Shopping on the Exchange—You Can Do Better! Healthshare

Shopping on the Exchange – You Can Do Better!

As you may know, I have been encouraging people not to make health insurance purchases without professional assistance, especially on the federal or state health insurance exchanges.

If you’ve succeeded in logging in, creating an account profile and browsing plans, congratulations. What you might not know, however, is whether you made the right choice, what your options are, or if you are actually enrolled!

Let’s say you do successfully upload your account profile on the exchange. From here on in, any help you might receive will amount to little more than asking an Average Joe on the street.

If I am going to alert you to the problems of shopping alone on the exchange, I have to provide real solutions for you as well. First, take a look at the solutions offered by the federal exchange if you are having a hard time with their site.

What HealthCare.gov Says

The Obama administration has admitted that the federally facilitated exchanges (FFE) are still having issues—so much so, in fact, that the Obama administration continues to offer “fixes” like extending enrollment deadlines (i.e., December 23 for January 1 coverage), bumping back next fall’s open enrollment period, extending premium payment dates, allowing catastrophic plans as a stop-gap measure, and so on.

Exchange shoppers hitting a wall on the FFE websites are offered alternative ways to get through the maze known as the application process.

  1. Submit a paper application. These downloaded applications only show the premium subsidy you will qualify for, not the actual plans and rates available to you. It also takes a couple of weeks for it to be processed—not an ideal option if you are looking for a policy with a quickly approaching effective date.
  2.  Apply by phone. Most people are not inclined to wait on the phone for the same application they tried to get online.
  3. Ask a navigator. You’ll get a government employee who probably knows little more (or less) than you do. They can’t show you all of your options, give you any advice, or tell you what you could find outside the exchange.

None of these options are real time-savers, and you won’t walk away feeling like you have all the facts. The end result might leave you no closer to plan choices or premium rates, because you haven’t actually applied for health insurance yet!

Don’t be surprised when you are required to apply (and be denied) for Medicaid before you can actually apply for an advance premium subsidy.

You Do Have Other Options!

There ARE options for purchasing off the exchanges, even if you know you will qualify for a premium subsidy or tax credit.

If your income is over 400 percent of the federal poverty level (FPL) and you know that you won’t qualify for a premium tax credit, you should stay away from the exchanges altogether if your goal is to get all of your plan options.

Off-Exchange Plans and Premium Subsidies

If you can estimate your 2014 income as below 400 percent of the poverty level and think that going through the health exchange is your only option, think again.

  1. Talk to a health insurance professional. He or she can help you calculate your subsidy amount to help you avoid future hassle of adjusted tax credits.
  2. Unless you want an advance premium tax credit (which must be done at the time you enroll on the exchange), you can wait to submit your actual income with your tax return to avoid any need for reconciling your estimate with the IRS.
  3. Using an insurance professional won’t raise your premium or cost you anything for services, but WILL reveal all of your purchasing options.

If your coverage was cancelled in 2013 due to the Affordable Care Act (ACA), you are exempt from a tax penalty from not having an ACA-approved plan. In that case, you may want to consider a short-term plan, which will have much lower rates than other plans.

Trust a Personal Advisor, Not a Navigator

Keep in mind that insurance professionals routinely have years of practical experience and continuing education covering insurance regulations and plans in force. Compared with the required 30 hours of training and the lack of criminal background checks on exchange navigators, you are just plain better off with a licensed Personal Advisor at your side.

Though the White House may be scrambling to fix the exchange websites and offer interim solutions to those of us left hanging, there is no reason to be anything less than proactive about your health care coverage.

Consider a licensed insurance advisor as your best resource for helping you gain complete control over your health plan choices (like health savings accounts), estimate your income correctly for a tax credit subsidy, review all of your benefit options, and get covered on time.

Wiley Long

Wiley Long

Wiley Long is President of HSA for America, and a passionate advocate for consumer-based solutions that will improve price transparency and lower health insurance and medical costs for people purchasing individual and family health insurance plans.
Wiley Long
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