- Health Care, Drugs & Insurance
How To Get the Most From Your Affordable Care Act Market Place
The Affordable Care Act was signed into law in 2010, but since that time, most of the information available in the news has been heavily politicized.
The ACA has already been passed by both houses of Congress and reviewed by the Supreme Court. Since political opinions are already so easy to access, this hub will not deal with arguments for or against the law.
Instead I hope to offer information on how to get the most out of ACA state Marketplaces so Americans can improve their medical care and hopefully, their health.
Applying through the web site is only one of many options, and even after an ACA application is complete, choosing from the variety of health care plans offered is far from easy or transparent.
Getting affordable insurance that is right for you IS possible however, and it IS worth the time and trouble. Consider the following facts:
- According to the Kaiser Family Foundation, 47 million Americans were uninsured in 2012 and lacked access to basic health care. Six out of ten of these Americans had at least once full-time worker in the family, and another 16% have a part-time worker in the family (source: KFF "Key Facts About the Uninsured.).
- Additionally, according to data collected by Princeton Research Associates International, 25 million Americans were underinsured in 2012, including 59% of families with moderate or middle class incomes between $30,657 and $57,625 for a family of four.
- Even families lucky enough to have health insurance coverage through work often found that their coverage was woefully inadequate when major illness hit. 75 million insured Americans reported having trouble paying their medical bills in 2012, up from 58 million in 2005 (Source: PRAI study cited above).
- Finally, according to data collected from the U.S Census and the Center for Disease Control, the number one cause of personal bankruptcy in the U.S. remains medical debt. Without filing for bankruptcy, another ten million American adults with employer-based health insurance will accumulate medical debt they cannot pay in 2013 (Source: Nerdwallet CNBC).
All of these groups can be significantly helped through the ACA Marketplace.
Even people with employer based plans will usually gain benefits under the terms of the new law, not lose them.
But first, you have to get through the enrollment process.
That can be frustrating and complicated.
In November of 2013 I successfully completed enrolling in an ACA Marketplace health care plan for myself and my husband. The plan takes effect January 1, 2014, costs a fraction of what we paid for employer-based care, covers much more, and is more transparent (understandable). I am in the process of enrolling my adult son and his girlfriend as well.
I spent eight years of my life working as a licensed insurance agent and a CSR for a major bank, but none of that professional experience was really all that helpful, believe it or not.
I'd like to share some practical advice here that was helpful, and I hope it will be helpful to others too.
Find Out If You Qualify for an ACA Subsidy and/or Discounts
The actual cost of an ACA Marketplace health policy is pro-rated according to income. But the reality of how your premium is determined is more complicated than that.
In general, the more money you make, the more you will be expected to pay for the coverage you choose. The actual policy costs a set amount, but the government subsidizes a varying percentage of that premium based on your personal income.
In addition to these government subsidies that reduce the cost of policies, individual insurance companies also offer additional discounts and expanded coverage based on income. These internal insurance company benefits are called Cost Sharing Benefits. They are available if your income falls below a certain level and if you choose a Silver level plan through the ACA Market place.
How to Find Out if You Qualify for a Subsidy: You can find out if you qualify for a government subsidy that will lower your insurance cost without going through the actual application process by using this Cost Estimator tool created by the Kaiser Family Foundation. Take five minutes right now to use this tool if you have not already done so. You may be surprised. Families and individuals can qualify for subsidies even when their incomes fall well into the middle class range.
How to Find Out if You Qualify for Cost Sharing Benefits: The best way to find out if you qualify for additional insurance company Cost Sharing Benefits is to go through the application process, and take a look at the range of plans offered to you. Then, after choosing a few Silver level plans, call the insurance company or companies offering those plans directly.
Calling the provider directly will not only save you an enormous amount of time and confusion trying to figure the plans out all alone, you may actually be surprised to discover that a plan you thought was horrible actually isn't.
Unfortunately, you can't see Cost Sharing Benefit information on the ACA web site, and if you call the ACA 7-day 24-hour help line (800-318-2596) they won't be able to tell you either.
The CSRs at the ACA are wonderful, but they are not insurance agents.
Healthcare.gov can show you whether you qualify for Cost Sharing Benefits for each plan though, it just can't tell you what those benefits are.
Understanding the full range of benefits available to you can make a big difference in what you decide to do and how you feel about it.
How Do I Apply If the Website Won't Work?
The good news is you don't have to apply through the ACA web site.
I recommend you check out the web site anyway. A lot of good information is posted there, and just spending twenty minutes or so browsing that info will teach you a lot without even going into the application process.
Yes the web site had a horrible start and is a work in progress, but speaking as someone who tried and kept trying to get into it from day one, it has improved A LOT and continues to improve daily.
You can apply for coverage four different ways however:
- Apply Through the ACA Web Site. Go to www.healthcare.gov and set up an account. Once your account is set up, you will be presented with a selection of plans available in your state along with their respective costs, based on your annual income. If your state has set up its own exchange (my state was one of those that refused to do so, so I had to use the federal site), you can go to your state web site, find the link for your state exchange, and apply that way. Either approach will work. If you go to www.healthcare.gov and your state has its own exchange, you will be redirected to your state's web site.
- Apply By Phone: You can call the ACA 24 hours a day, 7 days per week, at 800-318-2596 and a representative will take your application by phone. The process only takes ten or fifteen minutes, and is not difficult. You will need your social security number, your annual income, your employer's address and phone number, and you will be asked a series of easy questions. Then the ACA web site will mail you your policy options and subsidy amounts.
