Facing Obamacare Realities—7 Ways to Get the Most Out of Your New ACA-Compliant Health Insurance Plan
Many Americans appreciate Obamacare’s premium tax credits and cost-sharing subsidies, requirement that applicants cannot be denied coverage or charged more due to their health history, and inclusion of essential health benefits and covered preventive services. On the other hand, narrow networks, technical glitches, premium hikes, subsidy surprises and the concept of mandates in general disenchant many of us, to say the least.
While we may not love everything about health insurance in the age of Obamacare, we can make the most of it. Here are a seven ways to take advantage of your new ACA-compliant health insurance plan and use it in the most hassle-free as possible—right now and looking ahead to 2015:
1. Reality: You liked your old health insurance coverage a lot, but you had to switch in 2014
Solution: Get to know your new health insurance coverage
Your new plan might not be as bad as you think. It might even be better. Take the time to familiarize yourself with it. Read the membership materials your health insurance carrier sent after enrollment—or access them by logging on to your carrier’s website, if you did not receive them by mail. Find out what your benefits and costs are for various types of care—preventive, emergency, behavioral, in-patient hospital, out-of-network, etc. Make note of your annual deductible, copays, coinsurance and other out-of-pocket costs.
Understanding what the health insurance coverage you pay for each month can help you avoid surprises when medical bills arrive. If you have questions, contact your plan’s member services hotline and get the answers you need.
2. Reality: Whenever you call your carrier, you find yourself on hold
Solution: Register online
Most carriers have an online portal where you can access up-to-date provider directories, correspond with your health care providers, receive test results, pay bills, schedule appointments, access benefits information, view your health history, receive appointment reminders and much more. Take advantage of this feature, which can help you save time and keep your medical information organized.
Sure, the website won’t serve every purpose—sometimes you need to talk to a person. However, it may help with a lot of basic tasks you can perform on your own in half the time.
3. Reality: Your new plan network does not include your old primary care provider
Solution: Find a new primary care provider
It is often difficult to leave a health care provider with whom you’ve established a relationship, but it is a frequent reality of switching health insurance plans. Fortunately, there are many qualified physicians, physician assistants and specialists in the world.
Before you schedule your first appointment, your new health insurance plan will likely require you to select a primary care provider—the person who you will visit for preventive services and be your first point of contact for undiagnosed medical conditions. Start researching these individuals before you need care.
Your insurance carrier’s website will have a provider directory, which you can search to find a doctor who is taking new patients and is conveniently. Oftentimes these directories include a picture and biographical information to give you a sense of the individual. You can also call your carrier’s member services number, typically located on the back of your health insurance card, for assistance in finding an in-network health care provider.
Helpful hint: Should you decide to switch health insurance in 2015, research provider networks ahead of time to ensure your preferred doctors, clinics and hospitals are included. If they are not, research those offered and determine if they will be a good fit.
4. Reality: Your monthly premium changed, and you feel like your old health insurance plan was a better value
Solution: Use your preventive benefits
ACA-compliant health insurance plans include certain preventive services at no additional cost to insured persons. That means you cannot be charged a copay or coinsurance when you receive covered preventive services, even if you have not yet met your annual deductible. Keep in mind, however, that you must receive eligible preventive services from an in-network provider.
Preventive care can help catch medical concerns and conditions early on when they are often more treatable and less expensive. If you already have a medical condition, preventive care can be essential to managing it. For instance, preventive care practices have been shown to be effective in reducing both the incidence and progression of diabetes-related complications, according to the CDC.1 Since you are paying for preventive care services as part of your health insurance premium, get your money’s worth and use them.
Read “What Preventive Services are Covered by Obamacare?” and visit healthcare.gov/what-are-my-preventive-care-benefits for more details. If you are uncertain about what services are covered or if your preferred health care provider is in-network (or have any other questions or concerns about your benefits), contact your health insurance plan’s member services.
5. Reality: The urgent care facility down the road and the hospital a mile away are no longer in-network
Solution: Locate in-network urgent care facilities and hospitals now
As with your health care providers, the urgent care facilities and hospitals you relied upon under your former health insurance plan may no longer be in-network. Rather than add stress to urgent situations by scrambling to find in-network care, determine ahead of time where to receive it.
Use your carrier’s provider directory—either online or over the phone with member services—to locate the closest in-network urgent care facilities and hospitals. Be sure to make note of their hours, and consider adding their phone numbers and addresses to your cell phone contacts to ensure you have them readily available when prompt medical care is needed. Always call 9-1-1 for emergency and life-threatening situations.
6. Reality: Your financial situation has changed, which means you may struggle to pay your monthly premium or you could owe the IRS money in 2015
Solution: Report income changes throughout the year
A majority of Americans (85 percent) who purchased 2014 health insurance coverage from the state-based and federally facilitated exchanges selected plans with financial assistance in the form of income-based premium tax credits and cost-sharing subsidies.2 These amounts were awarded based on your projected income for 2014. When you file your 2014 federal income taxes, your actual and projected incomes will be compared, at which point you may own the IRS money for underpayment of health insurance premiums or receive a credit for overpaying.
Report income changes—and family size—to your health insurance exchange throughout the year. If your income lowers significantly, you may be eligible for lower rates or qualify for a special enrollment period in which you may select different coverage. If it increases, you may start paying more in monthly premium now rather than facing a blow at tax time.
7. Reality: You are happy enough with your new health insurance (or maybe you are not)
Solution: Keep shopping around—and do not wait until the last minute
You may not be able to change your health insurance coverage now—or maybe you do not want to. Whichever camp you are in, when 2015 open enrollment begins, you might take time to re-asses your health insurance coverage. It is easy enough to re-enroll in the same plan, but there are many reasons the health insurance plan you had for 2014 may not be the best fit for 2015. Rates are likely to increase or decrease, depending on where you live. New carriers will enter the market. Your income may impact subsidy eligibility. Your health care needs—and those of any covered family members—may have change.
Remember: You must apply by the 15th of the month prior your desired effective date. Avoid overworked websites and call centers by shopping ahead of time.
If you need help with your 2015 health insurance options, contact an agent or broker, or an exchange-based assistor. You can also call 888-839-7679 to talk to a licensed and certified health insurance agent from healthedeals.com. These individuals can help you determine your subsidy eligibility, explain the benefits and costs of health insurance plans available through an exchange, help you through the enrollment process and assist you in finding health insurance away from the state-based and federally facilitated exchanges.
If you need health insurance right now, visit your state’s exchange to determine whether or not you are eligible for a special enrollment period or consider a non-ACA-compliant temporary health insurance plan. Visit healthedeals.com or call 888-839-7679 to learn more about temporary health insurance options and get a free quote in seconds.
1 U.S. Centers for Disease Control and Prevention. “Age-Adjusted Percentages of Adults Aged 18 Years or Older with Diagnosed Diabetes Receiving Preventive Care Practices, United States, 2010.” Last reviewed Nov. 19, 2013.
2 Office of the Assistant Secretary for Planning and Evaluation. Health Insurance Marketplace: Summary Enrollment Report. Washington, D.C.: Department of Health and Human Services. May 1, 2014.