To recap: I live in Washington State. I am trying to sign up for a new health insurance plan under the Affordable Care Act (i.e., Obamacare) using the state’s Insurance Exchange website, which is working much better than the Federal government’s or those of most other states.
I’ve entered data (anonymously) into the site, seen what plans are available and dug into the details of each. I’ve also familiarized myself with the meanings of ‘deductible’, ‘co-pay’, and ‘out of pocket maximum’ and the various traps that can wind up costing big time if you chose the wrong insurance.
Having made it this far on my own, I decided to see what outside help would advise me to do. The ACA has set up two groups you can call on for assistance, the Navigators and Brokers. I got in contact with one of each.
The Navigator wasn’t much help in my particular case. These are people trained in how to use Exchange Sites and to help clients through the process. Since I was already through the process up to the point of applying for a plan, there wasn’t much she could do for me unless I ran into problems making my application. Also, they’re not supposed to offer advice on people’s individual circumstances…
I consulted a Broker. These are insurance agents, versed in the various plans being offered, who WILL offer advice and information. The one I spoke with, once I laid out my circumstances and explained what I’d already done and found out, complimented me on having done my homework.
He confirmed my suspicion that what appeared to be ten different plans available to me were actually just four. Several of the plans were just variants of the others, although they had different names and were from different companies. He also agreed that based on my circumstances, the plan I had chosen – one with a low deductible, moderately low out of pocket maximum, and premiums that would be lower than what I’m paying now under an insurance policy with a high deductible, high out of pocket maximum – would be a good fit. However, he raised a few points and warnings that I found valuable.
First, he suggested before committing to any plan, that I make sure my current doctor (if I wanted to keep him) was a member of that plan’s network of authorized medical care providers, AND is likely to remain so. Apparently some health insurance companies are saving costs by shrinking their coverage area or excluding physicians who don’t earn them a lot of profit from their pool of providers, effective 1-1-14. This is extremely unfortunate, but a fact of life.
He also advised that I check with my physician and make sure he had no objections to me going with a new and different plan before I signed up, as that might be a problem.
More generally, he agreed with my over all assessment of the ‘metal’ levels of the insurance plans. Namely, Bronze is minimal cheap coverage for people who don’t expect to be using it much, Gold is for those who will be having lots of procedures and/or are willing to pay more in premiums to pay less out of pocket, and Silver is in-between.
However, he urged me not to automatically dismiss the Gold plans. His view was I should get the most medical insurance I could comfortably afford. In the event of unexpected, severe medical problems, a Gold plan would be a Godsend. So if any of the Gold plans being offered in my area were relatively cheap – relatively being the key, here – in comparison to the Silver plans, then I should consider them, as well.
I took his comments to heart, and rechecked the numbers. Unfortunately, all the Gold plans had higher deductibles and MUCH higher out of pocket maximums than the Silver plan I was looking at, and the premiums were at least $70.00 more a month. I decided to stick with my original choice.
The last points he brought up were items especially worth noting. First, that since the insurance companies would want the premium for the first month paid ahead of time, it would be in my best financial interests not to sign up any sooner than I had to. Although I didn’t want to wait until the last minute in the event of problems. Sometime early in December might be the best time to apply for a plan, circumstances permitting.
The second point he raised was that although Washington’s insurance exchange web site was doing well on its own, when I made my application for an insurance policy, the personal information (including Social Security number) I provided would be shared with the Federal government and *its* insurance exchange system. I therefore might want to wait until the government fixed some of the security problems before giving out such sensitive data.
Also, that I’d have to go through Identity Verification by the credit bureau Experian when I did make my application.
So. I guess all that’s left now is to try to sign up for a plan. The deadline used to be December 15 but that’s been extended. Still, I don’t think I’m going to wait, I think I’m going to attempt it the weekend after Thanksgiving. That should give enough time.
We’ll see how this goes.