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Exchange Shopping Tips for Uninsured Boomers and Early Retirees
The new health insurance exchanges – also known as Obamacare – that
begin in 2014 will have a significant impact on millions of Americans who need
health insurance, especially pre-Medicare retirees and uninsured baby boomers
who often have a difficult time finding affordable coverage.
To help ensure you get the best health insurance coverage that fits your needs,
here are some things you should know.
Health Exchange Overview
Starting Oct. 1, you will be able to shop for health insurance policies, and
enroll in one directly through your state’s Health Insurance Marketplace
website, over the phone, via mail or in person at a designated center. The coverage
will go into effect on Jan. 1, 2014.
You can also be reassured to know that federal law prohibits Marketplace insurers
from denying you coverage or charging you higher rates if you have a pre-existing
health condition. But they are permitted to set premiums up to three times higher
for applicants over the age of 50, and smokers may be charged up to 50 percent
more than nonsmokers.
To help make coverage affordable, sliding scale tax-credits will be available
if you earn less than 400 percent of the poverty level – that’s $45,960
for a single person and $62,040 for couples. These tax-credit subsidies will
provide immediate savings off your monthly premiums. See the Kaiser Family Foundation
online calculator (kff.org/interactive/subsidy-calculator) for a premium estimate.
Every state will have a Marketplace, but each state can choose how it will operate.
Seventeen states and the District of Columbia will run their own state-based
Marketplace, seven states will partner with the federal government, and 26 states
will offer federal Marketplaces. The differences between federal and state programs
will be subtle. You will be able to access your state’s marketplace at
To make shopping and comparing a little easier, the health plans will be divided
into four different levels – bronze, silver, gold and platinum. The bronze
plan will have the lowest monthly premiums but the highest out-of-pocket costs
when you need care, while the platinum plans will have the highest premiums with
the lowest out-of-pocket costs.
You will also have a variety of health insurance companies to select from. To
help you evaluate insurers, the nonprofit National Committee for Quality Assurance
offers online “report cards” at ncqa.org that can help you narrow
Because most plans will be managed-care policies such as HMOs or PPOs that require
you to get your care within a network of providers, you’ll want to make
sure that the doctors and hospitals you typically use are covered in the plans
you’re considering. The new Marketplace plans are expected to offer fewer
choices of health-care providers, and who’s included may vary quite a bit.
You also need to find out what happens if you want to use a doctor or hospital
outside a plan’s network. Will you have to get a referral or pay more to
get these services, or will it even be covered at all?
Also check the plan’s formulary, which is the list of prescription drugs
they cover, to be sure all the medications you take are covered without excessive
co-pays or requirements that you try less expensive drugs first.
If you need some help with all this, the Marketplace Help Center offers a toll-free
helpline at 800-318-2596. Or, if you’d rather get face-to-face assistance,
there will be designated centers set up with trained and certified navigators,
counselors and application assistors to help you, along with insurance agents
and brokers. To find help in your area, call the Marketplace Help Center after
Oct. 1 for a referral.
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