Finding insurance

Kaiser's analysis of 2015 rates
Kaiser’s analysis of 2015 rates

Here’s everything you wanted to know about finding insurance under the Affordable Care Act, complete with videos. (Editor’s note: Updated Nov. 2014; some of the citations here still have year-ago data, but they are also being gradually freshened.)

Here are some cool tools:

Want to know 2015 rates in your state? You’re able to find them online. Not sure where your state’s exchange is? Find it here, on healthcare.gov, the federal government’s insurance exchange site, which will either direct you to your state’s site or tell you to continue on healthcare.gov.

Individual state exchanges also have their pages, without stopping at healthcare.gov. Here’s Maryland’s, for example, and here’s New York’s.

For analysis: Here’s the federal government’s analysis of 2015 rates, as presented by The New York Times. Here’s an analysis of the rates from The Kaiser Family Foundation for 2015; it’s the most exhaustive resource we’ve found so far. You’ll need to click through to “Issue brief” and scroll down for state-by-state information; we’ll update here as we find better resources.

This is a remarkable ProPublica tool: comparing plans on the federal exchanges. This helps you be  smarter shopper: it’s not just about the premium, but also about what is covered by the plan. Another amazing resource from the ProPublica team.

If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that by offering subsidies based on income and family size; see the subsidy calculator here. Different states may also have their own: here’s the one for New York, on New York State of Health.

Thinking about renewing? This paper, about rates for states on the federal exchange, suggests that the auto-renewals may bring hefty price increases. Shop carefully. Ask questions.

Want to know the 2014 rates in your state? Last year  it was easier to find info at the start: here’s a handy state-by-state update from Kaiser Health News for 2014. It may be updated; meanwhile, here’s a Kaiser analysis of premiums for 2015, that’s not quite so exhaustive.

Premium rates in the states where the feds ran the exchanges in 2014 may be found here; again, we’re looking for an update.

This Credit Suisse First Boston report shows 2014 subsidies, state by state. Scroll down for charts. We're looking for 2015 data.
This Credit Suisse First Boston report shows subsidies, state by state. Click image, scroll down for charts. We’re looking for 2015 data..

Free insurance? Well, maybe. As many as 7 million  people may qualify for insurance that is entirely or almost entirely paid for by U.S government subsidies. In some states, as many as 40 percent of the currently uninsured will be able to get health insurance for a $0 monthly premium, because their income level brings a full subsidy from the U.S. government under the Affordable Care Act, we learned the other day from The New York Times. A report by Credit Suisse from late 2013 has a state-by-state, income-level specific breakdown of who will pay what. Curious about your state? They’re all there; the charts also show the premium level/subsidy level at various income points. (We’ll update when the new one arrives.)

Planning to go without, or wondering if you should? This calculator tool walks you through some of the calculations of what penalty you might expect for an individual; this tool walks you through what  penalty you might expect for a family.

Any question you might have about enrollment should be answered here, in this remarkable Kaiser Family Foundation question-and-answer list.

What happened a year ago, and what did total enrollment wind up at? Here’s a great Charles Gaba blog post.

Do you have cancer or some other serious illness? Questions to ask in this Cancer Insurance Checklist, made in a partnership of some powerhouse organizations.

A website for people with AIDS giving insurance tips, from the Kaiser Family Foundation.

Kicking the tires at healthcare.gov, in the early going.

Quality rankings for insurance companies, from Consumer Reports using information from the National Committee for Quality Assurance.

An extremely thorough step-by-step handbook from Trudy Lieberman at CJR from late 2013. Read. This. Now.

The most important points of the Affordable Care Act, collected into two pages, in a complete once-over-lightly.

Questions about terminology? Our friends at the Association of Health Care Journalists made this amazing glossary.

Part 1: The Affordable Care Act: An overview
Part 2: Do I really have to buy health insurance?
Part 3: What will this insurance cost, and what will it cover?
Part 4: When, where, why?
Part 5: The private exchanges.

