Tips for Seniors Shopping For Health Care Coverage
Central Washington Senior Times
Health Exchange Overview
Starting Oct. 1, you will be able to shop for health insurance through your state's Health Insurance Marketplace website, over the phone, via mail or in person at a designated center. The coverage will go into effect on Jan. 1 2014. You can also be reassured to know that federal law prohibits Marketplace insurers from denying you coverage or charging you higher rates if you have a pre-existing health condition. But they are permitted to set premiums up to three higher for applicants over the age of 50, and smokers may be charged up to 50 percent more than non smokers. To help make coverage affordable, sliding scale tax credits will be available if you earn less that 400 percent of the poverty level that's $ 45,960 for a single person and $62,040 for couples. These tax credit subsidies will proved immediate savings off your monthly premiums. See the Kaiser Family Foundation online calculator for a premium estimate. Every state will have a Market place, but each state can choose how it will operate. Seventeen states and the District of Columbia will run their own state based Marketplace, seven states will partner with the federal government, and 26 states will offer federal Marketplaces. The differences between federal and state programs will be subtle. You will be able to access your state's marketplace at Healthcare.gov.
To make shopping and comparing a little easier, the health plans will be divided into four different levels-bronze, silver, gold and platinum. The bronze plan will have the lowest monthly premiums but the highest out of pocket costs when you need care, while the platinum plans will have the highest premiums with the lowest out of pocket costs. You will also have a variety of health insurance companies to select from. To help you evaluate insurers, the nonprofit National Committee for Quality Assurance offers online “report cards” at ncqa. Org that can help you narrow your choices. Because most plans will be managed-care policies such as HMOs and PPOs that require you to get your care within a network of providers, you’ll want to make sure that the doctors and hospitals you typically use are covered in the plans you’re considering. The new Marketplace plans are expected to offer fewer choices of health-care providers, and who’s included may vary quite a bit. You also need to find out what happens if you want to use a doctor or hospital outside a plan’s network. Will you have to get a referral or pay more to get these services, or will it even be covered at all? Also check the plan’s formulary, which is the list of prescription drugs they cover, to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.
If you need some help with all this, the Marketplace Help Center offers a toll-free helpline at 1- 800-318-2596. Or, if you’d rather get face to face assistance, there will be designated centers set up with trained and certified navigators, counselors and application assistors to help you, along with insurance agents and brokers. To find help in your area, call the Marketplace Help Center after Oct. 1 for a referral.