The deadline to enroll in health care under the Affordable Care Act is Feb. 15; if you still haven’t signed up, there are resources to help you navigate the health insurance marketplace.
“If you’ve never had health insurance before, it’s certainly complicated, but there are lots of avenues to get help,” said Jayme Simoes of Covering New Hampshire.
Coveringnewhampshire.org is the official, free source for Granite Staters to learn more about the health insurance marketplace. It is funded through a federal grant.
He said the website is the “gateway to [the] health insurance marketplace.”
Simoes said the first step in shopping for coverage is to visit the website and plug your information about household size and income into the financial assistance calculator and see if you qualify for assistance or Medicaid expansion. The less you make, the less you pay for coverage, he said.
Because insurance options will be different for people who qualify for assistance, it’s important to start the search process here.
Anyone with an income below 138 percent of the federal poverty line qualifies for Medicaid expansion, said Suzanne Tammaro, vice president of marketing for Southern New Hampshire Medical Center in Nashua. If a person is above the 138 percent threshold, Tammaro said, they might qualify for tax credits for the “silver plan,” which would help pay the monthly premium.
Weighing the options
The second step, Simoes said, is to use the tool that will allow you to compare over 40 plans from five carriers and examine how the different levels of coverage stack up.
Last year there was one insurance carrier on the exchange. This year, Granite Staters have a choice of over 40 plans from five different carriers: Anthem Blue Cross Blue Shield in New Hampshire, Assurant Health, Harvard Pilgrim Health Care, Maine Community Health Options and Minuteman (see box for information about each carrier).
Each insurance company offers a bronze, silver, gold and platinum plan. There is also a catastrophic category, which has higher deductibles and out-of-pocket expenses.
Colin Manning, public relations director for Anthem, said affordability is something consumers really focus on, which is a reason to evaluate plan options and go beyond comparing premium rates. Manning advises looking at copays, deductibles and coinsurance.
“The cost sharing associated with the different benefit plans can differ greatly. Look at the value of what you’re getting. A lower premium could mean a narrower network,” he said.
Beth Roberts, senior vice president for regional markets for Harvard Pilgrim out of Manchester, said consumers need to be aware of the variation between networks and understand which doctors and hospitals are in theirs.
“That’s the biggest single difference among the health plan offerings,” she said.
Maine Community Health Options was one of two providers in Maine in the first year and covered about 83 percent of consumers, said Mike Gendreau, communications director.
Gendreau reiterated that it’s key to make sure your doctors are covered in your network, and if you have prescription medication, make sure that is covered as well.
Still need help?
“With [the online financial assistance calculator and compare tools], you’re in a position to make a smart decision. And if that isn’t enough, there is a ‘get help’ section where you can find an insurance agent or in-person assister who could talk to you on the phone or meet with you,” Simoes said. “There is also an events page, and if you click on that you can see every day there are a bunch of events throughout the state.”
Coveringnewhampshire.org has a page that lists a network of in-person assisters throughout the state. Assisters include certified application counselors who are trained to help people navigate the health insurance marketplace, Tammaro said. She said counselors will help explain all the aspects of the insurers’ plans, including copay, deductibles, coinsurance and what the options are for individuals or families.
An insurance broker is another option for people who need assistance. Roberts pointed out that insurance brokers are paid by insurance carriers, not the prospective member.
“That’s one of the big misunderstandings,” Roberts said, noting that insurance brokers can help customers “work through the weeds.”
The final purchase
Coveringnewhampshire.org doesn’t actually sell the insurance plans — those still need to be purchased on healthcare.gov after you have done your research, Simoes said. If you have trouble navigating that website, you can get help from an insurance agent or in-person assister.
“An insurance agent can do all the work for you at no cost, or you could go to an in-person assister who could sit down at a computer with you and walk you through the application process,” Simoes said.
As seen in the January 29, 2015 issue of the Hippo.