With the number of insurance carriers on the Marketplace projected to grow by 25 percent this year, health care consumers would be wise to comparison shop during open enrollment, which began Nov. 15, 2014, experts say.
Health care consumers are encouraged to comparison shop during open enrollment, which began Nov. 15, 2014.
“Customers may be happy with their current health plan, but with additional choices, this year would be a good time to compare new offerings,” said Scott Krienke, Assurant Health senior vice president, product and marketing.
“Consumers need to compare apples to apples, however. While all plans are required to offer Essential Health Benefits, cover pre-existing conditions and preventive services, plans are not all created equal. It will be important to know what kind of provider network is included in the plan being offered,” Krienke explained.
“Narrow” networks offer a smaller number of doctors and facilities, which may result in lower costs but fewer choices. Under these plans, if your doctors are not in-network, you’ll likely pay more to see them. Plans with “broad” networks may cost more, but offer a wider range of provider options.
Another issue customers should consider is whether or not they’re eligible for advanced premium tax credits or cost-sharing reductions. These are available only when buying a health plan via the Marketplace, and eligibility depends on household income.
Under the Affordable Care Act, those who are not exempt and fail to have health insurance that constitutes Minimum Essential Coverage (MEC) can be charged a penalty, which in 2015 is 2 percent of household income or $325 per person, whichever is higher. In 2016, the penalty will increase to 2.5 percent of household income or $625, whichever is higher. Individuals are expected to pay the penalty on their federal income tax returns for the year in which they fail to have coverage.
It’s a lot of information to sort through, whether buying a plan on or off the exchange.
“Health care is a complex decision, and many customers last year found value in using an experienced agent to help them choose plans that fit their unique needs,” Krienke said. “It’s important to carefully select the right health coverage, because, barring a qualifying life event such as a marriage or loss of coverage due to unemployment, you won’t be able to buy again until the next Open Enrollment period in the fall of 2015.”
For more information about open enrollment, visit Healthcare.gov.
The next story in this series will look at the various “metallic” health plans available.