The state health insurance marketplaces, a signature feature of the new health-care law, opened for business last week. Although there have been some glitches, the marketplaces, or exchanges, allow consumers to compare a range of health plans that meet the standards of the law, to apply for subsidies and to pick the best policy for their needs.
Here are a few things to keep in mind when shopping on the marketplaces.
Don’t wait until the last minute to look for a plan.
Open enrollment lasts through March. If you want coverage to start on Jan. 1, you must sign up by Dec. 15. But don’t wait until Dec. 14 to shop, say experts.
“Start early,” says Cheryl Fish-Parcham, deputy director of health policy at Families USA, a consumer advocacy organization. “If you have questions, that’ll give you time to ask them.” And it will give you some breathing room should there be computer or other problems when signing up.
Look beyond the premium when figuring potential costs.
When shopping for plans, consider your total potential financial exposure, and not just your monthly premium. Look at the plan deductible, co-payments or coinsurance, and the maximum amount you could be responsible for paying out of pocket every year.
Exchange plans in every state will cover a similar package of 10 “essential health benefits,” but consumers’ proportion of the costs will vary: They’ll pay 40 percent of costs if they enroll in a bronze plan, 30 percent in a silver plan, 20 percent in gold and 10 percent in platinum.
This year only, some plans may have separate deductibles for medical services and prescription drugs. And a recent analysis of exchange plans in six states by Avalere Health found significant variations in prescription drug cost-sharing.
“Make sure the benefits are covered the way you want them to be . . . and look for limits on services,” says Kevin Lucia, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms.
Check provider networks.
It’s been widely reported that one of the ways that insurers have been able to keep premiums more affordable on the exchanges is by limiting provider networks. If it’s important to you that certain doctors or hospitals be in your network, check those details before signing up.
Smaller isn’t necessarily less desirable, though, experts say. “If all your providers participate in a narrow network, it’s not a problem,” says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.
Estimate your income carefully.
Roughly 80 percent of people who buy plans on the exchange will qualify for premium tax credits, according to Avalere Health. The credits, available to people with incomes up to 400 percent of the federal poverty level ($45,960 for an individual or $94,200 for a family of four in 2013), will be based on your projected income for next year. The credits can be sent directly to the insurer, reducing your monthly premium. If your income estimate turns out be too low, though, you might have to repay some money at tax time.
So monitor your income during the year and inform the exchange promptly if you realize your estimate was too high or too low so your tax credit can be adjusted.
Don’t be fooled by look-alike Web sites.
In a handful of states, experts have already encountered Web sites that look like official state marketplace sites but aren’t, and they expect more of these sites to crop up.
“Some could be deceptive but fairly benign sites designed to sell legitimate insurance products,” says James Quiggle, a spokesman at the Coalition Against Insurance Fraud. “Other sites could be malicious and intended to steal your identity.”
To ensure that you’re visiting the official health insurance marketplace for your state, go to www.healthcare.gov, which will either help you sign up or direct you to the right state Web site.
This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: firstname.lastname@example.org.