If These Are the Experts Hired to Help You, We Are All in Trouble! Healthshare

If These Are the Experts Hired to Help You, We Are All in Trouble!

Note From Wiley Long: As part of our ongoing effort to keep you informed about health care reform and how you are going to be impacted by it, I thought it would be a good idea if one of our Personal Advisors logged in to the federal Health Insurance Marketplace to get a first-hand account of how it worked. Hopefully this would put us in a better position to help clients navigate the exchange and discuss the different aspects of the process.

What follows is the first-hand account of our sales manager, Fred Adams, as he tried to first obtain a quote and then receive health exchange information about a particular state.

At First It Was Simply Inconvenient…

After unsuccessfully trying to log in using what I made sure was the correct information, I decided to call the federal marketplace directly to see if they could help me. The recording I got to begin with stated that an agent would be with me shortly, and then what I believe strongly to have been a customer service representative (not an agent) answered the phone.

Initially I was given the runaround, which included being told that I was simply doing it incorrectly. Finally, the person with whom I was speaking admitted that he could not help me, as their entire website was down.

And Then It Got Laughable…

Since I had him on the telephone, I decided to simply ask him what my options for coverage in Georgia are. At that point, I was told that I was not limited to where I could purchase a plan. For example, he told me that if I was a truck driver and traveled all over the United States, I could choose a plan in basically any state.

I told him that although I am not a truck driver, I do travel extensively and sleep in hotels about a quarter of the year overall. Therefore, my question was, “Which zip code do I use to purchase a plan, since you are unable to give me information about plans in Georgia?”

He put me on hold, and when he came back I was told that, no, I could only purchase a plan in my home state, but that I needed to be sure that the plan I chose had providers in other states so I could be sure to have coverage when I traveled.

This representative also tried to tell me that Georgia was handled differently because they have their own state-run health exchange, as opposed to the federally operated Health Insurance Marketplace. As a last resort, since he clearly was unable to help me, he suggested that I call the number listed at Healthcare.gov. When I asked him who I had called, he replied, “the Marketplace.” Believe it or not, the number he suggested I call was the same number I called in the first place.

And Downright Ridiculous!

I ended the phone call shaking my head at the absurdity of it all. I tried to obtain a quote for a health insurance plan that I am legally required to have, and was unable to access the website. When I called the number provided for assistance, the person on the phone could not help me either, and referred me to a help line that was the number I had already called. It was one of those scenarios where I just had to laugh.

But It Really Isn’t Funny…

However, despite the ridiculous conversation and the complete lack of information or help I received, this really is not funny at all. There are several reasons why I am more than a little alarmed by the whole encounter.

The Health Insurance Marketplace opened on October 1, yet on October 2 I was still unable to access their website. It would seem to me that the sensible thing to do before opening the federal marketplace would be to make sure that the websites were fully functioning and capable of handling a large influx of visitors.

The media have hyped up the opening of the exchange to the point that many people are all but panicked and feel they must purchase a policy before the Health Insurance Police start arresting people (an exaggeration, but you get my drift). Surely there were ways they could have tested the system prior to the day open enrollment was set to begin.

That said, although this was inconvenient and rather comical, the inability to access the marketplace online was the least of my concerns. The true issues for me began when I got that recording that stated an agent would be with me shortly.

It is Actually Disturbing!

As we have detailed in other blog posts, the person who answered the phone was not an agent by any means. He was possibly an ‘insurance navigator,’ but it seemed more likely that he was simply a customer service representative. Talk about misleading!

This person did not even have the training that the navigators are supposed to have! Instead, he had a very well-written script to follow, and any time I asked a question that deviated from the script, he floundered. Not only did he flounder, but he gave absolutely incorrect information.

This is exactly what I was worried about when talk of insurance navigators running the health exchanges started being hyped up. These people who are supposedly qualified to help you make insurance decisions have minimal training, and clearly do not have any real idea what they are doing. They are providing not just inaccurate but completely incorrect information.

For example, Georgia is, in fact, run by the federal government, and does not have its own exchange. Also, you have to purchase a policy in the state of your residence, regardless of how much time you spend away from home (which he eventually figured out, but not every consumer will keep questioning their representative until he finally gets his facts straight!).