Part 1: The Affordable Care Act: An overview

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You may have been hoping you could ignore the topic of health insurance, but Nov. 15 is almost here, and with it the new health insurance landscape brought by the Affordable Care Act. And we’re going to help you navigate through it.

Here is an outline of what we’ll write about, basically a handbook on how to buy health insurance. We’ll also include tips, tools and so on. Don’t feel like reading? Here’s a video from the Kaiser Family Foundation.

Who: Everybody. The Affordable Care Act, also known as Obamacare or the Patient Protection and Affordable Care Act (PPACA), seeks to cover everybody with some form of health insurance. Even if you don’t have employer-sponsored insurance, or parent-sponsored insurance, and you don’t feel the need for it, you’ll have to buy it or face a penalty, with a very few exceptions.

Employer-sponsored health insurance is changing too, but in ways that are less visible. We have talked a bit about that elsewhere; that’s not the focus of this series, and the 125 million or so people covered by employers will be less interested in parts of this series.

If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that. It’s particularly important for people with pre-existing conditions, who have found insurance prohibitively expensive. Many people  with pre-existing conditions either go without insurance or are covered by a mélange of state and federal programs.

Planning to go without? We’ll talk about that too. There are still millions of uninsured people in the country, and they’ll be urged to buy; about 15.4 million others buy their own health insurance because they’re self-employed, or otherwise are not covered by employer-sponsored health insurance, Medicare or Medicaid.

What: If you don’t have health insurance now, you’ll have a range of offerings and aids to purchasing. The health insurance exchanges, mandated by the Affordable Care Act, are designed to make the job of shopping for insurance – a messy, complicated, confusing process – a little more transparent.

To do this, the act establishes certain categories of coverage. From the most expensive (and the most extensive coverage) to the least expensive and extensive, they are named platinum, gold, silver, bronze and catastrophic.

The law also provides for the expansion of Medicaid, the joint state-federal program for the poor, to expand coverage for those who have not had it for various reasons.

Some states have refused to expand Medicaid, a right they were given in the Supreme Court’s ruling in summer 2012. Here’s a map and report from 2013 of what the landscape looked like before the Affordable Care Act for both the uninsured and Medicaid-eligible people.

Here’s an update on state Medicaid expansion activity.

When: The exchanges are scheduled to re-open for business on Nov. 15, 2014, with coverage to enter into force Jan. 1, 2014. (Most plans run on a calendar year.) If you want to change coverage, you have until Feb. 15, the end of open enrollment.   Some confusion is expected, since this is a big undertaking, and the idea is to make coverage available to all. While it’s believed that the technology will work better this year than it did last year, it’s not likely to be perfect.

Where: The idea is that people who are not covered by employer-sponsored insurance, Medicare or Medicaid will buy insurance on the health insurance exchanges. These are virtual marketplaces set up with an extensive online presence showing the range of options, making the choices easy to compare.

But. It couldn’t be that easy. Insurance and health-care coverage are a mix of state and federal jurisdictions. Also, the Affordable Care Act raised a lot of opposition, particularly from Republican governors or legislatures in the states who wanted nothing to do with it. So some  states didn’t set up their own exchanges. By law, that means that they effectively delegate to the federal government the running of their exchanges; in others, plus the District of Columbia, the states are running their own exchanges.

What we learned from last year: This is a complicated process. If you’re on the exchanges, you might want assistance from a navigator, the name for people who are experts in navigating the system. Navigators are generally found in places like libraries, clinics, community service organizations and the like; they are not to be confused with insurance brokers, who will try to sell you insurance and reap a commission off that sale.

Not sure where to find a navigator? Each marketplace website should have a place where you can find a navigator. We have not seen a nationwide list of navigators.

Also, if you don’t qualify for a tax subsidy or don’t want to buy on the exchange, you can go to a private broker. Exchange plans are roughly comparable; private market plans may differ greatly.

Why: Health care costs are out of control, running $2.7 trillion annually. We spend more per capita than any other nation in the world, and it’s a bigger part of our GDP than it is for any other nation in the world. And yet, millions are uninsured, and our general state of health is measurably not better as a nation than the general health of other developed nations. Making insurance available and affordable for everybody was one of the biggest goals of the act.

