Your Guide to Understanding Obamacare Health Plans for Individuals and Families

Transcription

Your Guide to Understanding Obamacare
Health Plans for Individuals and Families
A Quick, Clear Overview of Affordable Care Act Insurance Coverage Basics
A free e-book from The IHC Group
The information provided in this ebook is for informational purposes only. It does not constitute tax or
legal advice. Neither The IHC Group nor healthedeals.com is associated with any government agency.
The materials on this ebook are provided “as is” and without warranties of any kind to the fullest extent
permissible pursuant to applicable laws.
© The IHC Group 2013
www.healthedeals.com ACAebook1013
1
Table of Contents
Introducing Your Guide to Obamacare.........................................................................................4 Frequently Asked Questions about Obamacare.........................................................................5
Obamacare? Affordable Care Act? Is there a difference?..............................................................5
Do I have to buy health insurance?................................................................................................5
Do I have to buy health insurance from an exchange?...................................................................5
Are rates better on the exchanges?................................................................................................5
When is open enrollment?..............................................................................................................5
If I buy Obamacare coverage in 2013, may I use it right away?.....................................................6
What if I don’t buy during the open-enrollment period?..................................................................6
Does the Affordable Care Act require me to buy dental insurance?...............................................6
I have been denied coverage…will I be eligible for health plans on or off the new exchanges?....6
Coverage Details: Essential Health Benefits...............................................................................7 EHB benchmark plans....................................................................................................................7
Plan Design: Metal Levels...............................................................................................................8
How the metal plans work...............................................................................................................8
Plan similarities, differences...........................................................................................................8
Affordability: Tax Credits, Cost-Sharing Subsidies and Penalties.........................................9
Tax credits.......................................................................................................................................9
Cost-sharing subsidies....................................................................................................................9
Penalties.........................................................................................................................................9
How to estimate your Obamacare tax credit...................................................................................9
2
Dental Insurance and Obamacare..................................................................................................10
Does the Affordable Care Act require Americans to purchase dental insurance?..........................10
Will dental benefits be included in Obamacare health plans?.........................................................10
Will dental insurance be sold on the health insurance exchanges?................................................10
Are children allowed to stay on their parents’ dental insurance plans through age 26?.................10
Who is considered a child … pediatric dental and vision essential health benefit?........................11
If the pediatric dental and vision EHB in my state is sold separately, do I have to buy it for
my child(ren)?.................................................................................................................................11
What is covered by the pediatric dental and vision essential health benefit?.................................11
Are grandfathered plans required to include the pediatric dental and vision EHB?........................11
Are there Obamacare tax credits and subsidies for dental insurance premiums?..........................11
Glossary of Health Insurance and Affordable Care Act Terms................................................12
Where to Shop: Find Your State’s Exchange Website...............................................................14
Shopping Tips....................................................................................................................................18
Assess your needs..........................................................................................................................18
Know your budget...........................................................................................................................18
Gather application information........................................................................................................18
Compare plans and premiums........................................................................................................18
Look at network providers...............................................................................................................18
Consider Supplemental Coverage.................................................................................................19
Where to Find Help............................................................................................................................20
About The IHC Group.......................................................................................................................21
3
Introducing Your Guide to Obamacare
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act into law. Sweeping
health care reform began, and the health insurance started undergoing a transformation. The Affordable Care Act
commonly referred to as Obamacare, was designed to make health insurance and health care more affordable and
accessible to Americans.
The law’s provision highlights include the following:
• Access to preventive care services at no additional cost
• Dependent coverage on a parent’s health insurance plan extended through age 26
• Insurers can no longer deny applicants based on health history or preexisting condition
• Employers with 50 or more full-time employees must offer coverage
• Tax credits for individuals, families and small businesses who qualify
• Requirement that most Americans buy health insurance
• The creation of state-based, federally facilitated and state-federal partnership health insurance exchanges
• Elimination of lifetime and annual dollar limits
Although some of these provisions have already gone into effect, many of these provisions go into effect Jan. 1, 2014, which means
major changes for Americans who buy their own health insurance, as well as those who can now buy it for the first time. This guide is
designed specifically for such individuals and families. We hope it helps provide a better understanding of Obamacare’s basics, so you
can acquire the best possible coverage.
