Hot Topics in Health Care: 5 Things about Exchanges

Now that the government has reopened for business and it’s been three weeks since the opening of the health care exchanges, there are things that you should know before purchasing health insurance on the exchanges; not that there won’t be additional questions, however, the deadline is quickly approaching to be insured or face a penalty.

1.) The deadline for purchasing insurance is Dec. 15. If you aren’t already covered by your employer, Medicare, Medicaid or other private health insurance, you are required to purchase insurance by the exchange by Dec. 15 in order to be covered by Jan. 1.

Remember, you are required to have health insurance in order to avoid the penalty for not having insurance. This can prove challenging as the exchanges have been difficult to navigate. The current open enrolment period ends in March 2014, and it’s unclear when the next period will occur.

2.) There is confusion over which sites to use. The website www.healthcare.gov is the site for the 36 states that are not running their own exchanges, while 14 states have their own websites for enrolment. The best way to determine which site is correct for you is to go to www. healthcare.gov, where each state has a specific link, if applicable.

3.) It is unclear how much your premium will be. Since you have to fill out an application before finding out your subsidy eligibility and overall premium, it can prove scary to see the initial high numbers of the actual insurance cost. After you fill out the insurance application and have the correct subsidy, you can determine your actual monthly premium.

4.) Plans differ by regions. When you look at the specific health insurance plans, you will see differences in your region versus other regions in the same state. You cannot assume that you will be eligible for the same plan as your neighbour in the next county. It is vital that you check all the details of a plan, not just the cost to determine if it’s correct for your situation. In addition, make certain that your physicians take the plan you are considering.

5.) You may need the exchanges in the future. Just because you are currently covered by your employer or otherwise have health insurance, do not assume that you will never need an exchange and do not have to pay attention. Each day businesses are exploring whether to have employees use the exchanges and even some private insurers are cancelling policies because they will lose money covering high priced consumers. It is safe to assume that everyone should be educated on this system.

About Author

  • Email: mlamagna@hhrls.com
  • Michael LaMagna, LNHA, MPA, JD concentrates in the areas of Medicaid and Advanced Asset Protection Planning, Elder Law, Trusts and Estates, Probate and Probate Litigation, Guardianships, Health Care Regulatory Matters, Nursing Home Placement, Long Term Care Insurance, Medicare Appeals, Social Security/SSI Litigation and Special Needs Law. If you have a question for Mr. LaMagna, please call him at (914) 437-5955.