How much: That’s the biggest question of our time. Many states have already revealed a grid of premiums to be charged by the insurers taking part in the exchanges.

The Kaiser Health News team has terrific resources for understanding and navigating the exchanges. Here’s a  state-by-state status report and a comparative analysis. (Both have yet to be updated, as near as we can tell, to 2014 stats.)

Many of these reports are preliminary; many are also being updated on the web  as the exchange date opening approaches.

Subsidies? Penalties? It’s confusing: Yes it is. We’re here to help.

What about me? Got a question? E-mail us at info [at] clearhealthcosts.com, and we’ll call forth our experts to answer it. Meanwhile, here is the best collection of questions and answers on this topic we’ve seen, from the Kaiser Family Foundation.

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Today’s tipThe most important points of the Affordable Care Act, collected into two pages, in a complete once-over-lightly.

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Part 2: Do I really have to buy health insurance?

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Who has to buy health insurance? Can’t I just ignore the Affordable Care Act?

The Affordable Care Act seeks to cover everybody with some form of health insurance.

If you’re uninsured, you’ll be urged to buy. Even if you don’t have employer-sponsored insurance, or some kind of public insurance, or parent-sponsored insurance, and you don’t feel the need for it, you’ll need to buy it or face a penalty, with a very few exceptions.

If you have insurance now that you bought yourself off of the exchange — you may be able to keep it, but you may find a better deal by replacing it with a new plan from the exchanges.  That goes for individuals and many small businesses covering only a few employees.

(For a quick primer on the U.S. health-care system, see the John Green video on this page.)

Price breaks, or subsidies.

If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that by offering subsidies (see below, and see the subsidy calculator here, and our future piece on prices and subsidies). To get a subsidy, you have to buy on the state or federal exchanges — not from a private broker, or on one of the new private exchanges.

Pre-existing conditions.

The chance to buy health insurance particularly important for people with pre-existing conditions, who have found insurance prohibitively expensive. Many people  with pre-existing conditions either go without insurance, or have high-deductible plans and high premiums, or are covered by a mix of state and federal programs.

Planning to go without?

There’s no way of knowing how many people will skip it entirely. There’s a whole industry guessing that people in their 20’s and 30’s who are uninsured will choose not to spend hundreds of dollars a month on insurance, which they view as having dubious value. There’s another group of people who will suddenly have a changed environment too: that is people in their 40’s, 50’s and 60’s, who are not on public insurance, and who for one reason or another are uninsured. That’s about 20 percent of the uninsured population, and they tend to be more interested in health insurance because they have more medical issues as a rule.

Last year, “While there are 8 million Americans who thought the health plans in Obamacare were a good deal, the Kaiser Family Foundation estimates there are 20 million more who decided not to sign up,” Sarah Kliff wrote recently in Vox. “For many of them, the existing prices were too high; one survey found that 39 percent of shoppers who didn’t buy coverage cited “the costs aren’t worth it” as the reason.”

The Wall Street Journal recently did some great reporting about low- and middle-income Baby Boomers and what great blessings the new landscape offers them. Here’s a passage from a story: “A 60-year-old nonsmoker in Toledo, Ohio, would pay $420 a month for a basic insurance policy next year if he earned too much to get subsidies; if his income was $25,000 a year, however, his share of the premium would drop to $48 a month. …  One 62-year-old laid-off salesman, currently paying $1,328 a month for insurance for himself and his wife through his former employer, could see his monthly bill drop to $21.”

For young healthy people in Portland, The Journal did a similar set of reporting, showing calculations for all the various plans. A 35-year-old with a $35,000 annual income could pay as little as $158 or as much as $364, depending on the plan, according to their reporting; a 22-year-old with a $20,000 income, as little as $57 or as much as $226, subsidies included.

Of course, this is only the premium; the deductible should also be factored in to costs, and the lowest deductibles are on the most expensive plans.

How many people will buy health insurance on the state-federal exchanges?