- Apply Via a Health Care Navigator or Licensed Insurance Agent: Health care navigators are individuals trained to get your application submitted and help you through the policy selection process. To locate a health care navigator in your area, go to localhelp.heathcare.gov, enter your zip code, and a list of navigator locations, phone numbers, and web sites will pop up.
- Fill Out a Written Application: Finally, you can call the ACA service center and request a written application to fill out and either mail back or take to a navigator.
If you already have a personal insurance agent with whom you are comfortable, that person can help you through the process. Or, if you already know which companies are offering ACA Marketplace coverage in your state, you can all their 800 customer service numbers and speak with a licensed agent who will answer your questions and guide you through the process. I live in MI, where most of the policies are offered through Blue Cross, so I was able to call their number directly and complete my enrollment quickly and easily.
My Personal Experience Applying for ACA Insurance
My own personal experience is a good example of the good and bad associated with trying to get coverage through the ACA, also known as Obamacare.
After two weeks of battling the buggy ACA web site, I gave up and applied by phoning the ACA service center directly. The phone application was easy and quick, and I have never spoken to anyone at 800 number who was anything but kind and helpful.
Even so, I kept playing with the web site as corrections were made and while I was waiting for my packet of options and subsidy info. As a result of all my attempts, I managed to get my application through online before the packet of choices came by mail.
So I was able to see our plans and their costs, with subsidy, online. That was great, but also unexpectedly confusing.
After spending a lot of time reviewing the Marketplace insurance plans and getting more and more frustrated, my spouse and I settled on several possible plans but didn't really like any of them. The deductibles were very high (over $2,000), and we had to pick up 30% of the cost after meeting the deductible according to the info on the ACA web site.
In other words, we couldn't really use the insurance for much of anything. If you would have asked me how I felt about the ACA at the point I'd have said, "meh. Don't ask."
This discouraging online info was accurate for people who didn't qualify for Cost Sharing Benefits, but for us, it was misleadingly negative, because we do qualify. We didn't know what they were or why we should care.
So I called the MI Blue Cross Network line directly to ask questions and discovered that our Cost Sharing Benefits lower our annual deductible to $600, our out of pocket maximum to $2900, and our share after meeting that deductible to 10%, instead of 30%.
That's WAY better than the plan we have now, through work, and is indeed affordable. Very.
In addition to these substantial internal benefits, I also learned that two medications I have to take daily that currently cost me $600 per year (with our employer-based coverage), will only cost $180 per year under the ACA Cost Sharing plan. Without insurance of any kind, these medications would cost me $1800 per month, for a whopping annual total of $21,600.
I am certain plenty or people who need these medicines are currently doing without them, putting themselves at risk and lowering their quality of life dramatically.
Keep in mind that most people will have available to them a wide range of ACA plans to choose from, not just one; anywhere from high-deductible plans that cost nothing (after applying their individual subsidy), to very low deductible plans that cost as much as $1400 per month or more.
Making a choice between all these plans is difficult and complex, so calling the insurance companies directly or getting the advice of an insurance agent is vital.
The company that will be providing our policy completed our enrollment by phone, right there right then, without any need to get into the ACA web site again.
Now all we have to do is wait for our insurance cards, which will arrive in December.
Tips That Helped Me Get Affordable Coverage
The hardest part of this process for me was all the noise and emotion attached to it. Our health care system in the US was already a mess, and change is hard even when everyone isn't screaming. But everyone is screaming. So here's what helped me:
- Take a break from politics. I really had to turn off the screaming. For me, while I was trying to get enrolled, entertaining philosophical or political criticisms was not helpful. The ACA is here. I have to get this thing done. You may or may not be right, but... Please scream at me later. Thanks.
- Stay positive. What many people seem not to realize is that everyone will receive benefits through the Affordable Care Act that were not available to them before, including people who already have employer-based insurance that they like and intend to keep. For the time being, try to stay focused on what will be better, not on what won't.
- Embrace the power of 'next'. When things are horribly confusing and chaotic, what really helps me is asking myself, OK, what do I do next? What have I not tried yet? Keep moving and keep focused on what to do next, period. Don't indulge in tantrums about what isn't working until you get what you want. Then, once you are enrolled, you can rant, rave, and punch pillows all day long.
- Ask for help. You will get stuck. Ask for help. Keep asking until you get it.
- Know your priorities. Our priorities were 1) we wanted access to the better hospital system in our area, 2) we needed certain drugs covered, 3) we needed an affordable premium. Give your own priorities some serious thought. Maybe you won't get them all, but at least write them down and try.
Once you are successfully enrolled, take your anger about what didn't work for you and push for change. Write. Get involved. Join advocacy groups. And so forth.
Before You Comment
Please do share your story if you have successfully enrolled or are in the process of enrolling. Tips, info, frustrations, work-arounds, all of this is welcome in comments.
Please DO NOT comment if you are just going to rant about the president, spout political talking points, or talk about how the ACA will never work. Hub Pages provides plenty of opportunities for that kind of commentary in the forums, in questions, and in political hubs you can write yourself.
This hub is not for that kind of political discussion. This hub is for people trying to get enrolled.
All political comments will be deleted without explanation.
- Health Insurance Marketplace, Affordable Care Act | HealthCare.gov
Apply online at Healthcare.gov