Making Sense of the Health Insurance Marketplace


The launch of the much-anticipated online health insurance marketplace—and the subsequent technical issues—has led to a flurry of confusing, partisan-infused discussion.

All of this noise makes sorting out fact from fiction nearly impossible; creating an especially challenging situation for those caregivers who aren't yet 65 and are trying to get their own health insurance coverage before Medicare.

There are a few key things that caregivers, especially those who don't receive health benefits from an employer, should know about health insurance and the Affordable Care Act (ACA):

You may not be able to keep your plan: Some Americans (About 11 million individuals, according to U.S. Census Bureau estimates) have recently received notices that their current health plans are being cancelled as a result of the ACA. Negotiations are currently underway to allow these people to keep their plans for one more year, but the cancellations have come as a shock to many, given that lawmakers repeatedly assured consumers that anyone who wanted to would be able to keep their plan under the new law. The majority of the plans that will eventually be discontinued are ones that don't meet the specifications outlined in the ACA, specifically, mandatory coverage of certain services and a maximum cap on out-of-pocket expenses of $6,350 per year. "The law aims to standardize policies so that people aren't taken off-guard," says WebMD health reform expert Lisa Zamosky. "Lots of plans on the market simply don't meet these requirements." But a cancelled plan isn't akin to a complete loss of coverage. Most health insurers are offering beneficiaries the option to enroll in an ACA-compliant plan similar to their old one. Zamosky says it's prudent for people with cancelled plans to consider shopping around on the government site—once it's fixed.

You may have to pay more: An unfortunate consequence of forcing health insurers to cover a certain baseline level of care and preventing them from denying coverage to individuals with pre-existing health conditions is that the cost of the average health insurance plan is going up, according to Zamosky. It's nearly impossible for experts to determine the price of an "average" health insurance plan on the marketplace, but Mark Colwell, director of consumer marketing for says there are three main factors that determine how much an individual will have to pay for a given plan: household and annual income, health plan category (there are four levels of health plans on the exchange—bronze, silver, gold and platinum) and annual deductible level. Income is a huge factor in determining subsidy qualifications. If an individual makes more than $46,000 (or a family of three makes more than $78,000) annually, then they won't be eligible for financial assistance, and their health insurance costs are likely to increase.

You may benefit from looking outside the marketplace: One strategy insurance companies can still use to manage their costs is to limit the number of health care providers included in a given plan, so some people are discovering that their long-time doctor isn't included in the plans offered on the exchanges. If you find yourself in this situation, you can either find a new doctor who is included in the marketplace plans, or you can venture beyond the exchanges and look at the plans offered by larger online brokers. What you should do in this situation largely depends on whether you make enough money to qualify for a government subsidy. Zamosky says individuals and households that are eligible to receive a subsidy should probably stick to the online exchanges, but those who make too much money to get government assistance may benefit from going outside the marketplace to find a plan.

You may need assistance: The sheer complexity of health insurance and the confusion surrounding the new changes makes it almost a given that you'll have to re-visit the exchange website more than once before you find a plan that fits your needs. Especially if you've had to take an early retirement, stop and consider what you really need out of a health insurance plan. Which plans include your preferred doctors? Are the hospitals in a given plan close by? And don't assume that you won't qualify for financial assistance. Visit the government health insurance website to determine what level of subsidy you're eligible to obtain. Zamosky also suggests seeking the advice of an insurance agent or broker who is certified to sell through the marketplace; they will be able to offer the kind of personalized advice you'll need to make the best decision.

Ultimately, when seeking health insurance in this new environment it's essential that your try to, "put the political chatter aside and think about what is best for you," Zamosky says.

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You should be more accurate in your reporting. In your first paragraph where you address "lawmakers saying that you would be able to keep your plan", there were very specific lawmakers and the president of the US who made the repeated pledge of "being able to keep your plan and your doctor". You can search any database you wish and I don't believe that you will come up with one instance where a Republican lawmaker made that statement. You may wish to keep politics out of the ACA issue, but it is truly a creation from one side of the aisle. Please don't put all lawmakers in the same basket.
Sorry, Judy, but the Republicans HAVE put forth other ideas. They just are not socialized medicine...which IS the goal of the liberal/progressives. Health Savings Accounts, catastrophic coverage options for the young, and they are also FOR not canceling those with pre existing conditions too...but NOTHING should be controlled by gov't laws and regulations and depts. Let the private arena do it. And as for the oft stated 'every American has a right to health care' is simply NOT true. The 'rights' are all stated in our Constitution. And, one does not need insurance to get 'health care'. Just go to a doctor and pay your fee and you get 'care'. If you have no insurance, ask for your discounted price for cash payments. Or go to a 'free' clinic...not really free, because they are tax payer funded ultimately unless funded by private donations. You will never convince me, as I am almost 70 years old and spent a lot of years, in which I got a lot of health care WITHOUT any insurance. There was not any. One had to be self responsible and save money and PLAN to spend money on health care instead of on other nonsense. Now, YES, there will always be those who are honestly in need and they should be helped to get health care....but there was no need to mandate that everyone eventually move into a single payer system, run by the gov't in order in expand Medicaid. And, one final note...there was no need to create 'sub par' plans by adding on all these gov't requirements to a minimum policy....especially contraception services and abortion costs for all. To force people to pay for what they either do not need, or do not approve of, so it's 'free' to everyone. There always has been Planned Parenthood...and they are still being funded with tax payer monies, even while we're being forced to shell out more of our money to pay for such nonsense. Condoms and BC pills etc are NOT expensive. I paid cash for my pills without insurance, back in the days when they first came out and cost us $30/mo. We just chose to do without something else. WE didn't suffer, we were responsible and we made responsible choices. I am NOT going to change my opinion on this. And I'll not comment again on it.
I have worked in the medical supply industry for many years and we are hearing more and more about companies that have changed their policies without people realizing it. It's a sad situation.