One of the most important components of the Affordable Care Act (Obamacare) is the health insurance exchanges. While some states are operating their own exchanges, the federal government is actually running them in the 32 states that refused to create their own exchanges. If you go to your exchange looking for information about healthcare insurance, you’re likely to see something entirely different depending on whether the exchange is operated by your state or the federal government.
Not without glitches
All of the health insurance exchanges opened for business this week. You may or may not be surprised to hear that there were glitches. In some cases, people were not able to logon their exchange at all. In other cases they were able to logon but unable to find the information they wanted quickly and easily.
Our state as an example
The state in which we live has its own health insurance exchange. When you log on, a page greets you that features “Health Insurance For Young Adults” with “Learn More” and “Shop Now” buttons . The page offers three other options – “Is this for me”, “Exclusive Savings”, and “Learn about the Marketplace.” If you scroll down a bit, you get two more options “Find an Agent/Broker” and “Find an Assistance Site.” Oh, and there’s a banner with four photos labeled “Individuals and Families”, “Young Adults” (again), “Employees” and “Employers.”
What to make of all this?
We found this page to be a bit confusing and had a hard time determining where to go next. We finally clicked on Individuals and Families since we’re a number of years past being Young Adults. This changed the top banner to “Individuals and Families”, “Learn More” and “Shop Now.” We clicked on “Shop Now” and landed on a page where we would be required to fill out an application for health coverage. In other words, we wouldn’t be able to see any of the options available until we had clicked twice and then filled out an application.
We also visited the federal health insurance exchange site www.healthcare.gov. This website seemed a bit simpler because it basically offered only two choices – to “Apply Now” or to “Want To Learn More First.” We clicked on “Want To Learn More First: Start Here.” This took us to a page where we would be required to answer “a few” questions before applying for marketplace coverage. The following brief video explains a bit more more about healthcare.gov.
If you thought your marketplace would look like a mall, think again
If you think your marketplace will look like a mall and that you will be able to simply stroll in and start comparing policies and prices, think again. It’s pretty clear that you won’t be able to see any options – or even how many options you have – until you apply for your healthcare insurance.
If you’re a senior, whether or not Obamacare affects you will depend entirely on your age. If you’re over age 65, it will have no effect on you because you will be on Medicare. But if you’re a retiree and not on Medicare, you will have some important new options. For example, if you’ve had a problem finding affordable health insurance or you have an existing condition that prevents you from getting insurance, this has all changed. The insurance companies can no longer turn you down because you have an existing condition and there is now a floor under the benefits that the insurance policies must provide. Plus, the premiums you will be required to pay will be affordable if you qualify for the law’s sliding scale of subsidies and tax credits.
There has been some confusion on the part of seniors mostly due to the fact that the new health insurance exchanges are launching at about the same time that it’s Medicare’s fall enrollment period for prescription plans and Advantage plans. As a result, there is a concern that some seniors will try to enroll in a health insurance exchange or who might fall victim to a fraudulent sign-up campaign.
A simple fact
The simple fact is that if you are enrolled in Medicare Part A (Hospitalization), it‘s not necessary for you to sign up in any health insurance exchange to meet any of Onamacare’s insurance coverage mandates. In fact, it could be illegal.
One little wrinkle
However, if you will turn 65 during 2014, there is one wrinkle you need to be aware of. You are required to sign up for coverage that will take effect Jan. 1, 2014 so you won’t be hit with the penalty for not getting insurance. However, if you are now getting Social Security, you will be automatically enrolled in Medicare Parts A and B and should receive your Medicare card about three months before turning 65. On the other hand, if you are not on Social Security you will need to sign up three months before your 65th birthday and then do to the traditional Medicare thing – signing up for Medicare Part B, a drug plan or an Advantage plan. Then, when you are sure you know when your Medicare coverage will start, you can arrange for termination of the coverage you got through a health insurance exchange for that date.
The prescription drug plans
The reason why you need to re-shop your Part D coverage annually is due to the fact that while prices are expected to rise an average of just 5.1%, half of the 10 plans that are most popular are raising their premiums dramatically. In addition, the coverage for drugs can change from year to year and even if your plan lists a drug as covered, you need to study the detailed “formulary” to understand the specific coverage rules. The good news is that the “donut hole” will decrease by $80 next year.