Before the Affordable Care Act went into effect, there were anywhere from 41 to 50 million uninsured people in the country, depending on who was counting. Around 8 million people bought insurance on the exchanges before April 2014, though some of them were previously insured with non-exchange plans; some of those 8 million later dropped out. Another 8 million people gained coverage under Medicaid by the middle of the year. Another 15 million people  buy their own health insurance because they’re self-employed, or otherwise are not covered by employer-sponsored health insurance, Medicare or Medicaid.

Beyond that, some big companies like GE and IBM have recently announced that they are discontinuing retiree health insurance, and substituting for that coverage a lump-sum payment that retirees can use to buy their own insurance. Those retirees may wind up on the public exchanges, or may go to private ones.

Do I have to buy health insurance? Not if you are …

Who’s exempt? Here’s a great list from Emily Bazar at the California HealthCare Foundation:

“But the law contains many exemptions. For instance, you won’t have to pay a tax penalty if:

  • you’re a member of a federally recognized Native American tribe,
  • you’re incarcerated,
  • you’re in the country illegally,
  • you belong to a religion that opposes accepting benefits from a health insurance policy,
  • you cannot find “affordable” coverage, meaning the cost of your premium would be more than 8 percent of household income, or
  • your household income is low enough that you’re not required to file a federal tax return. (Click here to find out if this means you.)”

What about the penalties?

If you don’t meet these criteria, you could be in for a penalty: whichever is greater of 1)  $695 per person (up to a maximum of $2,085 per family), or 2) 2.5% of household income, which will be phased in from 2014-2016.

The formula isn’t that complicated, but it has to be figured both ways (the fixed sum and the percentage). Here’s a calculator page that’s pretty clear from about.com; it shows that the minimum penalty in 2014 is $95, which isn’t too scary.

My income is really low. Do I have to buy insurance anyway?

Note the exemption above for people who can’t find affordable covverage.

Also, for people with low incomes, there’s always Medicaid, the joint state-federal program for low-income people. The ACA is expanding Medicaid to people with incomes up to 138% of the federal poverty level, based on modified adjusted gross income, although of course your state may not be participating in the Medicaid expansion. “This expansion creates a new minimum Medicaid eligibility level for adults and eliminates a limitation of the program that prohibits most adults without dependent children from enrolling in the program (though as under current law, undocumented immigrants are not eligible for Medicaid),” the Kaiser Family Foundation fact sheet explains.

Eligibility for, and availability of, Medicaid varies from state to state. While the  Affordable Care Act offered the expansion of Medicaid to all states (virtually paid for by the federal government), in order to extend coverage to a lot more low-income people than have it right now, many states have rejected the Medicaid expansion.

In those states, people will find a dramatically different landscape than in states where Medicaid and ACA coverage are likely to cover more people.

In some states that initially rejected Medicaid expansion, governors and legislatures have decided to support it. The landscape’s still changing.

Employer-sponsored health insurance is changing too, but in ways that are less visible. We have talked a bit about that elsewhere; that’s not the focus of this series.

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Part 3: What will this insurance cost, and what will it cover?

New York State has approved these rates for health insurance on the state exchange.
New York State has approved these rates for 2014 health insurance on the state exchange NEEDS UPDATE.

What can you tell me about buying health insurance under the new law? Not too much, please. 

Stick with us. This is not too complicated.

The law had a primary goal of expanding health insurance coverage for all Americans with three main strategies:

  • Expanding Medicaid coverage, for poor people, up to 138% of the federal poverty level. The Supreme Court decided to let states make their choice on this; only about half the states are expanding Medicaid coverage.
  • Setting up health-insurance exchanges to enable consumers to easily compare plans, and subsidizing insurance for people with incomes betwen 138 percent and 400 percent of the federal poverty level
  • Requiring everybody with an income above 400 percent of the federal poverty level to buy insurance or pay a penalty.

The health insurance exchanges are designed to make shopping for insurance – a messy, complicated, confusing process – a little more transparent.