4
Frequently Asked Questions about Obamacare
You likely have many questions about the new health care law. There is a lot to know, and sometimes it’s difficult to locate the answers.
We’d like to start things off by addressing some of the frequently asked questions and concerns.
Obamacare? Affordable Care? Is there a difference?
No. These are names that are commonly used for the Patient Protection and Affordable Care Act mentioned on the previous page.
Throughout this ebook we may use the names interchangeably.
Do I have to buy health insurance?
Most Americans have to buy health insurance as part of the health care reform law. However, those who earn too little to file a federal
tax return or for whom buying health insurance would mean spending more than 8 percent of their income would not be subject to this
requirement.
Do I have to buy health insurance from an exchange?
No. Health insurance that qualifies as minimal essential coverage under Obamacare may be purchased on the exchanges or off of the
exchanges via a producer, broker or carrier. However, it is important to note that only plans sold on state-based and federally facilitated
exchanges are eligible for tax credits, cost-sharing subsidies and other financial assistance.
Are rates better on the exchanges?
It depends on where you live and your eligibility for financial assistance. For those who will not receive a tax credit or cost-sharing
subsidy, buying in the private marketplace may have its appeal. The Manhattan Institute for Policy Research released an interactive
map, which allows users to click on their state and see how their rates may have increased or decreased.
When is open enrollment?
Open enrollment is the time period during which eligible Americans can buy health insurance from the state-based and federally
facilitated exchanges. The open-enrollment period for 2014 coverage runs from Oct. 1, 2013, through March 31, 2014. Dec. 1, 2013,
is the latest individuals and families can sign up for coverage that starts Jan. 1, 2014. Otherwise, you must apply by the 15th of the
month before you want coverage to begin.
5
Frequently Asked Questions about Obamacare
If I buy Obamacare coverage in 2013, may I use it right away?
No. If you enroll in an exchange-based plan during the open-enrollment period in 2013, your coverage does not begin until
Jan. 1, 2014.
If you need a health plan to get you by until your Affordable Care Act plan becomes effective, you might consider a short-term medical
insurance. These plans provide temporary health insurance for as few as 30 days and as many as 364, depending on your state. For
more information, as well as quick-and-easy quote and enrollment, visit healthedeals.com.
What if I don’t buy during the open-enrollment period?
You will have to wait for the next open-enrollment period to begin, unless you have a qualifying life event such as moving, leaving a job
with employer-based health insurance coverage, getting a divorce, having a baby or getting married. Under such circumstances, you
have 30 days to enroll through an exchange. If you go more than a three-month period without health insurance, you may be subject to
a tax penalty.
Does the Affordable Care Act require me to buy dental insurance?
No. The law has minimal impact on adult dental insurance. However, pediatric dental and vision is among the 10 categories of
essential health benefits, the extent of coverage may vary by state.. Furthermore, if this coverage is not embedded in a major medical
plan, parents must buy a separate standalone plan. See page 15 for more dental-related FAQs.
I have been denied coverage due to my health history, but my state’s high-risk pool is going away, will I be eligible for
health plans on or off the new exchanges?
Yes. Under the Affordable Care Act, insurers can no longer deny applicants based on health history and preexisting conditions—on or
off the new exchanges. You cannot be denied based on age, gender or other factors that may predict your use of benefits. Plans that
qualify as minimal essential coverage are guaranteed issue.
6
Coverage Details: Essential Health Benefits
As of Jan. 1, 2014, individual and small group market health insurance plans must start covering a set of health care services
categories known as essential health benefits. Essential health benefits, also known as EHBs, must be equal in scope to benefits
offered by a “typical employer plan,” according to healthcare.gov.
