Complete Guide to Health Insurance Plans and Coverage
Why there are new networks since the ACA
Since passage of the Affordable Care Act (ACA), insurance companies have worked diligently to retool and tweak their offerings to accommodate the requirements and demands of the law. Some of these changes have made it more difficult to accurately compare insurance plans and benefits. One area of change health insurance consumers must be aware of is the use of “new networks.”
A provision of the ACA has the effect of limiting insurance companies spending on overhead by requiring the companies to spend at least 80% of premium revenue on “medical care and efforts to improve the quality of care.” When matched with the requirement to provide all 10 Essential Health Benefits[link] in each plan, the insurance companies look for ways to control spending.
One way to do this is by creating new provider networks that limit the doctors and hospitals included as “in-network” providers. Typically, these networks rely on providers that offer the best discounts to that insurance company. The result is a provider network that stands beside the insurer’s traditional network. Another is to make the plan an HMO design[link], to make the less-expensive network required for exclusive use by policyholders.
Given what we have, how should a consumer think about all this in choosing health insurance? Here are some ideas:
- If you are a new consumer of health insurance, none of this may matter to you. Pick a doctor from the new network and have coverage if you need an emergency room or generate big medical bills.
- If you’re facing the double-whammy of high premiums and low use of the plan (that is, you never get sick), you may be willing to give up any out-of-network doctors in exchange for lower premiums.
- If you have significant, ongoing medical costs, specialized doctors/facilities, or travel a lot, you may require the traditional type of health insurance. Happily, there are still PPOs[link] with national networks to serve these needs as well.
What’s right for you? CHB is always available to provide quotes and help with making decisions among the various plans and companies.
- Published in Health Insurance
DECEMBER 1: TIME TO GET THAT HEALTH INSURANCE YOU’VE BEEN TALKING ABOUT
Since last year, Thanksgiving has a new meaning for people who need health insurance. The time for buying individual and family plans (as opposed to plans through your work) is approaching. If you need to be sure your 2014 insurance is still the best option, or if you are looking for insurance the very first time, the application deadline is very close. Your quickest path to insurance? Call one of our certified brokers to get individualized hands on help at no charge.
DEADLINE: December 15 is the deadline to apply for individual health insurance that begins January 1. Since there are no medical qualifying hoops to jump through any more, you need only apply to get health insurance for yourself and your family. Applications must in no later than Dec. 15 if you want your insurance to begin on January 1.
HOW TO CREATE AN ACCOUNT ON THE COLORADO EXCHANGE: If you want to buy insurance for 2015, it is helpful to have an account on the Connect for Health Colorado (Connect) Marketplace (the state’s health benefit exchange. Click on this link for a guide to doing this: https://www.dropbox.com/s/q3iy9dw8b5df9dl/CreateAccount112814.pdf?dl=0
HOW TO APPLY FOR FINANCIAL ASSISTANCE: Financial assistance with health insurance premiums depends on income level and family size. You may qualify for financial assistance for 2015 if your family income is less than these amounts:
Individual: $46,680
Two People: $62,920
Four People: $95,400
For self-employed people, income is after your business expenses. To create an account on Connect for Health Colorado and see how much assistance you qualify for, click on this link for our easy-to-follow, free guide to doing this: https://www.dropbox.com/s/3bi0fajhm03gnoe/NewCustomerWithFinancial%20Assistance%20app113014.pdf?dl=0
If you want to purchase a plan, but do not qualify or want to apply for financial assistance, use this link for instructions on how to shop for a plan on the Colorado Marketplace: https://www.dropbox.com/s/1t6k83zqlwbheod/NewCustomerNoFA113014.pdf?dl=0
IF YOU HAVE QUESTIONS OR PROBLEMS: If you have technical or computer problems creating an account or completing the financial assistance application, you can call Connect’s Customer Service line at 855-752-6749 for help solving the problem. For questions or issues related to your insurance, rely on your broker.
FINDING THE BEST PLAN: There is no single best health insurance plan. The best plan for each person balances the monthly cost of the insurance, with the health of the person, their preferences for certain doctors, and likely out of pocket costs. My role as a broker is to help compare all available plans to find the one that best meets your needs and requirements. You do not pay anything extra to use a broker.
At Colorado Health Brokers, we all live in Colorado and enjoy helping people find the best possible health insurance plan for their particular situation. I am a broker, also trained and certified to help find financial assistance to help with insurance premiums. There is no charge to you for the help I provide.
Hal Winslow
Colorado Health Brokers
720-323-9747 cell/303-541-9533 ofc
CAN I RENEW MY 2014 COLORADO MARKETPLACE PLAN? SHOULD I?
What’s different about your Connect for Health Colorado Marketplace (Connect) account this year? Renewal options. Most people who purchased plans from Connect for 2014 will be able to renew those plans for the 2015 plan year (with the Affordable Care Act, individual and family plans are all on a calendar year cycle).
You should renew your 2014 policy for 2015 if you are generally happy with:
- The amount of the monthly premium you will pay in 2015
- The amount of deductible and coinsurance, as well as other terms of coverage
- The network of doctors, hospitals and facilities that accept this insurance.
You will not be offered a renewal of your policy if you are no longer eligible for your 2014 arrangement:
- Children on family plans turning 26 must get their own plans
- Persons with Marketplace Catastrophic plans turning 30 must get standard plans
- Persons who turned 65 who begin receiving Medicare benefits are no longer eligible
What about Subsidies?
If you received Marketplace subsidies (help with premiums, lower out of pocket costs) during 2014, your 2015 subsidy will automatically be calculated so long as Connect has enough information to do so. If there is no 2015 determination shown in your personal Connect account, you must reapply. This year, applying for a subsidy is easier. The new Connect system incorporates the relevant information screens of the PEAK Medicaid system. This means you do not have to create a PEAK account and go through that separate system any more.
How do you Renew?
You will receive notice of your renewal option from Connect and from your insurance company. In almost all cases, you can renew your plan by doing nothing. If your plan is through the Connect Marketplace, you may renew by:
- Doing nothing. In this case, Connect will renew you for 2015
- Selecting “I want to continue with my current plan” in your Connect account.
What if you don’t want to Renew or Need Help Deciding?
Renewing may not be the best option for you, or you may need help navigating the new eligibility process for financial assistance. It costs you nothing in fees or extra premiums to get the advice and perspective of a professional broker.
Colorado Health Brokers are certified by Connect for Health Colorado and work extensively with Connect staff and clients purchasing plans on the Connect Marketplace. We also handle client purchases directly from insurance companies and offer a range of supplementary coverages (accident, critical illness, travel, foreign medical, disability, life) to help each client find the best mix of coverage. Contact us at:
CO Health Brokers
NEXT: What about renewing plans purchased directly from the insurance companies (off-Marketplace)?