Signing up for a health plan on the federal exchange begins in less than two weeks. Are you ready?
If you didn’t get health coverage previously under the Affordable Care Act, you can enroll in a plan for next year starting Nov. 15. And if you’re already covered, you can change or renew your plan for next year. If you don’t sign up by Feb. 15, 2015, you’ll be without coverage until January 2016 unless you have a qualifying life event (such as marriage or the birth of a child).
Consumer experts say it’s important to begin the process early, understand your choices, and above all, ask questions.
“It’s a very short window of time and there is a lot to get done,” Sabrina Corlette, a researcher at the Center on Health Insurance Reforms at Georgetown University, told The Wall Street Journal.
Unfortunately, a lot of people who should be interested in coverage through the ACA simply aren’t aware. Almost nine out of 10 uninsured Americans don’t know the ACA’s Annual Enrollment Period begins Nov. 15, according to a recent Kaiser Family Foundation survey. And more than half are unaware of subsidies that could help them purchase coverage.
There are at least three key components to choosing an ACA plan that’s right for you and your family: Benefits, premiums and the network of doctors and hospitals. Let’s zero in on each of these.
All ACA plans are required to cover “essential health benefits” as described in the law. And all individual plans must cover preventive health benefits entirely.
Beyond these requirements, consumers have choices when it comes to how much they pay out-of-pocket for covered services. Plans are broken into four categories — bronze, silver, gold and platinum. As these names suggest, bronze plans have the highest deductibles and copayments, platinum the lowest.
When shopping for a plan, look for the “Summary of Benefits and Coverage” which describes what the plan covers. Also be sure to review each plan’s prescription drug formulary to see what drugs are covered. Or call the plans you’re considering and ask about any specific services you think you might use in the coming year.
Health plans across the nation have been preparing customers for changes in rates from current plans for the new ACA enrollment period. Blue Cross and Blue Shield of North Carolina is no exception: We recently announced average rate increases of 13.5 percent for our ACA plans for 2015.
Generally speaking, the higher your out-of-pocket costs, the lower your premiums are. This tradeoff between rates and out-of-pocket costs is an important element to consider when shopping for coverage.
Federal subsidies help consumers pay for coverage through the ACA. If your household income is between 100% and 400% of the federal poverty level, you don’t have coverage through an employer, and you meet certain other requirements, you’ll be eligible for a federal subsidy to purchase a plan through the exchange. After submitting your application, you’ll receive notice on whether you qualify for a subsidy.
Another important consideration for consumers is whether their current physicians and hospitals are in-network. Going outside the plan’s network typically results in higher charges — sometimes significantly higher. And some plans don’t cover services provided outside their networks.
If you’ve had coverage before, or have a current plan, don’t automatically assume your doctors will still be in-network for a new or renewed plan. It’s best to check each time you go through an open enrollment period. All ACA plans are required to tell consumers which providers are in the plan’s networks. When shopping, look for the link to the provider directory. Current BCBSNC customers may find the directory by logging into Member Services and clicking the “Doctors & Facilities” tab.
We wrote about in-network and out-of-network considerations in detail back in September — it’s worth a look.
For More Information
BCBSNC is offering a host of resources to help North Carolinians learn more and make their choices:
- Our Blue Map online feature offers a step-by-step approach to renewing coverage.
- Our seven retail stores across the state offer personal help.
- We’re hosting in-person events throughout the state.
- Current customers are invited to join one of three webinars in November.
- You can call a local insurance agent or reach us at 1-800-894-2880.
And we’ve covered the launch of Blue Map, what information to gather and key dates for 2015 coverage on our blog so far. Keep checking or subscribe by email (see the link in the top right of the blog home page) to stay on top of developments for the Annual Enrollment Period.