The act establishes categories of coverage. From the most expensive (and the most extensive coverage) to the least expensive and extensive, they are named platinum, gold, silver, bronze and catastrophic. Every company offering, say, a bronze plan in the New York City area must make the same services available, meaning that all bronze plans are comparable. Click on the table here to see the New York plans and rates.

Here’s an easy-to-use graphic from Covered California NEEDS UPDATE that shows the out-of-pocket and deductible levels for the different plans. Basically, the more you pay in premiums, the lower your out-of-pocket, co-pay or deductible.  Estimates say that the platinum plans are supposed to cover 90 percent of your health spending, gold 80 percent, silver 70 percent and bronze 60 percent.

Catastrophic plans are also available to cover, well, catastrophes. They are available for people under 30, and do not cover routine care. They are also available to people who can certify that they are in a hardship situation — they can’t afford anything else,  because they would be required to pay more than 8% of their income for a health plan.

Many insurance companies have chosen not to take part in the exchanges, and are selling their insurance policies separately from the exchanges. While there are many big players off the exchanges in all states, a recent study by the health information company HealthPocket found that the premiums off the exchanges could be cheaper – and yet, those off-exchange policies will not be eligible for a subsidy.

So if you don’t qualify for a subsidy, you might find a better deal off the exchanges.

Wherever you buy, if you buy, pay careful attention to what’s being sold. “Health insurers are showing just how creative they can be at shirking their obligation to provide new consumer protections under the Affordable Care Act,” Sabrina Corlette wrote in a piece about health insurers recently on the blog from the Center for Health Insurance Reforms from Georgetown University.

What is this insurance going to cover?

Ten essential health benefits are supposed to be covered in the platinum, gold, silver and bronze plans offered to individuals and small groups. Here’s a list from healthcare.gov:

  • Ambulatory patient services (outpatient care, without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (before and after a baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (used to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

To say it’s covered, though, may mean that only 60 percent is covered, or if a provider is out of network, none is covered. Or you’re out of pocket until you meet your deductible, whatever that may be.

The out of pocket maximum: $6,250 for a single policyholder and $12,500 for a family.

Medications: Well, it’s complicated. Anyone who has filled a prescription recently knows that the insurance company can decide what the doctor prescribed isn’t available to you with your insurance coverage. (Here’s our page on buying prescriptions, with tips and tools.)

For the Affordable Care Act, “The final, 149-page rule retains requirements that insurers offer at least one drug per therapeutic category, or the same number as a state’s benchmark plan, whichever is greater. Many state benchmark plans require at least two drugs per class,” Kaiser Health News writes.

“Responding to concerns from some advocacy groups, the final rule also states that insurers must have procedures to allow patients to get ‘clinically appropriate’ prescriptions not on the plan’s list of covered medications.”

The insurance company coverage is often governed by a formulary, or list of approved medications. Those formularies can change, and so one should always check with the insurance company or pharmacy benefits manager on coverage. Here’s a nationwide formulary resource that we have not completely vetted, but at a glance it looks to be valuable (in my quick test it was 50 percent right). It’s free, and it lets you search any plan in any state.

Cool tools 

If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that by offering subsidies based on income and family size; see the subsidy calculator here.

Want to know the rates in your state? Here’s a handy state-by-state update from Kaiser Health News.

Planning to go without, or wondering if you should? This calculator tool walks you through some of the calculations.

For young healthy people in Portland, The Wall Street Journal  walked through some scenarios, showing calculations for all the various plans.

The most important points of the Affordable Care Act, collected into two pages, in a complete once-over-lightly.

Expanding Medicaid

The law also provides for the expansion of Medicaid, the joint state-federal program for the poor, to expand coverage for those who have not had it for various reasons. If you are on Medicaid now, or if you’re not on Medicaid but think you might qualify, go to this page and follow the step-by-step instructions.

Some states have refused to expand Medicaid, a right they were given in the Supreme Court’s ruling in summer 2012. In those states, some of the poorest of the poor will have few options.