Under this Obamacare provision, plans that fall both within and outside of the Health Insurance Marketplace must include coverage for
at least the following 10 categories:
1. Ambulatory patient services
6. Prescription drugs
2. Emergency services
7. Rehabilitative and habilitative services and devices
3.Hospitalization
8. Laboratory services
4. Maternity and newborn care
9. Preventive and wellness services and chronic
5. Mental health and substance use disorder services,
disease management
including behavioral health treatment
10. Pediatric services, including oral and vision care
When Americans gain access to EHB in 2014, it is estimated that 8.7 million will gain maternity coverage, 4.8 million will gain
substance abuse coverage, 2.3 million will gain mental health coverage, and 1.3 million will gain prescription drug coverage.1
Additionally, plans and policies that began on or after September 23, 2010, cannot impose a lifetime limit for EHB services. Healthcare.
gov states, “All plans, except grandfathered individual health insurance policies, must phase out annual dollar spending limits for these
services by 2014.”
EHB benchmark plans
Each state selected a benchmark plan from previously existing health insurance plans offered within their market. All plans required to
cover EHB must offer similar minimum benefits to that plan. The small group health plan with the largest enrollment was selected by
default in states that failed to select a benchmark plan on their own. Benchmark plans that do not include all 10 EHB categories will be
subject to supplementation under the proposed rule.
Additionally, as listed on healthcare.gov, a proposed rule on benchmark plans:
• Prohibits benefit designs that could discriminate against potential or current enrollees
• Includes special standards and options for health plans for benefits not typically covered by individual and small group
policies today, including habilitative services
• Includes standards for prescription drug coverage to ensure that individuals have access to needed prescription medications
1
“Essential Health Benefits: Individual Market Coverage.” ASPE.hhs.gov. U.S. Department of Health and Human Services, 16 Dec. 2011. Web.
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Plan Design: Metal Levels
Under the Affordable Care Act, health insurance plans that meet the standard for minimal essential coverage are classified into four
tiers by actuarial value—the percentage of total expected medical costs paid by the plan.
These Obamacare coverage tiers have been dubbed the metal levels or metal plans:
• Bronze plan – 60 percent of covered medical expenses paid by the plan; 40 percent by the consumer
• Silver plan – 70 percent of covered medical expenses paid by the plan; 30 percent by the consumer
• Gold plan – 80 percent of covered medical expenses paid by the plan; 20 percent by the consumer
• Platinum plan – 90 percent of covered medical expenses paid by the plan; 10 percent by the consumer
While Obamacare requires that all plans include the same minimal coverage for health care items and services in 10 essential health
benefits categories, plan costs will vary depending on which metal level is selected. This is meant to encourage consumers to shop
with cost-sharing in mind and determine what share of covered medical expenses they can afford.
How the metal plans work
The higher the share of covered medical expenses paid by the plan, the lower the consumer’s out-of-pocket cost. However, this
scenario also translates into a higher premium. If you are relatively healthy and do not anticipate many medical expenses, a Bronze
or Silver Plan may be the right solution. If you have health conditions that necessitate frequent care and services, you may find it
advantageous to select a Gold or Platinum Plan.
Those who opt for the Silver Plan and whose incomes fall below 250 percent of the federal poverty level will receive cost-sharing
subsidies—these are in addition to any tax credit for which you may be eligible. Cost-sharing will be automatically applied based on
income and will help with the cost of deductibles, copayments, coinsurance and total out-of-pocket spending limits.
Plan similarities, differences
Obamacare’s metal plans may share basic benefits and include the same actuarial values, but they will not be identical. All health
insurance plans must fit within the tiered structure, but carriers can choose to offer more than the minimal essential health benefits. As
such, it is important to compare plans and carefully consider which is best for you and your family.
