurance but you MUST Call today! Then, tomorrow you get more, and so on. I have started sending back rude letters. And, when you get the business reply envelopes, they usually go to a different address than the one that sent you the junk. You also get offers of a reverse mortgage that in my opinion is designed to take your home. I think we need a national healtcare system but nothing like what we have today. VOTE CONGRESS OUT!!! They allow direct marketing and then you get endless junk mail pressuring you to buy TODAY always AFFORDABLE!
One thing I did not see mentioned was that seniors over the age of 65 will not be purchasing their insurance through these health exchanges. Individuals (not on an employer health plan) will still purchase Medicare Supplement and Medicare Advantage Plans through traditional methods.
Medicare Supplement Plans will not be affected by the Affordable Care Act, but Medicare Advantage Plans are expected to see a 7% cut in subsidies.
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