| NEW YORK
NEW YORK Oct 23 Frustrated by the new U.S.
federal and state health insurance exchanges?
The best advice, insurance industry insiders say, is to put
down the computer. Window-shop for a couple of weeks, but don't
even think about buying a plan right now.
That's because any policy you would buy this way will not
kick in until January. "You still have some time, and you should
take it," says Carrie McLean, director of customer service for
eHealth Inc, which runs the private insurance
But you can get ready by educating yourself about what is
available - including options beyond the public exchanges that
opened on Oct. 1 as part of the Affordable Care Act.
For instance, you can go directly to insurance carriers to
find plans that aren't offered on the exchanges. These plans
meet the same minimum standards set out by the healthcare reform
law as those on the public exchanges, but they include no
government subsidies. You could go to an online broker like
eHealthinsurance.com that aggregates private plans from around
the country. Or you could go to one of your state's licensed
brokers, many of which sell on- and off-exchange policies, for a
"Literacy is low out there - people don't even know that
Obamacare and Affordable Care Act are the same thing," says
Aaron Smith, executive director of Young Invincibles, a
nationwide non-profit that helps inform young Americans about
their healthcare options.
Here's another reason to take it slow: Brokers around the
country report that they are missing decision-making elements
they need to compare plans, such as directories of doctors
participating in networks and drug formularies to show what's
covered. Some of the off-exchange plans don't even have their
rates listed yet.
Marcus Newman, an insurance agent in Bannockburn, Illinois,
outside Chicago, does not know anyone who has purchased a plan
on a public exchange. "I've quoted prices, and every single
person choked on the rates," Newman says. "I don't know what
they were expecting."
For those not getting government subsidies, there could be a
bit of sticker shock as prices range from $150 for the
lowest-tier individual policies to thousands for top-tier family
coverage, depending on the state.
If you're hoping there is something better out there, here's
what you need to know to help you shop:
1. You can still buy 2013 coverage in some states.
The Affordable Care Act affects all individual insurance
plans, even if they aren't offered on one of the public
exchanges. One key upgrade that starts Jan. 1, 2014, is that
carriers have to accept you and cover pre-existing conditions.
Other provisions mandate coverage of maternity care, mental
health, pediatric dental and vision and pharmacy benefits.
Some states allow carriers that do not offer plans on the
public exchanges to lock customers in for one more year at 2013
levels. Typically, those plans are less expensive for people who
had already qualified for them in the past. Forget this option
if you have anything at all wrong with you - you won't pass the
medical underwriting process.
"For the healthy people, the current plan is the easier
solution," says Tony Nefouse, who sells both exchange and
off-exchange plans in Indiana. "They can have a policy in place,
no online enrollments or glitches or delays, and they're able to
get a policy that starts immediately."
For his own coverage, Neil Primack, an insurance agent in
Jupiter, Florida, who runs the site
floridahealthinsurancebroker.com, simply renewed his
$200-per-month plan. "If I went on any of the new plans, my
premium would have doubled," he says.
2. Even if you qualify for a subsidy, consider other
Some prices will be hard to beat - such as that found by Des
Moines, Iowa, insurance broker Jesse Patton for a client whose
subsidized platinum-level plan on Iowa's exchange will cost her
$30 a month starting in January.
Others need to shop around. Patton also has a client who is
a 51-year-old woman, previously on a private insurance plan for
$550 per month. She has a job that pays $21,000 a year, but her
employer doesn't offer insurance.
Coverage from Iowa's public exchange next year would cost
her $511 - though just $400 with a subsidy. But Patton priced
the rest of the market and found her a comparable plan for $373
without a subsidy.
3. It's worth waiting for off-exchange plan information.
HealthPocket.com, a site that analyzes healthcare costs, has
found some limited pricing information showing that off-exchange
plans are slightly more expensive than the non-subsidized
offerings on the exchanges. But that was only at the base
premium rate and does not include any qualitative analyses of
"A health insurance plan is only as good as the doctors that
accept it," says Kev Coleman, HealthPocket's head of research
and data, who has found that exchange plans tend to have
narrower networks than plans offered off the exchanges.
In most states, brokers advise that those who don't qualify
for subsidies will do better on the private marketplace, if only
because they don't have to go through all the paperwork required
on the public marketplace.
"The plans they are marketing are not that much different.
There's no incentive to go on the exchange if you don't have
to," says Cammie Scott, president of CK Harp and Associates, an
insurance brokerage in Springdale, Arkansas.