What to know about buying health insurance on individual market

November 30, 2013

A look at questions related to recent health-care news. Today’s focus: people who buy insurance on the individual market.

Q. I have a private health insurance plan, not through my employer. How will the Affordable Care Act affect me?

A. You could be affected in a big way.

Starting Jan. 1, insurance companies can no longer reject you because you have a preexisting condition, or charge you more because you are a woman. You might be able to get a more comprehensive plan and get financial assistance to pay your premiums.

But there is bad news for some people. A number of Americans who like their private health plans have learned in recent months that their policies are being terminated. The reason is that the old plans do not comply with new rules under the health-care law. And some people will find that their new plans are more expensive.

Q. I’m one of those people whose plans are being terminated. But didn’t President Obama fix that problem?

A. Sort of. Last month, the president did take action to make amends for his broken promise that people who like their health insurance would be able to keep it. He decided that insurance companies would be able to extend policies for an extra year.

But because insurance is regulated by the states and not the federal government, it is up to state insurance commissioners and insurers, who have to figure out what state law allows them to do and how it could affect premiums in 2015 and 2016. Most haven’t decided yet what to do.

Q. If I extend my plan under the president’s fix, can I keep it forever?

A. No. The best scenario you can hope for is to keep your plan until its expiration date, and then renew it for one more year. The longest you can keep it is through September 2015.

You will eventually have to switch to a new plan that complies with the health-care law.

Q. Is there any reason I should not take that option if it is offered to me?

A. It may turn out that you can get a more robust plan at a lower cost on the online health insurance marketplace, depending on your age, income and other factors.

There is also a catch. At some point, you will have to switch to an Obamacare-compliant plan. If you switch mid-year, you might have to start paying toward your annual deductible again. It’s one factor to think about as you consider your options.

Q. Isn’t the Web site you referenced broken?

A. You’re probably thinking of HealthCare.gov, the main federal health insurance portal for 36 states, which has been glitchy to say the least. Other states have their own portals, with some working better than others.

It’s not totally broken, and according to the Obama administration, it should be working now for the majority of Americans. But for 20 percent of you, it might not go as well.

Q. My insurance is getting canceled at the end of the year. What can I do to ensure that I won’t have a lapse in my coverage?

A. You’re in a tough spot, no doubt about it, and you should probably get on that Web site to check out your options. You have until Dec. 23 to sign up for a plan that is guaranteed to kick in Jan. 1.

If you have tried the marketplace with no success, you can try the government hotline,
1-800-318-2596, or try getting help from a local insurance agent or broker. You can try to find a “navigator,” the official Obamacare helpers, whose names should be listed on the Web site. You can also buy a plan directly from a health insurance company.

You might try to access the Web site on off-peak hours, or try a different browser — techniques that have helped some people get through the rough patches.

Q. My plan is not being terminated. Does that mean I don’t have to worry about this whole thing?

A. Yes — for now. It could be that you will get a letter down the road asking you to switch plans because of the health-care law. It is a good idea to get on the health insurance marketplace in your state to look at your options.

Sandhya Somashekhar is a health reporter for the Washington Post.
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