Beginning in 2014, individual and family health insurance plans were purchased through State Exchanges. New rates and regulations changed how we purchase medical coverage and the price that we pay for it. Our website provides the lowest available Health Exchange rates, and makes it easy for you to apply and enroll for a policy.
We also help you request obtain instant subsidy tax credits that reduce your premium and teach you about the Affordable Care Act and the newly-created Marketplaces. Determining your eligibility involves several steps, and we can quickly calculate the amount in about a minute.
What Is Different About Buying Coverage Through An Exchange?
Each policy that is offered must (by law) contain certain provisions (referred to as EHB), whether you request them or not. Some of these benefits are newborn and maternity, substance use disorder, mental health, treatment of behavioral health, vision and oral care, prescriptions and management of chronic diseases. Of course, this is just a partial list of ailments that must be covered in advance.
Each year, it is expected that the Department of Health and Human Services (HHS) will add a few new mandates. Mental illness and preventive coverage are two of the major areas that have made the most progress in recent years. Expansion of newborn expenses and chronic treatment may be the next items that are expanded.
When Will Rates Be Available?
Prices are published by each state separately, since costs are different. Usually, carriers officially file their anticipated pricing by June or July. State Insurance Departments typically approve (or disapprove) the requests within 3-5 weeks. Also considered are rates from new companies entering the Marketplace. For instance, in 2015, Aetna and UnitedHealthcare will participate in may more states than in 2014.
Vermont was the initial state to publish their premiums. Vermont Health Connect will charge between $750 and $1,750 per month for a family, depending on the plan. Tax subsidies, if available, will reduce these amounts. Blue Cross Blue Shield of Vermont and MVP Health are the two carriers that will offer policies in the state. Although Vt. is preparing to become a single-payer system, it will not be effective until 2017.
Bigger states, such as Texas and California were also able to quickly provide their Marketplace prices, despite the higher number of carriers and plans available for consumers. Larger states will typically feature a combination of HMO, PPO, HSA and Point-Of-Service options, which often allows a broker to custom-fit a plan to meet needs more easily.
Since that time, all states have published prices, and you can request a free quote from our website. Additional policies are offered “off” the Exchanges and options are especially attractive for households making more than $100,000 per year. There are also several “non-compliant” plans that cost about 40%-65% less than a Marketplace policy, but contain mainly catastrophic benefits.
Will You Apply For Coverage Like You Do Now?
Applications look completely different. One reason is that there are no medical questions! Although your premium can be adjusted due to your age, smoking status and zip code, your overall health will have no impact on prices. So hypothetically, an applicant that is treated for terminal cancer and insulin-dependent diabetes will pay the same rate that a perfectly healthy person pays (assuming same age etc…) Is that fair? I suppose that depends on what medical conditions you are being treated for.
We have set up a special section of each page on our website to enter your zip code. That will generate a free online quote so you can easily look at the different plans. Ultimately, if you decide to apply for benefits, we will help, including determining how much money the government will give you in the form of a federal subsidy.
For some individuals and families, your policy may be free, since the subsidy may exceed the cost of the plan you are buying. And of course, certain states (Ohio and Pennsylvania) will be cheaper than other states, such as New Jersey and New York.
Will All Of The Big Companies Offer Policies in 2014?
Initially, in the first year, not every company is actively participating. This includes the “biggies” like Blue Cross (Blue Shield), Aetna, UnitedHealthcare, Humana and Cigna. Although there will be other carriers that join this group, it is expected that some of them will eventually stop offering individual health care coverage to consumers. For example, UnitedHealthcare has opted out of most states, but will offer contracts away from the Marketplaces. Aetna and Cigna have followed the same path.
Why? The toll of having to guarantee unlimited benefits to anybody who applies for a policy is a tremendous financial risk. And not every insurer can sustain paying out higher than expected claims every year. In fact,both UnitedHealthcare and Aetna have stated that one reason they will not initially participate in many State Exchanges is because of profit concerns.
Will I Be Able To Keep My Current Plan?
