Thinking About Health: Getting insurance under the Affordable Care Act
On Oct. 1, millions of uninsured Americans — 716,000 in Colorado — got a new way to buy health insurance. They now can shop in the state insurance exchanges. Many of them had been shut out of the insurance market because they have pre-existing health conditions. In January, it will be illegal for insurers to turn away sick people.
It’s expected that about 24 million people will find insurance coverage in the exchanges, and about 60 percent of them will be eligible for a subsidy to help them pay the premiums. For families with incomes hovering near the federal poverty level ($23,550 for a family of four, $11,490 for individuals) and somewhat above, subsidies will be large and might cover a good chunk of the premium. Families with higher incomes will get smaller subsidies and will have to pay most of the premium themselves. That could be a big chunk of the family budget if they choose a policy with good coverage.
Customers in the exchanges mostly will be those who have no coverage and those who now buy it in what’s called the individual market. If you have employer coverage, Medicare, Medicaid or coverage from the military or the Indian Health Service, forget the exchanges. The law assumes you already have health coverage.
People who have coverage they’ve already bought in the individual market also can check out the exchange to see if they can get a better deal. That includes freelancers, retirees not yet old enough to get Medicare, people between jobs and families of workers whose employers provide insurance for employees but not for their spouses or kids.
A Hastings woman who is disabled because of a medical error is one of those who will be looking for an insurance deal on the exchange. She and her husband already have insurance they bought in the individual market. She had heard about the new law and went online to do a bit of research. She left her name on the site of http://www.ehealthinsurance.com and received calls from 15 agents eager to sign her up when the exchanges opened for business. One from Florida told her that if she didn’t sign up quickly, her application would not be accepted. The woman told me the agent’s message was, “If you don’t work with me on this, you’ve blown it, honey.”
That brings up the matter of where to go for help. Colorado operates its own exchange — Connect for Health Colorado — reachable at 855-752-6749.
You also can look for a navigator, a real live person trained to help people enroll in a policy. They are supposed to be unbiased and can’t steer consumers to any particular policy.
You don’t have to rush into anything right now. Take your time and study the options. Coverage doesn’t begin until January (if you sign up by Dec. 15), and open enrollment doesn’t end until March 31. If you buy a cheap policy that doesn’t cover your needs when you’re sick, you may be stuck with it for months until the next open enrollment. “It’s a like walking into a chasm of uncertainty,” the Hastings woman said. “It’s a little like shopping for a used car. You don’t know if you’re getting a lemon.”
The Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed through the Nebraska Press Association Foundation, the Colorado Press Association and the South Dakota Newspaper Association.