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Today’s tip: Pre-existing conditions are not supposed to matter under the new law — you should be able to get insurance anyhow, where before it was prohibitively expensive. Not sure if you have a pre-existing condition? Go to this site and search pre-existing conditions, and you’ll easily find this handy fact sheet explaining what the current situation is, and how it will change as of Jan. 1, 2014 – information that’s useful for people looking for coverage starting Oct. 1.

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Part 4: When, where, why?

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While Congress continues to create cliffhangers over whether the Affordable Care Act will be de-funded, we are continuing with our series on the implementation of the Affordable Care Act. This is Part 4.  Part 1 is here; Part 2 is here and Part 3 is here.

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When: The exchanges are scheduled to open for business on Oct. 1, 2013, with coverage to enter into force Jan. 1, 2014. The exchanges are also to be open through March 31, 2014, so anyone who doesn’t get done in time for the Jan. 1 grand opening will still have plenty of time to sign up and avoid a penalty.

This is handy, because it’s clear that some of the exchanges will be open only on a limited basis on Oct. 1, because of the challenges of building the technically complicated systems. Also, activity in Congress pretty much assures that there will be confusion on opening day, though some of the states are likely to press ahead anyway because of what they have in place.

“It’s looking more and more like Tuesday will be a split-screen day: The government will shut down, and Obamacare will open for business,” Politico wrote.

To get covered starting Jan. 1, you’ll generally need to sign up by Dec. 15.

Where: The idea is that people  who currently are not insured by employers or by the government (Medicare, Medicaid) will buy insurance on the health insurance exchanges. These are virtual marketplaces set up with an extensive online presence showing the range of options, making the choices easy to compare.

But. It couldn’t be that easy. Insurance and health-care coverage are a mix of state and federal jurisdictions. Also, the Affordable Care Act raised a lot of opposition, particularly from Republican governors or legislatures in the states who wanted nothing to do with it. Also, the technology is complicated. So some of the states  didn’t set up their own exchanges. By law, that means that they effectively delegate to the federal government the running of their exchanges.

Not sure where your state’s exchange is? Find it here.

Want to know the rates in your state? Here’s a handy state-by-state update from Kaiser Health News.

If you have not been able to buy coverage because it’s been too expensive, the act is supposed to rectify that by offering subsidies based on income and family size; see the subsidy calculator here.

Planning to go without, or wondering if you should? This calculator tool walks you through some of the calculations of what penalty you might expect.

Do you have to do this at all? Maybe not. We’ve covered such topics in previous parts of the series, or, take a look here: The most important points of the Affordable Care Act, collected into two pages, in a complete once-over-lightly.

Also, many insurance companies have chosen not to take part in the exchanges, and are selling their insurance policies separately. While there are many big players off the exchanges in all states, a recent study by the health information company HealthPocket found that the premiums off the exchanges could be cheaper – and yet, those off-exchange policies will not be eligible for a subsidy.

So if you don’t qualify for a subsidy, you might find a better deal off the exchanges.

Anybody can buy insurance on the exchanges, but people with employer-sponsored health care will have little or no reason, same as people on Medicare or Medicaid. The exchanges generally are designed to make insurance buying easy for people who are uninsured, or who buy their insurance themselves. The only people specifically barred from the exchanges are immigrants who are undocumented.

Why: Health care costs are out of control, running $2.7 trillion annually. We spend more per-capita than any other nation in the world, and it’s a bigger part of our GDP than it is for any other nation in the world. And yet, nearly 50 million people are uninsured. Making insurance available and affordable for everybody was one of the biggest goals of the act.

More questions? Here’s a thorough roundup from the folks at Kaiser.

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Today’s tip: There’s a lot of information, and a lot of misinformation, flying around about the Affordable Care Act:   (“Ohmygosh, your premiums will be really really high” or  “The whole system is failing” or  “Buy this, it’s perfect for you” or “Quick, renew your old insurance right now so you don’t have to go under Obamacare.”).

Make sure the source of your information is independent and doesn’t profit from you. Don’t believe everything you’re told. Do your research. Inform yourself.

