It’s almost upon us, the first year of health insurance exchanges. There are several pitfalls you can avoid by reading through.
It’s going to cost you. If you’re employed 30 or more hours a week, and your employer offers benefits, pay special attention to the rates being charged by your employer-sponsored insurance for your dependents. While your premium amounts are covered by Affordable Care, there are no such barriers to charges imposed by insurers on your dependents. There will be little you can do in many cases except opt for worse insurance coverage for your dependents. If your spouse is employed more than 30 hours a week, their insurance options through their employer might be better.
Maybe you won’t cover your grown adult children. If you’re currently paying for insurance for your grown children, consider new options available to them depending on whether they’re in school, eligible for Medicaid, or perhaps eligible to participate in the exchanges and get premium credits or rebates. Obamacare might have shot itself in the foot with this one, and may end up actually losing some of the gains in getting young people insured that were achieved by “allowing” parents to pay for health insurance coverage for their grown children, depending on whether such coverage remains affordable for parents in the coming year.
Calculate your income. Make sure that you don’t underestimate your income if you participate in the health exchange, either state or federal. While your rebates and credits for premiums will be calculated on those sites, if you end up earning more in the year, you’ll have to repay amounts that exceed what you would have been entitled to if you had entered a more accurate picture of what you earn.
Leave yourself time. Make sure you leave yourself enough time to consider what kind of coverage you’re getting with your insurance plan choice. Remember, insurance companies make money in two ways, charging more and covering less. Even within plans that are both described as silver, you’re likely to see differences in providers, and coverages.
Bronze, Silver, or Gold? Don’t be penny wise and pound foolish when you choose your insurance coverage. Remember, if you don’t get sick, you really don’t need health insurance since a checkup will ALWAYS cost less than a year’s worth of premiums. If you do get sick, you should try to make sure that you have coverage that will prevent you from going broke, which means a silver plan, at 70 percent coverage of covered costs is less value than a gold at 80 percent. If the difference is not so significant as to price between silver and gold, and you can afford the better coverage, choose it.
Teeth. Don’t forget the dental insurance.
You should always get medical treatment you need. There are people who will slip through the cracks. Likely, they will also likely be exempt from paying the tax on individuals who fail to get health insurance. But, the result is that they have no health insurance. This is our system’s failure, and getting the health care you need is your primary goal. Do it any way you need to. Remember Obamacare is a politically motivated insurance program, not a healthcare program.
When. Pay attention to timing for enrollment season. Open enrollment for insurance plans (typically from October through November of one year for insurance coverage for the next) applies to the health exchanges, although this year open enrollment for the federal health exchange goes through March 2014.
You must enroll during open enrollment UNLESS some exception applies to you such as becoming newly unemployed/uninsured, change in status impacts your health insurance coverage during the year (these are open enrollment exceptions that occur with triggering events).
Less Choice. Make sure your plan provides enough choices of providers for you under a plan so that you can change providers if you notice changes that don’t suit you. There are currently many monetary incentive programs awarding physicians for implementing different cost-savings strategies that can impact your experience as a patient, including all the “counseling” type of services designed to reduce the time you spend with your physician by assigning you to another worker.
Physicians are currently getting paid for implementing cost-savings practices and will do it to a larger or lesser extent so that you should be prepared to change providers if you’re unhappy with your level of care.
Most of these “counseling” type of programs are elective but you’ll be pressured to use them because there is often money in it for the physician. These programs are not bad, because they give you personalized attention from professionals seeking to improve your health outcomes, but they are financially motivated by physicians and insurance plans.
Medicaid. If you’re eligible for Medicaid expansion in your state, double check on how your prescriptions will be handled. Unfortunately, it’s a stubborn rule, insurance is only less expensive when it provides less, and already some drug categories are so limited that you’ll have only a single option for coverage. While it’s less clear how this will work with private insurers, it is important to find out how your medications will be covered under your plan.
Appeals. Before you sign up, read the appeals process of any plan and make sure that you understand it when it come to claim denials.
Make sure you understand when pre-authorization for medical treatment is required. The Affordable Care Act removes this requirement only for emergency treatment, though notifying your health insurance as soon as possible afterwards is wise, even in the case of emergencies.
Try using the “Subsidy Calculator” from Kaiser Permanente.
