Tips for buying an insurance plan on the exchange

 

dchang@MiamiHerald.com

Insurance companies have been preparing for the rollout of the insurance marketplace since the Patient Protection and Affordable Care Act was enacted in March 2010, and they know a lot about you.

Insurers know, for instance, that price will be your most important consideration when buying a plan on the federally run exchanges.

They know you want to have a strong relationship with your primary care doctor, and that you have many questions about healthcare reform.

Some tips to help you choose a plan:

To buy a health plan on Florida’s exchange, you must enroll by March 31. But to be insured Jan. 1, you will need to buy your plan by Dec. 15.

Price may be key but you also should study other elements of an insurance plan to decide its value.

Check the doctors and hospitals your plan will give you access to, how much of the bill you’re going to be responsible for during a major medical event and what medications are covered.

President Barack Obama has said that Americans will be able to keep their doctors, and that will be true — if your doctor is in your plan’s provider network.

To price plans affordably, insurance companies can use several tools, adjusting the size and composition of the provider network.

You’ll want to ensure that the network includes any specialists you may need.

Fewer providers equal lower costs for the insurer, so some plans may allow access to fewer specialists.

Provider networks can also include retail clinics staffed with registered nurses, nurse practitioners or physicians’ assistants who can give a flu shot or treat a sore throat at lower costs than at a doctor’s office.Retail clinics can range from a CVS or Walgreens pharmacy to a center maintained by your insurer.

And one more thing to check: whether an insurer limits the number of visits to a doctor.

Other price-setting tools available to insurers include deductibles and co-insurance.

The deductible is the amount of money that you are responsible for in a plan year.

Some plans will have high deductibles, up to $6,000. Other plans may offer deductibles as low as $500.

Higher deductibles typically mean lower premiums for consumers — at the risk of assuming a higher share of medical costs.

Insurers will offer plans at different rates of co-insurance. Co-insurance is your share of the costs of a covered service, calculated as a percentage of the allowed amount for the service. For instance, bronze plans sold on the exchange will have co-insurance rates of 40 percent for the consumer and 60 percent for the insurer. That means if the health plan’s allowed amount for an office visit is $100 and you’ve met your deductible, you’d pay 40 percent, or $40. Plans at the higher end — platinum plans on the exchange — will pay for 90 percent of covered medical expenses, and consumers would pay 10 percent.

Plans also will have out-of-pocket maximums, which limit the maxium amount you pay during a policy period. Plans will vary but under the health law, the 2014 limits are expected to be $6,350 for individuals and $12,700 for families.

Read more Healthcare Reform stories from the Miami Herald

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