Individual Health Insurance and Your Options for 2014

Next week the Federal Marketplace (aka “exchanges”) are slated to open up.  With many companies opting to have their employees purchase health coverage in the individual market, the opening of these exchanges is an important event.  Some background points:

·         Open enrollment is slated for October 1, 2013 through March 31, 2014.  You must enroll during this time period or you will generally not be able to enroll without a qualifying event.

·         The individual mandate requires we obtain a “Qualified Health Plan” containing the Essential Health benefits with a minimum actuarial value of 60%.

·         These plans will be offered in or out of the exchanges.  However, you can only receive financial assistance by purchasing in the exchange.  It is estimated 7 of 10 will qualify for some sort of assistance.

Enrolling in the exchange is accomplished in 4 steps (www.healthcare.gov):

1.    Setting up an account.

2.    Filling out the online application. 

3.    Comparing your exchange options. 

4.    Enrollment

Seems simple?  Now I am going to complicate it.  You will have options outside the exchanges.  Many carriers will offer “Qualified Health Plans” outside the exchanges.  You will also have renewal options that could carry you on your current program well into next year.  Provider network options are changing.  You also could be grandfathered if your current insurance was purchased before 3/2010. However, know that the only vehicle for obtaining financial assistance is in the exchange if you qualify.

My Recommendations:

•       Obtain Health Insurance.  Not having it can result in catastrophic financial problems should you get sick or have an accident.

•       Know your eligibility for financial assistance.

•       Fully assess all your options (not just the exchange).

•       Carefully assess the new plan designs.  While there are essential health benefits, provider networks could change and there are different benefit designs.

•       Budget for premium changes (community rating, some age, smoker/non-smoker). 

•       Stay in touch with your carrier/professional as PPACA moves forward.   Obtain any enrollment assistance. It will cost you no more to work through a professional.  Make sure he or she is certified to help in or out of the exchanges and offer objective advice.

Finally, stay in touch with any last minute changes.