Also note that health insurance companies are not required to offer all four metal levels. That means certain carriers may choose to
offer Bronze and Silver Plans on the exchanges while others might offer only Gold and Platinum.
Monthly premiums will vary based on factors such age and region. As of Jan. 1, 2014, the Affordable Care Act prohibits insurers from
denying coverage or charging applicants more based on medical history. They must also cover care for preexisting conditions.
health savings account might be the right solution.
8
Tax Credits, Cost-Sharing Subsidies and Penalties
As of Jan. 1, 2014, most Americans must buy health insurance or face a tax penalty. Also effective 2014, individuals and families who
purchase health insurance from state-based and federally facilitated exchanges may be eligible for cost-sharing subsidies and/or
premium tax credits to help make coverage more affordable.
Tax credits
Those who buy from the new Health Insurance Marketplace, whose incomes fall between 100 and 400 percent of the federal poverty
level, and who meet other eligibility requirements outlined by the IRS will be eligible for subsidies in the form of premium tax credits.
Those who qualify must claim their credit on their federal tax returns beginning 2015 for 2014 coverage. These tax credits will impact
an estimated 26 million Americans.2
Cost-sharing subsidies
For those with incomes up to 250 percent of the federal poverty level, additional cost-sharing subsidies will be available. These
subsidies assist with deductibles, copayments, coinsurance and total out-of-pocket spending limits.
Cost-sharing subsidies will be applied automatically depending on3:
1. A consumer’s income
2. Their purchase of a silver-level plan
Of course, this doesn’t mean the silver plan is best for everyone who is eligible for the cost-sharing subsidy. Consumers should
evaluate their overall health care needs and financial situation and then determine health plan best accommodates both.
Penalties
Those who do not maintain minimal essential coverage will face a penalty of $95 per adult and $47.50 per child (up to $285 for a
family) or 1 percent of family income, whichever is greater, in 2014; $325 per adult and $162.50 per child (up to $975 for a family) or
2 percent of family income, whichever is greater, in 2015; and $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5
percent of family income, whichever is greater, in 2016 and beyond. There is no penalty for a single gap in coverage of less than three
months of the year.4
How to estimate your Obamacare credits Use the healthedeals.com Health Reform Calculator, which was ranked among The Fiscal
Times’ “Best Online Tools for the Toughest Health Questions,” to estimate your annual insurance premium at each metal level. You
may also estimate your tax credit, if eligible, and your opt-out penalty.
Luhby, Tami. “Millions Eligible for Obamacare Subsidies, but Most Don’t Know It.” CNNMoney. Cable News Network, 23 Apr. 2013. Web.
Andrews, Michelle. “In Addition To Premium Credits, Health Law Offers Some Consumers Help Paying Deductibles And Co-Pays.” Kaiserhealthnews.org.
Kaiser Health News, 9 July 2013. Web.
4
“The Requirement to Buy Coverage Under the Affordable Care Act « » The Henry J. Kaiser Family Foundation.” Kff.org.
The Henry J. Kaiser Family Foundation, n.d. Web.
2
3
9
Dental Insurance and Obamacare
Obamacare has relatively minimal impact on dental coverage for adults. It does, however, aim to expand such benefits for children.
Below, we’ve answered some frequently answer questions related to Obamacare as it relates to dental insurance.
Does the Affordable Care Act require Americans to purchase dental insurance?
No. While most Americans must buy health insurance in 2014 or face a tax penalty, there is no Obamacare mandate for dental
insurance. Adults are not required to acquire it for themselves. Technically, they do not need to buy dental plans for their children,
either. However, since pediatric dental and vision is one of the Act’s 10 essential health benefit categories, it must be embedded into
qualified health insurance plans unless it is offered as standalone coverage on health insurance exchanges.