The federal government’s site is healthcare.gov.

Want a non-government source? We’ve already mentioned the Kaiser Family Foundation, but there are also other resources in the states.

A good clearing house for state-by-state updates is the National Council on State Legislatures, which has a health information page here.

The National Women’s Law Center has a lot of information about what the law means, and what you can do if you think you’re not getting what you’re supposed to get. Here’s a fact sheet on LGBT issues, for example; here’s one on women’s preventive services and coverage under the ACA. Here’s a step-by-step fact sheet on what to do if you think your plan should be covering birth-control pills but does not; these suggestions could be transferred to other situations as well.

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Part 5: The private exchanges

 

If you’re a health insurance broker, you’re probably hearing the sound of thundering feet. More and  more competitors are coming to the marketplace, both online and off. And what’s the deal with all those places selling insurance online that are not healthcare.gov.?

The state and federal exchanges for selling insurance are augmented by a slew of private, non-government options, also called private exchanges.

These players — some of the big ones are eHealthGetInsured, GoHealthExtendHealth (from Towers Watson) and ConnectedHealth — are selling insurance online, some with private options and some a mix of  Affordable Care Act plans and non-A.C.A. plans. Many of them pre-dated the Affordable Care Act, but have ramped up operations in light of A.C.A. options.

Towers Watson, for example, is a big benefits company. They bought ExtendHealth and turned into a private exchange called OneExchange, which  “offers employers both private and public exchange-based health insurance options for their full- and part-time workers, and for all retirees.”

These private exchanges, called web-based entities or web-based brokers, have both A.C.A. plans and plans that differ from the A.C.A. ones, and also may have vision and dental insurance and other products, while the state and federal exchanges have specifically A.C.A. options.

They signed an agreement with the government to be part of the Federally Facilitated Health Insurance Exchange (FFE), the new federal health data system.  HealthCare.gov is perhaps the best-known part of that system.

Many of these exchanges have been in business for some time. EHealth, for example, was founded in 1998.

The private exchanges are paid by insurers for bringing in customers. Since they offer plans that are not A.C.A. plans, they may have more variety — bigger or smaller networks, bigger or smaller price tags, and differing options. Non-A.C.A. plans on the private exchanges do not qualify for subsidies, however.

Private exchanges may have broker-advisers to help people through the process. Those brokers will be paid by how much business they bring in. On the A.C.A. exchange sites, both state-run and federal, there are advisers available by phone; navigators trained in the process also give advice. They don’t get paid by the business they bring in.

There are some unusual players entering the marketplace: Intuit’s Turbotax has a new page allowing people to see the costs and penalties of health insurance. It also sends people to either Healthcare.gov or  EHealth, suggesting that they’re getting paid for directing people there.

A new entrant, healthsherpa.com, is a web-based entity that was founded by San Francisco entrepreneurs with background in real estate. They used their tech chops to launch a site called opscost, comparing hospital pricing information released by the government. Then, in advance of the Affordable Care Act, they launched healthsherpa, collecting and sorting A.C.A. plans. When the problems with healthcare.gov during the launch kept people from finding information, healthsherpa had it. Now they’re qualified to sell both A.C.A. plans and non-A.C.A. plans.

There are also a number of A.C.A. scams — entities that purport to be reputable businesses, but aren’t. If you have any questions about who you’re dealing with, here are some suggestions from the Federal Trade Commission. Much of it is common sense: don’t give personal information to just anybody, be cautious about medical discount plans (No! they’re not insurance! and some of them exist just to get your information and your money!) and just generally, don’t give your money to just anybody who asks for it. Be thoughtful.

Think you’re seeing a scam? Call 1-877-FTC-HELP (1-877-382-4357) or go to ftc.gov/complaint. “Your reports give the FTC the information it needs to launch investigations, and put scammers out of business,” the FTC web site says.

 

This Credit Suisse First Boston report shows 2014 subsidies, state by state. Scroll down for the charts.
This Credit Suisse First Boston report shows subsidies, state by state. Click image, then scroll down for the charts.