Recently, a friend was reviewing her new strategy with me.
A healthcare professional and a mother, she was getting ready to have “the talk” with her son. “I don’t think he knows much about it,” she said, “and it’s so complicated.” Her son is an intelligent, 25 year-old who works with complex social policy issues in Washington, D.C. “The talk” was about the Health Insurance Marketplace and enrolling him in a plan for the first time.
Even for those like my friend with 30-plus years of healthcare experience and thoroughly schooled in the finer points of health insurance, the Health Insurance Marketplace provides an eye-opening experience and lots of confusion. Many of your clients are probably starting to have the talk with their adult children who are “aging in” to the marketplace and transitioning from their private insurance.
The setting and structure when shopping for qualified health plans (QHPs), the range of cost provisions that may apply, and the potential for missteps along the way provide the perfect recipe for muddled decision making by even the most astute client.
As a nation, we still are struggling with our role as healthcare consumers. Many of our insurance decisions and activities are made for us—by our employer, for example. Open up the doors and invite everyone into a healthcare marketplace however, and we realize how little we understand about how to compare and select insurance, and how difficult cost and pricing can be to calculate when we don’t understand what’s happening “behind the curtain.” Allsup has seen this with our Medicare plan selection service customers, especially as Medicare Advantage plans grow in popularity.
Consider a Kaiser Family Foundation (KFF) survey from earlier this year showing that more than one in four Americans think people who are buying health insurance on the exchanges can choose only one government health plan. The truth of the matter is that millions of people now have a marketplace of potentially dozens of plans to shop from and to match to their personal needs. I can confirm how little some advisors know about the Affordable Care Act (ACA), primarily because they didn’t think they had to pay attention. But if it hasn’t happened already, one day your phone will ring and a client will ask you about Obamacare.
Allsup helps clients of advisors consider their marketplace health insurance options and coordinate their benefits so they can make an informed decision for themselves and their families. The second open enrollment period is upon us, through Feb. 15, and there are special enrollment periods triggered by life events throughout the year.
Clients who can benefit by the marketplace are likely to come from a range of circumstances including individuals who own their own business, self-employed professionals, early retirees who have a few years to go before they are Medicare-eligible at age 65, and families with large households and adult dependents.
Lessons From The Marketplace
Here are a few lessons we’ve learned from working with customers choosing a marketplace plan.
1. The reports are true. HealthCare.gov is working much better than last year’s maiden outing. That said, getting a consistent or helpful answer to a complicated situation can be problematic when contacting the HealthCare.gov call center directly.
Individuals using the marketplace still don’t have a convenient way of comparing plans and coverage provisions. It takes time and effort to compare provider networks and determine which plans cover which doctors and hospitals, and prescription medications that are covered.
Once individuals have created an account and enrolled, they move on and communicate primarily with the plan carrier. But some issues require persistence when you are trying to reconcile what you were told by the marketplace and the reality of your carrier’s policy.
The government was smart to tell those who had enrolled in year one that they could stay with their plan for the second year without re-enrolling, and this was communicated by the plans. However, some consumers were confused by communications from HealthCare.gov to update their profiles and confirm enrollment.