Just because Americans aren’t required to buy dental plans doesn’t mean they should forego them. Dental insurance has been linked
to access to preventive care, and preventive care such as regular exams and cleanings is key to oral health and overall health. Most
basic dental plans cover preventive visits and services at 100 percent and cost only a few dollars a month.
Will dental benefits be included in Obamacare health plans?
The Affordable Care Act does not include dental benefit requirements outside the pediatric dental and vision EHB. Health plan designs
vary, so it is possible some major medical insurance sold on and off the exchanges will include dental benefits; however, it is not
common.
Typically, individual and family medical plans do not cover oral surgery and other dental procedures unless such services are
considered medical in nature. Before buying health insurance, read the fine print and be sure to ask any questions you have about
the plan’s benefits. Always check with your dental and/or health insurance carrier to see if treatments, physicians, hospitals, etc. are
covered before receiving care.
Will dental insurance be sold on the health insurance exchanges?
It depends on your state. Some state marketplaces will sell standalone dental plans for adults, as well as children, but just because
dental coverage is sold on an exchange doesn’t mean consumers have to buy it on an exchange. Shop around on and off your state’s
exchange to find the best rate and coverage for you and your family’s needs.
Contact an agent or broker, or consult a healthedeals.com sales specialist for help finding an affordable, trustworthy dental plan.
Are children allowed to stay on their parents’ dental insurance plans through age 26?
While the Affordable Care Act does not mandate that child eligibility for dental coverage be through age 26, many dental carriers have
opted to increase the dependent age limit for their plans. This practice is strictly optional. Check with your current dental plan or the
dental plans you are considering. Again, work directly with the carrier or an agent/broker to find the best fit for you and your family.
10
Dental Insurance and Obamacare
Who is considered a child when it comes to Obamacare’s pediatric dental and vision essential health benefit?
Children under age 19 are eligible for pediatric services.
If the pediatric dental and vision EHB in my state is sold separately, do I have to buy it for my child(ren)?
No. There is no requirement that parents or guardians acquire standalone pediatric dental and vision EHB plans for their dependents, if
they buy on their state’s exchange. Those who buy health plans through an employer, as well as those who buy off the exchange, are
required to buy the pediatric dental and vision EHB, according to the American Dental Association’s interpretation of the law.
What is covered by the pediatric dental and vision essential health benefit?
These benefits will vary. Each state selected a benchmark plan, and all plans must include the same basic benefits. According to the
American Dental Association, “all states except Utah (which is offering only preventive dental services) have chosen either the state’s
Children’s Health Insurance Program plan or the MetLife High Option plan from the Federal Employee Dental and Vision Insurance
Program as their benchmark plan.”
Plans with embedded dental benefits may include common, relatively low-cost preventive, diagnostic and emergency procedures,
while a CHIP program may have more robust benefits including medically necessary orthodontia.
Are grandfathered plans required to include the pediatric dental and vision EHB?
No, health plans granted grandfathered status are not subject to the Affordable Care Act’s essential health benefits categories or
other provisions.
Are there Obamacare tax credits and subsidies for dental insurance premiums?
No. This assistance applies specifically to health insurance plans purchased from state-based and federally funded exchanges, and
eligibility is determined by household income.
11
Glossary of Health Insurance and Affordable Care Act Terms
When it comes to securing the best coverage for you and your family, it is critical you understand what you are buying. However,
many people do not. A 2013 Harris Interactive Survey conducted for the American Institute of CPAs found that half of the respondents
(51 percent) “could not accurately define at least one of three common health insurance terms: premium, deductible and copay.”
Below are some definitions to commonly used health insurance and ACA terms you will encounter when shopping for a plan.
