The Edmond Sun

Local News

November 5, 2013

Other options available for finding health care coverage

OKLA. CITY — Looking for health insurance? Can’t get the Obamacare website to work? There are other ways to shop.

You can go directly to insurance company websites, where you’ll find coverage details and premium costs of every policy each company is offering both on and off the federal health insurance marketplace.

You also can contact an independent insurance agent, who can compare plans offered by several insurance companies and help you pick one that best fits your circumstances, at no cost to you.

Neither option has received much attention in the initial rollout of the Affordable Care Act marketplace in Oklahoma and other states.

You may not be able to finish the process until the federal government’s bug-afflicted website is fixed, which may be weeks away. But at least you’ll be able to compare plans and premiums and receive estimates of how much your policy will cost after federal tax credits are figured in. If you know you’re ineligible for subsidies, you can enroll in a health plan now.

“They don’t have to go through the marketplace portal,” said Deputy State Insurance Commissioner Mike Rhoads. “They can go directly to the company websites and start that enrollment process. Or if they want to get all of the array of offerings out there, they can go to an agent who can shop that for them.”

“It’s really going to depend on the person and their own personal shopping preferences,” said Blue Cross Blue Shield spokeswoman Ashley Hudgeons. “For someone who is used to the online shopping-cart experience, that might be a good choice for them. For some people, it might be going to an agent or a navigator.”

One caveat: Insurance company websites might be a good starting place, but they can’t provide official calculations of federal tax credits and cost-sharing subsidies. For that, you’ll still need to go through the ACA marketplace by Dec. 15 if you want your policy to take effect on Jan. 1. (You can wait until March 15 and not pay a fine, but your policy won’t take effect as soon.)

Another caveat: Besides cost, one of the most important differences among competing plans is the number of doctors, hospitals and other providers participating in the “network” covered by each plan type.

Those networks vary by company and type of plan. Some Obamacare critics have expressed concern that individual policies offered on the federal marketplace may have smaller provider networks than the group plans offered by some employers.

The company websites let you enter the names of specific doctors or medical facilities to determine whether they are included in a plan. Some sites also let you enter a geographic location and will list all providers within a specified distance.

Plans with bigger provider networks tend to have higher premiums. In Tulsa, for example, Blue Cross Blue Shield offers higher-cost “Blue Choice” plans offering in-network access to several area hospitals. Its lower-cost “Blue Preferred” plans exclude St. John Medical Center and Saint Francis Hospital.

Five companies are offering individual health plans in Oklahoma through the ACA marketplace. Besides Blue Cross Blue Shield, they are Aetna Life Insurance Co., CommunityCare, Coventry Health Care Inc. and GlobalHealth Inc. Aetna acquired Coventry earlier this year, but they are still marketing health insurance as separate entities.

All five companies have websites with information about their plans and premiums. In some cases, companies list “on-exchange” and “off-exchange” policies with identical provisions and premium amounts. They may also have plans available only to ACA marketplace customers, or only to off-exchange shoppers.

To obtain policy details, you’ll need to enter your geographic location, your age, the ages of other people in your family who need coverage and whether you use tobacco. Those are the only variables the government allows companies to use to calculate premium amounts, even for policies sold outside the marketplace.

Each company will show you a list of policy options. In northeast Oklahoma City, for example, a shopper can compare six Aetna plans, 19 Blue Cross plans, 12 CommunityCare plans, 16 Coventry plans and eight GlobalHealth plans.

The unsubsidized premium amounts for a 40-year-old single nonsmoker range from $154 to $507 per month. The plans are grouped into five coverage tiers — catastrophic, bronze, silver, gold and platinum — based on uniform ACA benefit criteria.

“It’s almost standardized, like we did with Medicare supplement plans 15 or 20 years ago,” said Rhoads, the deputy insurance commissioner. “So what you do is you select on price point and on provider network.”

The unsubsidized premium amounts listed by the companies do not include the value of any tax credits you are eligible to receive under the Affordable Care Act. Credits are available to single people with incomes between $11,490 and $45,960 a year, two people with combined incomes of $15,510 and $62,040, three people with $19,530 to $78,120, and larger families with household income of $23,440 to $94,200.  

Blue Cross Blue Shield is the only one of the five companies whose website will estimate your net policy cost after tax credits are applied. The others direct you to the federal marketplace or to an unofficial tax credit estimator provided by the Henry J. Kaiser Family Foundation.

Another way to compare plans is to contact an independent insurance agent. The National Association of Health Underwriters has a roster of agents in Oklahoma certified to help people obtain health policies through the marketplace. Its website will help you locate one in your area.

Independent agents also can show you off-exchange plans if you don’t qualify for ACA tax credits and thus are not required to buy your plan through the marketplace.

The commissions received by independent agents, typically 5 percent of the premium amount, are paid by the insurance companies and not by you. The amounts are the same as those charged if you go through the federal marketplace or acquire your plan directly from an insurance company.

The advantage of dealing with an independent agent is that he or she can describe plans offered by several companies instead of just one, and provide information about provider networks and other coverage provisions.

“You can take a step back and allow them to do some of the legwork and tell you about the subsidies and what some of the options are,” said Rep. Glen Mulready, R-Tulsa, who has worked as an independent health insurance agent for 30 years.

Mulready said his firm, Benefit Plan Strategies of Tulsa, has seen little traffic so far from individuals interested in buying ACA policies. Many agents like him specialize in selling health plans to businesses instead of individuals, but he expects that will change if the Affordable Care Act remains in place.

“It has turned our whole industry on its head, and we have to respond to that,” Mulready said.

Still another option for comparing plans is to contact one of the organizations certified by the government to provide counseling to people needing insurance.

Those organizations have trained scores of “navigators” to help people enroll in health plans through the federal marketplace. Unlike independent agents, however, they can’t recommend specific plans.

David Blatt, director of the Oklahoma Policy Institute, a nonprofit advocacy group that supports the Affordable Care Act, said it doesn’t matter which path is followed as long as people who need health insurance wind up getting it.

“I think that pursuing whatever means feels comfortable is fine,” Blatt said. “There are navigators. There are agents and brokers. I don’t see any objection to using any or all of the above.”

OKLAHOMA WATCH is a nonprofit, nonpartisan journalism organization that produces in-depth and investigative content on important public-policy issues facing the state. For more Oklahoma Watch content, go to www.oklahomawatch.org.

 

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