A few highlights:
Initial enrollment. From October 1 though the end of March 2014, the 24 or so million Americans eligible for exchange coverage can sign up online at HealthCare.gov or with the help of specially trained navigators. That includes people already in the individual market and those who are newcomers. Beginning in 2015, open enrollment will start October 1 and end December 31.
People with employer-provided insurance may still need to visit the exchange to see if they’re eligible for exchange coverage (they may be, if their share of the premium for employer coverage is more than 9.5 percent of their income). Employers with more than $500,000 in annual sales that offer group coverage must give all workers a document that tells them about the existence of the exchanges, and the premium that a worker would pay for the lowest-priced plan the employer offers for single coverage. This form lets workers know if their employer coverage is affordable according to the government. If it isn’t, they can shop in the exchange and receive a subsidy. Their families, however, cannot receive a subsidy.
Provider choice. Choice, choice, choice! We say we want it, but in the new insurance order we may not get it. As a trade-off for lower premiums, many companies selling in the exchanges are limiting their networks only to those who agree to steep discounts for their services. Those discounts allow companies to offer cheaper premiums. As a result, consumers may find that particular doctors, specialists, or even certain services are not available in the network for a policy they choose. It’s possible insurers selling similar policies outside the exchanges have a better selection. And that brings up yet another thing to think about. Consumers must look to see if their plan has out-of-network coverage. Some plans may not, and that limits consumers’ choices if they want to go to a super duper cardiologist who’s not in the plan. Most plans will have a list of drugs on a formulary that they will pay for. Consumers must make sure their list of drugs matches that of the plan. But beware, next year the plan may have different drugs on their formulary.
And most importantly:
Finding and reading the disclosures: The Affordable Care Act called for a disclosure document to help shoppers compare plans, and the form that was created is pretty good as these documents go. Shoppers can find out about the policy elements, deductibles (and what they apply to), coinsurance and copays for different services (especially common ones like diagnostic tests and outpatient surgery), amounts for different services, and fees. It also spells out some services that are not covered and provides sample charges for common conditions. But consumers must take the initiative to find the disclosures, says Lynn Quincy, senior health policy analyst at Consumers Union. “It’s not the health plans,’ employers,’ or exchanges’ responsibility to insure the consumer has seen these. If a consumer requests one, they have to make it available.”