By: Marti Lolli
While in most cases I would recommend you work with an agent or a health insurance company directly, there are instances when shopping and enrolling on the Health Insurance Marketplace makes sense. If you choose to go that way, here are some tips to help guide you:
Tip #1: Understand if you must visit the Marketplace.
The only reason you would have to visit Healthcare.gov is if you qualify or think you qualify for savings on your Health Insurance plan – either with the Advanced Premium Tax Credit (APTC) that discounts your monthly premium or through Cost Sharing Reduction which would discount your out-of-pocket costs like deductibles and co-payments. To get either of these savings you must qualify based on the Federal Poverty Level guidelines and enroll through healthcare.gov or through an insurance company site that links to healthcare.gov.
Tip #2: Do some window shopping first.
When you first get to healthcare.gov, you’ll be asked to either “see plans and prices” or “get ready to enroll.” If you want to view choices without creating an account, including providing household income and other eligibility factors, the “see plans and prices” will get you to what you want fastest. Once you have chosen a plan that fits your needs and you are ready to enroll then you can do the work of creating an account.
Tip #3: Don’t pick the lowest cost plan until you know what the trade-offs are.
You know the phrase “you get what you pay for?” That’s especially true for health insurance plans. Some insurance companies are expanding their “limited network” or “narrow network” plans from last year because the price tag is so appealing to consumers who just look at the monthly premium cost. But it could end up costing them a lot more. Consider the following about those plans:
- You can only go to a provider or facility in your health insurance provider’s specific network or you’ll pay out-of-network prices, which can be as much as 100 percent of the cost.
- Often referrals are required to see a specialist, even within the limited network.
- Prior authorization from the insurance company is always required to see a specialist or for a non-standard procedure outside of the network.
- Many benefits aren’t covered before the deductible, which is often thousands of dollars.
Tip #4: Get an edge with fast facts.
Knowledge is power. Healthcare.gov provides resources for shoppers to really understand the insurance plan they’re considering before they enroll.
Make sure you find out
- If your doctor is in the health plan’s network.
- The plan’s Summary of Benefits and Coverage (SBC) that is in the same format across all insurance company plans, making it easy for you to compare. The SBC provides information of what benefits are covered before you meet your deductible, as well as emergency and hospital stay costs like co-payments and coinsurance.
- The plan brochure that can show member benefits like discounts and tools for their members.
These are just a few tips to help you confidently shop on the Marketplace. There are many resources available at no cost as well – from agents to health insurance companies. The key is to make sure you’re as informed as you can be BEFORE you buy.
About the Author: Marti Lolli leads development of health care products to meet the needs of employers and consumers. She is also responsible for setting health care reform strategies and tactics for commercial, individual and government programs. Marti works across the company to identify opportunities and risks within the Affordable Care Act (PPACA) and its associated regulations as they are issued, as well as ensuring that corporate strategies and tactics are implemented.