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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

December 11, 2013 at 3:42 PM

Step by step: what to know before you buy health insurance

Photo by Cristiano Betta, from Flickr's The Commons.

Photo by Cristiano Betta, from Flickr’s The Commons.

The clock is ticking folks — and no, we don’t mean the countdown to Christmas. Those people who are not insured or had their current health insurance canceled and don’t want to go with the default plan recommended by their insurance company have until Dec. 23 to enroll in a new plan, if they want it to start Jan. 1.

Luckily for those in Washington, the website used to enroll in government-subsidized insurance plans and Medicaid is working, at least most of the time. And the government exchange site isn’t the only option for buying insurance — there’s also an individual market outside of the exchange.

But even if the websites work, the truth is that buying health insurance can be overwhelming and confusing. So we’ve distilled the process down to five steps to help get you through it.

1. Figure out if you are eligible for a tax subsidy.

Depending on your income and household size, you could be eligible for a tax subsidy under the Affordable Care Act. To figure this out, go to Washington Healthplanfinder, the state’s insurance exchange, or use a calculator on a site like the Kaiser Family Foundation. The subsidies are available to those earning up to four times the federal poverty line. For an individual, that’s roughly $45,000 a year.

And be careful about what you’re using as your income. The subsidies are based on your Modified Adjusted Gross Income (MAGI), which includes wages, tips, taxable income, ordinary dividends, unemployment benefits, alimony, etc. minus a variety of deductions such as student loan interest, health savings account deductions, some self-employed expenses and other items. (Check out this great fact sheet from University of California Berkeley for more information on MAGI.)

If you are eligible for a subsidy, you should buy your insurance from the exchange because your premiums will be lower. Also, catastrophic plans are available only through the exchange, though they’re limited to people under age 30 and those with certain financial exemptions. And plans on the exchange are likely to be cheaper because they often include coverage for fewer doctors and hospitals.

If you’re not getting a subsidy and want more doctors included in your plan, you might as well buy it outside of the exchange where there are more options.

2. Find a good insurance broker.

There are two main categories of people who can help you sign up for health insurance: brokers and in-person assisters/navigators. Both offer their services for free. Brokers are paid by insurance companies when they sign people up for one of their plans. Navigators are often associated with community groups, health organizations or other nonprofits who pay their way, or are volunteers.

Of the two, only brokers can legally advise you on which plan works best for your budget and health-care needs. They can help you find a plan inside the health-insurance exchange, or on the general market. An in-person assister or navigator is trained to aid people trying to maneuver the health-insurance exchange, Washington Healthplanfinder. They can’t tell you which plan to get.

By entering your zip code, you can search for brokers and navigators near you.

If you’re going the broker route, you can double check the state database to make sure they’re legit and see which insurance companies they represent. It’s also not a bad idea to check a site like Yelp to find out what other shoppers have to say about a company or person.

3. Compare plans.

Maybe you’re going with a broker and don’t want to think about this further on your own (who would blame you?!). But if you’d like to poke around a little and compare plans, you have some options.

If you’re shopping inside of the exchange, the state’s Healthplanfinder site will allow you to first call up all the plans available to you, then mark the ones you like best, and the site will display them in side-by-side comparisons showing deductibles and other benefits. The Affordable Care Act requires that all plans include 10 essential benefits and limit deductibles and out-of-pocket costs. But the 10 essentials can be met different ways and there is still a lot of fine print to consider.

If you’re shopping outside of the exchange, you have a couple of options for comparing plans.

  • Washington Health Insurance Exchange is a site owned by a broker and allows comparisons inside and outside of the exchange
  • The Office of the Insurance Commissioner’s webpage, a government site, allows comparisons inside and out the exchange
  • eHealth, is a national company that provides comparisons, though their site only displays “featured” insurance companies, unless you look for the fine print and ask it to display all of the plans available
  • And a reader recently shared with us his Health Insurance Plan Comparison Calculator to help add up all the potential costs for a plan — though we at HealthCare Checkup blog haven’t had a chance to play around with it much

4. Compare which doctors and hospitals are covered.

Now that you’ve got an idea of what plans cost and offer in benefits, you might have a favorite doctor or clinic. So next you’ll want to make sure the plan you like will cover the bills from your doctor.

My colleagues at The Seattle Times came up with this terrific article and chart showing which insurance companies include which providers in the plans sold through the exchange. The Times also has these directions using Healthplanfinder to figure out if a doctor or hospital is part of a certain plan.

It’s also not a bad idea to call your doc to verify who includes their services.

5. Pat yourself on the back.

Congratulations! If all goes well — and we hope it did — you now have now found and purchased health insurance and are not facing penalties for failing to get coverage. (With certain exceptions, going without coverage in 2014 will cost you $95 per adult and $47.50 per child, or 1 percent of your household income — whichever is MORE. And the penalties go up in 2015.)

Shopping for health insurance is not as easy as buying an airplane ticket from Expedia or a toaster from Amazon. But help is available and in the past individual insurance applications required lengthy questionnaires about your health and there was the risk that an insurance company would deny you coverage for pre-existing conditions. None of that is allowed under the Affordable Care Act.

Now about that will you’ve been meaning to update…

Comments | Topics: Affordable Care Act, health insurance, Healthplanfinder


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