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Sep 24, 2013

Obamacare implementation feels like that summer I had a cast – it’s dragging on and on! Now that we’re days away from the Health Insurance Exchanges going LIVE on 10/1/13 and weeks away from the 1/1/14 start date, most people are scrambling to figure out what the heck it means to them. 

Are you feeling behind the 8-ball because you don’t read every Obamacare article or watch CNN 24/7? Relax. I’m sharing my tips and brain power in these 6 things you need to know about Health Insurance Exchanges….

1. Refresh me…what’s a Health Insurance Exchange?

It’s an online site that leads you through the insurance buying process - kind of like an Expedia for health insurance that’s run by the government. On 10/1, Exchanges open in each state (some states chose not to create their own, so they’ll be using the Federal government’s Exchange). All that to say….there’s a website where you can get prices for your health insurance. 

2. Do I have to buy health insurance in an Exchange?

**If you’re offered health insurance at your job or your spouse’s job – get it there (and thank them for subsidizing your costs). If they provide a plan that meets the criteria for being “affordable” (and most will or they’ll be fined), you aren’t allowed to buy in an Exchange.  

**If you’re buying health insurance on your own and could qualify for a subsidy, the only place to get that deal is through an Exchange.

**If you won’t get a subsidy, there’s very little reason to purchase in an Exchange. My advice: go talk to a Health Insurance Agent who can get all the same plans & more options out in the open market. You don’t pay any more for their expertise, so you don’t have anything to lose!

**If you’re on any other type of government-provided healthcare plan (Medicaid, Medicare, military, government employee, etc.), you would not use the Exchange.

3. What about the money?

**Nobody will get health insurance for free (well, other than Medicaid qualifiers, but don’t set that as your goal). Everybody will pay SOMETHING toward their health insurance.

**Are you a single making less than about $48,000 per year? A family of 4 making less than about $99,000 per year? If so, you could qualify for a subsidy (yes, the government will help pay for monthly insurance premiums!). More about that later…

**Because a price quote is based on your personal information (age, city, income, family, etc.), you’ll have to answer some questions to verify your identity before you’ll get specific rates (i.e. “Which of the following 4 addresses did you live at in 2001?”). You have been forewarned.

**Speaking of money - watch out for scammers. If someone tells you they’ll take cash for your premium & submit it for you – just say no. If someone is helping you get a price quote, don’t let them see the private information you’re entering – and for cryin’ out loud don’t give it to them verbally so they can fill it out for you!

4. When should I start looking for rates & plans?

**Your insurance won’t be effective until January 1st, so don’t freak out about looking for rates in October. There’s a lot of hype right now, so just wait a month. Give it until November and go in after all the bugs are sorted out.

**Some people doubt that it’ll all be ready to go by January 1st. I think there’s too much at stake for any of the players to be late (still, don’t wait until your New Years party to start the process)!

5. Who should I talk to for advice?

**Talk to an independent licensed health insurance agent. You’re going to want their help and advice because they’re the most knowledgeable people on the plans and rules.  If you feel like your agent is a descendant of Herb Tarlek, go find another one you like! Need to find a good one?  Ask me – I personally know a ton of great agents throughout the country and will refer you to one near you!

**Did an insurance company set up a storefront in your local mall? Steer clear. You’ll only have access to their insurance plans, but they won’t look across all the insurance companies in your area to find the best plan for you.

**The government is hiring “Navigators” to help you through the process (but, by law they aren’t allowed to help you choose a plan). 

6. What should I do right now?

If you know you’ll be buying insurance on the exchange, go check it out! (then click on the green button) will get you to your local Exchange, answer some basic questions and give you an idea of your insurance costs and potential subsidy.

Bonus tips:

**Platinum? Gold? Silver? Bronze? These are just levels of plans available in the Exchanges. Most people have a Platinum appetite, but a Bronze budget. Start by looking at the Bronze level plans – they’ll have the most affordable monthly rate although they won’t cover as much as the higher metallic plans.

**Even with insurance, you’ll be paying out of pocket for healthcare costs – none of these plans cover everything, so don’t be surprised if you have to pay thousands before your insurance starts paying.  

**Go here to learn more about Surviving Obamacare Simply


Reid has a passion for helping brokers & employers strategize fresh approaches to benefit plans that contain costs and increase access to care - helping employers & employees control their healthcare dime, time, and peace of mind. He writes & speaks around the country and is the Co-Founder & CEO of freshbenies.

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