What To Do If You Don't Have Health Insurance, Part 2

Mary Ann HodorowiczBy Mary Ann Hodorowicz RD, LDN, MBA, CDE, CEC

This is part 2 of our previous July article on what to do if you don't have health insurance. The really great news right now is that individuals without healthcare coverage through an employer or government program will have access to affordable coverage through the new state-based health insurance exchanges. These exchange health plans are effective January 1, 2014; this is the date when most people are required to have health insurance or pay a tax penalty based on their annual income. Open enrollment for the plan that best suits each person's needs begins October 1, 2013. This very transparent "apples to apples" health plan shopping can be done on the Internet and also in person at local centers specifically set up for this. The exchanges were created under the 2010 Patient Protection and Affordable Care Act (ACA), also known as "Obamacare" or the new healthcare reform law.

People who have not been able to afford their high premiums because of their age and/or medical conditions, denied coverage for pre-existing conditions, or had coverage rejected completely because they made a mistake on their application will now find multiple insurers competing for their business in the exchange market place.

The ACA requires these new exchange plans eliminate annual coverage limits, pay for a set of ten "essential health benefits," (including hospitalization, prescription drugs, and lab services) and provide select preventive services for free. The new exchange plans must also comply with some other key aspects of the law, such as the elimination of lifetime coverage limits and protections against insurers canceling your coverage after you get sick. The ACA also mandates that tax credits be available to people who enroll in qualified health plans through the exchange market.

There will be four different "metal" levels of health plans on the exchange. A bronze plan will cover at least 60% of costs, on average; a silver plan, 70%; a gold plan, 80%; and a platinum plan, 90%. Bronze plans represent the minimum coverage that most new health plans must provide in 2014. This translates to a major improvement for many people in the individual market. Why? Because in 2010, more than half of people in the individual health plan market had "tin" plans that covered less than 60% of costs. In bronze plans, people will generally see lower premiums but higher deductibles and higher out-of-pocket costs. Platinum plans, however, will typically have higher premiums but lower deductibles and lower out-of-pocket costs. There will also be a ‘catastrophic' plan (5th type) for people younger than 30 years old who are exempt from the ACA's individual insurance mandate due to financial hardship.

Finding a Plan

The big question is "How can I find the plan that's best for me?"  Here are some key suggestions: 1. Ask for help with specially trained ‘exchange navigators" whether you are shopping online or at local centers. Every exchange will have these navigators who will also help consumers prepare their plan applications. Navigators can't receive compensation from health plans for enrolling consumers. If the state permits it, insurance agents and brokers can enroll people in exchange plans and receive compensation from insurers for doing so.

2. Learn the fine points of each health care plan, and not just the name of the metal. It is very important to consider the maximum out-of-pocket costs and deductible you may have to pay, as well as the types of services that require co-payments (a fixed dollar amount you pay for a service) and co-insurance (a percentage of the cost of services that you must cover). Two plans at the same metal level can mean dramatically different out-of-pocket costs for consumers.

3. Review your health-spending patterns when assessing all the plan options. If you have an expensive chronic condition, deductibles and co-pays may matter less to you than the annual limit on out-of-pocket costs. If most of your spending is on drugs, however, you might focus on plans that have low drug co-pays.

4. When comparing plans, also pay attention to the choice of physicians, other providers (example, nurse practitioners, physical therapists), hospital, clinics, etc. that you will have within the health care plan's network. Insurers trying to hold down costs may have smaller provider networks than people who get coverage through their employers.

5. Federal government subsidies may also have an impact on the type of plan that works best for you. The premium tax credit, for example, is tied to the second-lowest-cost silver plan in your area. If you choose a gold or platinum plan, your tax credit will cover less of the premium. And the cost-sharing subsidies available to people with income below 250% of the poverty line apply only to silver plans.

If you would like more information, here's two things you can do:

Read Mary Ann's bio.

Read more of Mary Ann's columns.

Mary Ann is a consultant, speaker, writer and trainer for the health, food and pharmaceutical industries in nutrition, diabetes and insurance reimbursement.  Her clients include healthcare entities, membership associations, research firms, pharmacies, education/training firms, government, websites, academia, media and individual healthcare professionals.  Mary Ann specializes in helping clients establish AADE-accredited DSME programs, MNT programs, shared medical appointments, marketing and insurance reimbursement policies and procedures, and training educators on motivational interviewing and strategies for successful patient behavior change. Mary Ann is on the AADE Board of Directors and has served on numerous committees of the Academy of Nutrition and Dietetics, its practice groups and state affiliates.

For more information about Mary Ann Hodorowicz, RD, MBA, CDE, CEC and Mary Ann Hodorowicz Consulting, LLC, visit www.maryannhodorowicz.com - Nutrition, Diabetes Care & Education, Health Promotion and Insurance Reimbursement for Professionals for the Healthcare and Food Industry.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: July 27, 2015

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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