In recent webinars, I have talked about the importance of making your health insurance decisions with the help of a licensed, experienced insurance professional. My experience with the federal marketplace certainly solidifies that belief.

Licensed agents and brokers must undergo extensive studying and testing in order to be allowed to sell insurance. In addition, we have also had to undergo hundreds of hours of training to help make sense of all the ins and outs of the Affordable Care Act.

Ask for Expert Advice

Our job as Personal Advisors has always been, and will continue to be, to help health care consumers receive accurate information regarding health insurance, whether they are our clients or not. We are all committed to helping you make wise, informed decisions. When you call or log onto the marketplace, you are simply being read a script and are expected to make a decision based on that script—even if the information you are provided is wrong.

Millions of people will be making a health insurance purchase using either the federal marketplace or a state-run health exchange, but you have a responsibility to yourself to be as informed as possible before making any decision.

For this reason, we offer the help and guidance of our Personal Advisors at no cost or obligation to you. Simply call us at 866-749-2039 and allow us to answer any questions you have. We can provide all of the information you need regarding health insurance, whether you are purchasing on or off the exchanges.

Fred Adams

From agent to V.P. of Business Development, Fred Adams has filled most every role imaginable during 21 years working with health insurance.When Congress passed the 2003 law on health savings accounts, Fred was dubbed “The HSA Expert” by press and a growing, fanatical client base.
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  • dennis

    why are they offering gold and platinum plans to people that qualify for the cost sharing subsidy? that should offer one bronze hsa ,and one silver enhanced hsa plan to people that qualify for the subsidies. one bronze hsa, one silver hsa, one gold hsa, and one platinum hsa plan to people that dont qualify for subsidies? all plans should be hsa plans.

  • Fred Adams

    Hi Dennis,

    I am not sure who you are referring to what you say “whey are they offering gold and platinum plans….” That is certainly not something anyone at HSA for America would do. If you earn less than 250% of the federal poverty level, you are eligible for cost sharing credits in addition to premium credits.

    Anyone we speak to in this income range is made very well aware of the implications of this additional credit, as well as the fact that the cost sharing credit only applies if you purchase a Silver plan on the exchange. That said, while you may be able to obtain a Bronze level plan with lower premium than a Silver plan, that would be a very short sighted decision for most anyone under 250% of FPL. If you are under 200% FPL, at which point your cost sharing credit limits your out of pocket medical bills to just $2250 per person per year (compared to $6350 with most Bronze or Gold plans), you would be making a very uniformed decision to purchase any coverage other than a Silver plan.

    As for your comment about HSA, while I do agree they are the way to go for the vast majority of people, even we at HSA for America recognize that an HSA is not always best suited for some family’s needs, namely because of the fact that an HSA-qualified health plan can not legally offer any first dollar benefits (other than the mandated free preventative care visits). For some families, it is more important to have a $25 co-payment when they go to the doctor, without having to meet their deductible first. An HSA can not offer that benefit.

    That said, if you are at 209% of FPL, as one of the clients I spoke to today is, I can show you how an HSA can actually lower your taxable income, increasing your cost sharing credit by $2950. This individual simply needed to contribute $1100 to her HSA account next year, and it would lower your out of pocket cost for medical bills from $5200 to $2250. In addition, it lowers her taxable income, and, if she does have any medical bills, half of that out of pocket can be paid, tax free, from the money she put in her HSA. When combined, making this decision will save this individual, living in Colorado on a $24,000 annual income, over $4000 next year.

    An HSA is still the way, now more so than ever before! True story, just like all the information above.

  • dennis

    in north carolina , bronze health saving account plan is the only health savings account plan available, cost sharing subsidies are not available here on hsa plans . but the hsa contribution well reduce the premium credit. at 16356.00 the premium well be zero but the deductible and max out of pocket is 5500.00 16356.00 +4300.00 (hsa contribution) + 6500.00 IRA contribution = 27156.00 i can make 27156.00 without having to pay premium if i choice a not hsa plan premium well be higher, but i well qualify for cost sharing subsidies. sense my 2013 medical bills are about 700.00 the hsa should be the better deal, does hsa of america agree?????????????????????????

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