Although President Obama said you can, most industry experts say it won’t be possible for every plan to be kept. In fact, it is possible that the majority of plans will not be able to be kept. Since there will be requirements (by law) to include maternity, mental health coverage, drug addiction treatment and contraceptive coverage in all policies, any existing plans that don’t include them, will have to be scrapped.
While it is possible that some of these plans can be revised to include these benefits, that will force premiums up. Also, it is assumed that many employers will opt to pay a small fine instead of offering health care to their employees. This could save millions of dollars, and it would be hard to explain to company shareholders why they did not do this. And certainly, the number of part-time employee hires will be greater than ever, since benefits paid will be a fraction of what full-time employees will receive.
Our Household Income Is More Than $100,000. Will We Receive Tax Credits?
No. The maximum family income to receive a tax credit is about $95,000. So you would have to pay the entire cost yourself. However, by selecting an HSA plan, you will be able to lower your premium and tax-deduct contributions you make to the Health Savings Account portion of your coverage. In fact, we expect HSA plans to be one of the most popular options for families that want to pay as little as possibly but keep control over their costs and benefits.
Can I Buy A Plan Outside Of The Exchange?
Yes, you can. However, you may not be eligible for tax credit reimbursements by purchasing an outside policy. However, assuming it is a reputable plan from one of the large insurers, the premium you pay could be substantially less than what is typically available. In that situation, it may benefit you to choose coverage outside of the Exchanges, especially if your household income exceeds $95,000. And you can expect a richer network provider list.
Will HSA Plans Be Available?
Fortunately, they are, and all tax advantages of these types of contracts should remain. We anticipate that the usage of HSAs will substantially increase in 2014. Many of the other plan options will be very expensive to consumers that are in excellent health and thus, may not utilize many of the benefits that will be required to have. Blue Cross, UnitedHealthcare, Humana and Aetna (and perhaps some other carriers) will be some of the companies offering the best options.
What Type Of Scams Should I Look Out For?
The Better Business Bureau and State Attorney Generals are already watching very closely how consumer confusion with the legislation is starting to give scammers some ideas, especially with seniors who are already a big target.
Releasing your social security number should always be a top concern. When comparing and reviewing different plans, you do not need to provide your social security number. You should also never provide your checking account, debit account or credit card information when visiting a website. The exception, of course, is when you are applying for coverage through a respected and recognized broker or government website. If you’re uncertain, ask us and we will investigate.
Also, if you receive a call (phone) from a federal worker that is offering to send you a new “federal medical card,” but needs personal information, it is probably a bogus call. Simply hang up. This type of card does not exist and no legitimate person will call you about it.
Are The Establishment Of The Health Insurance Exchanges The First Step Towards Socialized Medicine?
That depends on who is answering the question. We have 32 years of experience in this field, so we believe we are fairly informed and unbiased. Based on the large number of unanticipated claims that will be filed by previously uninsured persons, there will be a lot of financial pressure on the health insurers, especially the smaller regional carriers.
Not all of them will survive. And what happens if only a few are left…or perhaps even one? That would create a very gloomy outlook, which would almost guarantee that federal intervention would be required, and probably a single-payer socialized medicine health care system. But let’s give the Exchanges a chance. The concept might work.
UPDATE: December 20 2013 – Was your health insurance policy canceled? If it was, you’re getting a slight reprieve since you now ill not have to pay the tax (mandate) for not purchasing qualified coverage. Also, you will now be eligible to buy “catastrophic” plans, that are often the cheapest option on the Exchanges. However, they do have very limited benefits in some areas.
The timing is helpful since December 23rd is the deadline for securing a January 1 2014 effective date. Applications received after December 23rd will be issued with a February 1 effective date. Open Enrollment ends in the Spring, and will start over again later in the year.
UPDATE: March 6 2014 – Open Enrollment is scheduled to end at the end of the month. However, it is possible an extension will be announced (despite contrary rumors). For 2015, an additional 30 days was added. Also, it was announced by the White House that if you own an existing policy that does not meet ACA guidelines, you may keep it an additional two years.
Annual limits for out-of-pocket costs (cost-sharing) has now been increased to $6,600 for individuals and $13,200 for families.