Obamacare: A Shopping Mall Experience

SHoppingmallMost of us get our health insurance through our employer. Many work for employers who pay part of the cost of our monthly premium, decide on the issuer of our plan, and chose our co-pays, deductibles and out-of-pocket costs for us. Individuals purchasing insurance, mainly the self-employed or individuals who find it cheaper to have their own individual plans, go out and attempt to buy insurance on their own in the open market.  On Tuesday, Oct. 1, 2013, a new shopping experience opened for individuals by way of a website at healthcare.gov. This website allows individuals to compare issuers and plans all in one place and is called the Health Insurance Marketplace.

Imagine the Health Insurance Marketplace as a virtual shopping mall experience. On the Marketplace, you compare, chose and enroll in insurance company plans which have been reviewed and approved by both the state and federal governments for purchase on the Marketplace.

In order to make these plans comparable for you, the government has required that plans be issued as a metal tier and there are limits on how much you would have to pay annually for your deductibles, copays and coinsurance combined together. This limit is called your annual out of pocket maximum.

What’s a Metal Tier?

Simply put, a metal tier is the estimated amount that a health plan would pay for covered services in that specific metal tier. In a bronze plan, the health plan would pay 60 percent of the expected cost of care which translates to a lower monthly premium. In a silver plan, the health plan would pay 70 percent of the expected cost of care which would translate to a slightly higher monthly premium but more of your medical costs would be covered by the plan when you receive care.

Have the following information handy when you sit down to evaluate your options and enroll:

  • Social Security Numbers (or document numbers for legal immigrants)
  • Employer and income information for every member of your household who needs coverage (for
  • example, recent pay stubs or W-2 forms)
  • Policy numbers for any current health insurance plans covering members of your household.

You also need to complete an Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. You need to fill out this form for coverage you are eligible for but didn’t enroll in. Your employer can help you complete that form.

You are still be able to purchase individual health insurance directly from an insurance company during the open enrollment period which ends on March 31, 2014, but in order to receive a tax credit to reduce the cost of your monthly premium, you need to purchase your insurance through the Health Insurance Marketplace. These tax credits are only available if you enroll through the Health Insurance Marketplace.

If you are curious whether or not you would qualify for a tax credit and the estimated amount of that tax credit, the Kaiser Family Foundation has a cool tool you can use to help answer that question.

As you can tell, there are lots of moving parts in the operation of the Marketplace.  I’m telling my friends and family to wait to sign on until November, let the system glitches get worked out first. The first coverage date for insurance plans sold on the Health Insurance Marketplace is Jan. 1, 2014, so you have time.

By Deb Muller

Chief Administrative Officer at Avera Health Plans