Actuarial value — The percentage of total average health care costs covered by a health insurance plan. Qualified health
Carrier — The insurance company that sells an insurance plan/policy, issues it and contractually assumes the associated
Claim — The bill for medical products and services that is submitted by a health care provider to a patient’s health
Coinsurance — The arrangement between the insurance carrier and the insured in which the insurance company pays the
Copay (copayment) — A flat fee the insured person pays for medical services up front. This amount varies by plan design
Deductible — The fixed dollar amount an insured individual and/or family must pay each year before the health plan’s
Dependent — The spouse and/or children that rely on an insured person for coverage; children may remain on a parent’s
Essential Health Benefits — Ten categories of medical items and services that must be covered by individual and small
plans under the Affordable Care Act fit into four coverage levels based on their actuarial value; these are known as the metal
levels because they are classified as bronze, silver, gold and platinum. See page 15.
risk. Also called the insurer.
insurance company.
specified percentage for a specific class of covered services and the remaining percentage is the responsibility of the insured.
For example: You have a PPO dental plan and you go to a PPO provider. Your charges are $100 for services classified under
basic care payable at 80 percent, then the insurance company will cover 80 percent or $80 and you will be responsible for the
remaining 20 percent or $20.
and benefit; for example, there may be separate copays for ER visits, generic drugs, brand name drugs, physician office visits,
surgical services, hospital confinement, etc. Short for copayment.
benefits take effect.
health insurance plan through age 26 under the Affordable Care Act.
group health plans sold on and off the state-based and federal facilitated exchanges. See page 11.
12
Glossary of Health Insurance and Affordable Care Act Terms
Exchange — State-based and federally facilitated health insurance marketplaces created as a result of the Affordable Care
Grandfathered plan — Health plans purchased on or before March 23, 2010. These plans are not subject to Obamacare
Health Insurance Marketplace — What the U.S. government is calling the state-based and federally facilitated health
Individual mandate — The Affordable Care Act’s requirement that most Americans have health insurance coverage by
Minimal essential coverage — Plans that meet the Affordable Care Act’s basic provisions and thereby fulfill the
Network — A group of clinics, hospitals and health care providers; participants agree to provide medical services at
Open enrollment — The annual time period in which Americans can buy exchange-based individual major medical
Premium — The dollar amount paid to an insurance company for the benefits and coverage of an insurance policy. Many
Preventive care — Medical care aimed at preventing health problems and detecting them early. This includes immunizations
Qualified health plan — A health insurance plan that meets the Affordable Care Act’s minimum requirements and has been
For a comprehensive list of health insurance terms, visit healthedeals.com.
Act. Americans can buy individual and small group plans on the exchanges or directly from a private insurer.
requirements unless they undergo a significant reduction in benefits or increase in cost to consumers.
insurance exchanges created as a result of the Affordable Care Act.
Jan. 1, 2014.
requirement that most Americans have health insurance. These plans include those sold on the exchanges as well as some
sold off the exchanges, employer-sponsored plans, Medicare, Medicaid, CHIP and others.
discounted rates.
health insurance plans for themselves and their families. The 2014 enrollment period began Oct. 1, 2013, and runs through
March 31, 2014.
policies allow a monthly, quarterly, or annual payment option.
and checkups, as well as Pap smears, mammograms and other health screenings. Under the Affordable Care Act, certain
preventive services are covered at no additional cost to insured patients.
certified by the state and federal government. All exchange-based plans must be certified as such.
13
Where to Shop: Find Your State’s Exchange Website
You can search for and enroll in a health insurance plan on the Obamacare Health Insurance Marketplace exchanges or in the private
marketplace. If you do buy from the state-based and federally facilitated exchanges, you may do so online, in person or over the
phone. Use the chart below to find state-by-state information about where to shop for your exchange-based health insurance plan.
