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Q&A: What should you ask about new “ObamaCare” plans?

By on June 5th, 2013
Filed: Advice, FAQs, You

Image of Einstein writing health reform question on chalk boardAs new ACA-compliant health insurance plans and new rates for these plans become available, consumers may start to wonder how it will impact their current and future health insurance plans. Recently Covered California, the state health insurance exchange for Californians, released information on qualified health plans and rates for plans effective January 1, 2014. These plans aren’t available just yet, but below are some questions and answers for consumers as they prepare for the new open enrollment period starting October 1, 2013.

Q: I saw that new health reform plans were announced – what should I do today?

A: Open enrollment for the new ACA-compliant plans on Covered California starts on October 1, 2013, with coverage beginning on January 1, 2014.  In advance of open enrollment, you should take the time to understand the new provisions of the Affordable Care Act and evaluate your own health care needs to understand what may change for you in the coming year. A few things to consider:

  • Review new plan benefits: As new plan information and detail becomes available, look at what type of benefits the new plans will offer to understand what might be best for your needs.
  • Will you qualify for a subsidy? Start looking at your income information now and see if you might qualify. And understand the tax penalties associated with not enrolling in qualified coverage. (see our blog post on subsidies)
  • Is your doctor in the new plan? Is your doctor in the network of these and other future plans, and how important is it to keep your current physician? Even if the network does include your doctor, how broad of a network is it? Does it cover a large percentage of physicians and hospitals in your area, and is that important to you? Some of this information may not be available right now, so check back regularly as it gets closer to open enrollment.
  • Can you keep the plan you have? If you are currently on an individual plan, how long will you be able to stay on it? Find out if your current needs to change and when your health insurance company plans on transitioning it to an ACA-compliant plan.

Q: I don’t see my current health insurance carrier on this list of new plans for the Covered California exchange. How does that impact me?

A: If you qualify and wish to enroll in a subsidized qualified health plan, you will have to enroll with a health insurance carrier that offers a qualified health plan on the Covered California exchange.

If your health insurance company is not offering plans on the exchange, you will have to switch to another carrier to qualify for a subsidy. Your current carrier might offer plans outside the exchange and you may continue to enroll in plans through them, but if they’re not on the exchange, you won’t be able to get a subsidy.

If you are subsidy-eligible, you’ll have to make a decision about what is more important – working with the same insurer or getting the subsidy. If you don’t qualify for a subsidy, then you’re free to shop for whatever plan wherever you wish.

Q: If I have an individual plan today, will I have to enroll in a new plan next year?

A: You will have to check with your current insurer to see when and if they will require you to transition to a new plan that meets all the ACA-required essential health benefits.

If you have a grandfathered plan, which are plans purchased and active before March 23, 2010, when the ACA was signed into law, these plans do not have to meet all the requirements of the law and therefore you would not be required to upgrade to a new ACA-compliant plan.

You may want to enroll in a new plan because of the more comprehensive benefits. The best thing to do is explore all of your options.

Q: Will I be able to shop for plans outside of the California (or other state) exchange?

A: Starting in 2014, individuals and families can enroll in subsidized health insurance plans, depending on their income level. These subsidized plans will be available on state exchanges and possibly through certified private sector marketplaces designated by the state. Individuals and families earning more than the 400% federal poverty level, which is the top end of the eligibility range for subsidies, can shop for health insurance wherever they want and there may be plans offered by insurers that are not listed on the California exchange. These non-exchange plans have yet to be announced.

Q: What sort of protection is there against rate increases?

A: Health insurance premiums are regulated at the state level and the Affordable Care Act requires insurance companies in each state to publicly justify any rate increase of 10% or more. Even if a health plan is not on the exchange, they are still subject to this state-level rate review and justification.

Q: What if none of the plans offered on the state exchange meet my family’s coverage needs?

A: If you don’t qualify for a subsidy, or the subsidy is not significant enough to make a plan affordable, investigate plans on and off of the exchange so you have a complete view of everything available in the market.

You can work with licensed agents like eHealthInsurance to compare options in your area. However, if you earn less than 400% of the Federal Poverty Level and qualify for subsidies, you’ll need to decide what’s most important to you: getting federal dollars to help you afford coverage that may not meet your needs or paying on your own for coverage that meets your needs better.

To help make your decision, pick the exchange plan closest to your needs and do the math to see how much money you would save with a government subsidy. Then compare that with the cost of coverage purchased off the exchange.

About Carrie McLean


Carrie McLean has been in the health insurance field for 7 years and is licensed in all 50 states. She is often seen in the media discussing health insurance trends and issues from an insider’s perspective and as a consumer advocate, having personally helped thousands of individuals and families search for and find affordable health insurance.

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