There’s still time to shop for coverage before open enrollment closes March 31. But this year — with the Patient Protection and Affordable Care Act — there’s more to know and understand than ever.
Brokers need to do their best to inform their clients of important information for enrollment time. And giving them a series of easy-to-read shopping tips might be useful.
2. Shop outside of public exchanges to explore all your coverage options. Government exchange websites are designed to provide subsidy-eligible consumers with access to plans specially qualified for purchase with a subsidy. Not all plans are. Some major carriers have opted not to sell plans through the exchanges. Consumers who want to choose from the broadest selection of plans and find the best match for their needs and budget also should consider plans available off the exchange through licensed online agents. These plans will still meet the coverage requirements of the law and keep you from having to pay a tax penalty, so long as you maintain your coverage during the year without a gap of more than three consecutive months.
3. Understand the true cost of any health plan you’re considering. The true cost of any health insurance plan is about more than your monthly premiums. It’s also about how costs are shared when you actually receive medical care. Look at your annual deductible, copayments, and coinsurance — and your annual out-of-pocket maximum. Understand how different forms of cost-sharing may apply to different kinds of medical care. Read the fine print, and talk to a licensed agent for personal help understanding your coverage details.
4. Make sure that government subsidies will work for you. PPACA allows some people earning less than 400 percent of the federal poverty level (about $46,000 per year for a single person or $94,000 for a family of four) to receive subsidies to help with their monthly premiums, depending on the cost of coverage for the benchmark plans in their area. Be aware that your eligibility is based on your projected earnings for 2014 rather than your past earnings, and only the government can make the final determination on your subsidy eligibility. If your income fluctuates or changes during the year, your eligibility for a subsidy may also change. If you earn more than expected in 2014, you may have to repay all or a part of any subsidy you received when you complete your 2014 federal tax return.