State
Exchange
Type
Exchange Name
Official Website
Alabama
Federal
Health Insurance Marketplace
healthcare.gov
Alaska
Federal
healthcare.gov
Arizona
Federal
healthcare.gov
Arkansas
Partnership
Arkansas Health Connector – information
Health Insurance Marketplace – enrollment
arhealthconnector.org
healthcare.gov
California
State
Covered California
coveredca.com
Colorado
State
Connect for Health Colorado
connectforhealthco.com
Connecticut
State
Access Health CT
accesshealthct.com
Delaware
Partnership
Choose Health Delaware – information
choosehealthde.com
healthcare.gov
District of Columbia
State
DC Health Link
dchealthlink.com
Florida
Federal
healthcare.gov
Georgia
Federal
healthcare.gov
Hawaii
State
Hawaii Health Connector
hawaiihealthconnector.com
14
Idaho
State
Your Health Idaho
yourhealthidaho.com
Illinois
Partnership
Illinois Health Matters – information
illinoishealthmatters.org
healthcare.gov
Indiana
Federal
healthcare.gov
Iowa
Partnership
healthcare.gov
Kansas
Federal
healthcare.gov
Kentucky
State
kynect: Kentucky’s Healthcare Connection
kynect.ky.gov
Louisiana
Federal
healthcare.gov
Maine
Federal
healthcare.gov
Maryland
State
Maryland Health Connection
marylandhealthconnection.gov
Massachusetts
State
Health Connector
mahealthconnector.org
Michigan
Partnership
healthcare.gov
Minnesota
State
MNsure
mn.gov/hix
Mississippi
Federal
healthcare.gov
Missouri
Federal
healthcare.gov
Montana
Federal
healthcare.gov
15
Nebraska
Federal
healthcare.gov
Nevada
State
Nevada Health Link
nevadahealthlink.com
New Hampshire
Partnership
healthcare.gov
New Jersey
Federal
healthcare.gov
New Mexico
State
Be Well New Mexico Health Insurance Exchange
(NMHIX)
bewellnm.com
New York
State
New York State of Health
info.nystateofhealth.ny.gov
North Carolina
Federal
healthcare.gov
North Dakota
Federal
healthcare.gov
Ohio
Federal
healthcare.gov
Oklahoma
Federal
healthcare.gov
Oregon
State
Cover Oregon
coveroregon.com
Pennsylvania
Federal
healthcare.gov
Rhode Island
State
Health Source RI
healthsoureceri.com
South Carolina
Federal
healthcare.gov
South Dakota
Federal
healthcare.gov
16
Tennessee
Federal
healthcare.gov
Texas
Federal
healthcare.gov
Utah
Federal
healthcare.gov
Vermont
State
Vermont Health Connect
healthconnect.vermont.gov
Virginia
Federal
healthcare.gov
Washington
State
Washington Health Benefit Exchange – information
Washington Healthplanfinder – enrollment
wahbexchange.org
wahealthplanfinder.org
West Virginia
Partnership
West Virginia Health Insurance Marketplace – information
bewv.wvinsurance.gov
healthcare.gov
Wisconsin
Federal
healthcare.gov
Wyoming
Federal
healthcare.gov
17
Shopping Tips
Buying online health insurance, whether through an exchange
or in the private marketplace, can be fast and easy. However,
there’s no pressure to buy the moment you start shopping, so
don’t rush to enroll. Selecting the right health insurance plan for
you and your family is a serious financial decision. Here are five
top tips for making an online health insurance purchase you can
feel good about—and they apply to offline purchases, as well.
1. Assess your needs
Purchasing health insurance is a financial commitment that can
mean paying for more than you need or paying more for what
you need if you do not select appropriate coverage.
•How long will you need coverage? For instance, if you are
newly self-employed, you will want to look into an individual
major medical plan. However, you might consider a short term medical plan if you recently lost your job or are in some
other temporary situation without insurance and need
coverage to get you through the gap.
•How do you use health insurance? Do you typically see the
doctor for preventive care visits and rely on insurance for
the unexpected? Or do you visit the doctor several times
a year? Consider the medical needs and expenses for every
person in your family throughout recent years. List
any ongoing medical conditions, surgeries, hospital stays,
medications, etc.
