Plan and Pricing Info is Availableby Denise Early on Oct. 21, 2013, under Health
I’m not even trying to use the healthcare.gov website at this point, but I am now able to get plan and price information for clients – but it’s a lot of work. The insurance company websites all have links to the Kaiser Family Foundation subsidy calculator, so a person can put in their 2012 adjusted gross income (or estimate for 2014) to see how much help they will get for their health insurance premium. Then we must go shopping at each company website for the Tucson market.
I figure I can help my clients identify the plans that will fit their needs so they will be ready to enroll once the healthcare.gov website is working smoothly.
I’m pretty busy right now with my Medicare clients, but I’ve put in some time to familiarize myself with the 2014 individual health insurance plans – and there are many of them.
I figured out the three BlueCross BlueShield of Arizona plans I like – because they provide unlimited doctor visits for a co-pay. While the BCBSAZ premiums are not the lowest in Tucson, their exchange plans offer access to the large BCBS network of providers. Most of the other companies’ plans have smaller networks.
I then moved on to Humana and found their Silver plans with co-pays for doctor visits. These plans also cover $500 worth of lab services and x-rays with no co-pay. With unlimited doctor visits for a co-pay, I like the plan design of two of their Silver plans.
Before shopping on the BCBS of AZ and Humana sites, you need to use the Kaiser subsidy calculator so you can subtract your monthly subsidy from the premium you will see for each plan.
I tried to check out Health Net plans, but I can’t find any way to get a premium quote on their website. They ask you to provide information so a Health Net rep can contact you. That’s not helpful for someone who just wants to shop.
Meritus Health Partners gets my award for best shopping because its website let’s me put in an income amount and then incorporates the subsidy into the premium it shows for each plan (based on age). But the devil is in the details and you need to look at the “outline of coverage” to see how the plan(s) work – and the Meritus Silver plans have co-pays for a number of services beyond doctor visits, but this varies from plan to plan.
It’s all a bit confusing.
I have worked with individual health insurance for several years and it has taken me a while to understand the plans I’ve been looking at. I don’t see how most people can figure out which plan is the best for them. Picking a plan based on price alone is not a good idea. If a person already sees doctors, they might need to pay a higher premium to keep those doctors.
I think having co-pays for doctor visits is important so people don’t avoid going to the doctor for fear of getting a $200 bill. I think anyone with kids would want this type of plan. But the lowest-priced plans are those in which everything comes under the deductible.
People who want the lowest-cost plan (and are betting they won’t need to see a doctor) will pick a plan in which everything comes under the deductible. The highest deductible is $6,350 for an individual and $12,700 for a family. This type of health insurance is meant to protect against “catastrophic” costs.
It’s all rather complicated and I don’t think most people can figure it out on their own. They really do need an insurance agent/broker who has experience with individual insurance. I’m not saying this to get business - because I’m quite busy with the Medicare Open Enrollment Period. I’m just saying that picking a health insurance plan is pretty complicated – and having guidance from a professional would be a good idea.
I’ve helped my sister in Connecticut review several plans, and she has identified one that she will probably sign up for. I told her she ought to call the company and ask them to review the details of the plan with her – just to make sure there is nothing she is missing. Does the doctor visit co-pay cover everything that happens in the doctor’s office? If there is an emergency room co-pay, does it cover everything that happens in the ER, or are there going to be other charges? Is her doctor really in the plan’s network?
Picking a health insurance plan is kind of complicated, so why not take one more step to be sure you really understand the plan you choose. Some politicians have said selecting a health insurance plan using the Marketplace/Exchange will be like arranging your travel plans using Expedia or Kayak. That is a dumb thing to say because health insurance is a lot more complicated and a lot more important.