•Do you anticipate a change in medical needs? If you are
planning to have a baby or foresee using health insurance
more or less than you have in the past, take that into
consideration as well. Are there hereditary health conditions
in your family that you risk developing at this point in your
life? That is also something to consider.
2. Know your budget
Look at the entire picture. What can you afford to spend
on health care? Consider premium, copay, coinsurance,
prescriptions, over-the-counter drugs, services not covered by
insurance and any other out-of-pocket medical expenses. Also
factor in dental and vision coverage, as well as any ancillary
coverage such as critical illness. And don’t forget to factor in any
Obamacare tax credits and cost-sharing subsidies you may be
eligible for. Knowing how much you can spend will be important
when obtaining quotes and comparing plans.
3. Gather application information
At a minimum, you will need to have the birth dates, addresses,
and coverage start dates of everyone on the health insurance
policy you apply for. You may also need financial information
such as W2 forms and tax returns to buy from an exchange and
apply for credits and subsidies.
4. Compare plans and premiums
Again, take your time with the decision. Get a few quotes. Once
you narrow them down to a few that fit your budget, compare
the details closely. Look at premium, coinsurance, prescription
drug coverage, deductible, coinsurance, copays, and other
out-of-pocket costs. Run the numbers as they apply to your
expected use of benefits, and make sure the plan makes sense
for your budget as well as your health care needs.ch released
an interactive map, which allows users to click on their state and
see how their rates may have increased or decreased.
5. Look at network providers
Take the top plans you are considering and examine their
provider lists. Will you have in-network access to the doctors,
specialists, clinics and hospitals you prefer or that are most
convenient for you?
18
Consider Supplemental Coverage
Consumers who buy their own health insurance plans are wise to consider additional protection beyond major medical insurance.
Those who purchase only individual health insurance for themselves and their families often miss out on the ancillary benefits offered
through an employer. For instance, a bundled plan that includes coverage such as accident medical expense insurance and accident
disability income insurance that pays lump-sum cash benefits when a qualifying event occurs.
A critical illness insurance plan pays out lump-sum cash benefits upon diagnosis of certain illnesses that can be used for everything
from medical bills to childcare. It can even help pay for experimental treatments, copays and deductibles, and providers your medical
insurance doesn’t cover. Most plans cover six to 12 different critical conditions, which may include life-threatening cancer, kidney
failure, heart attack, stroke, coma, cancer in situ, major organ transplant and severe burn.
Supplemental insurance is not available through state-based or federally operated health insurance exchanges; however, they
are easy to obtain directly from the plan’s carrier or a licensed producer or broker. Visit healthedeals.com for more information on
supplemental plans.
19
Where to Find Help
You will likely have many questions as you go through the enrollment process. Ask them before you apply and start paying premiums!
Consumers who wish to purchase in the private marketplace can buy health insurance and supplemental coverage from producers and
brokers, as well as directly from carriers. As it was before Obamacare, these knowledgeable individuals can help guide individuals and
families to secure plans that suit their health care and financial needs.
For those buying from the Health Insurance Marketplace, each state has trained and certified people to help the public in
understanding their options and enrolling in a plan. These individuals may be called navigators, application assisters or certified
application counselors. Those who buy from an exchange can find such resources through their state’s exchange website or visit
localhelp.healthcare.gov.
20
About The IHC Group
The IHC Group is an organization of affiliated insurance carriers, and marketing and administrative companies and agencies
dedicated to delivering insurance solutions to groups and individuals. The IHC Group includes Independence Holding Company
(NYSE:IHC), American Independence Corp. (NASDAQ:AMIC), Standard Security Life Insurance Company of New York, Madison
National Life Insurance Company, Inc., and Independence American Insurance Company. The companies in the IHC Group have
been providing health, life, disability, dental, vision and stop-loss insurance for over 30 years. For information on The IHC Group,
visit www.ihcgroup.com.
21

Your Guide to Understanding Obamacare Health Plans for Individuals and Families

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