How does it feel to be an empowered consumer? Now that you've read our article, The "New" Healthcare: Part 1 in our September issue, you're well on your way to being exactly that when it comes to healthcare. You've learned that October 1 is the first day of open enrollment for healthcare coverage, and the law requires you to have an active policy beginning January 1, 2014. You've learned that healthcare coverage can no longer be denied if you have a pre-existing condition, and instead, coverage is based on community rating. You've learned that you may be eligible for a government subsidy through the Health Insurance Marketplace, which is good because premiums may be going up for some consumers. Armed with all this information, where do you go from here? Michael Parker, CFP and senior consultant at Thrive Advisory Group, who contributed to The "New" Healthcare: Part 1, explains what your next steps might be.
If you currently have coverage through your employer, your first step is to find out from your company how that coverage might be changing. Parker explains, "Possible consequences of the law could be companies shifting more of the cost impact to employees, cutting back benefits, or in the case of some businesses, completely eliminating their employer-sponsored health plan." This complete elimination of a health plan offering might happen for several reasons. Companies with fewer than 50 employees can, in fact, eliminate their employer-sponsored health plan without incurring a penalty, so they may choose to do so in order to save themselves money. If a company has more than 50 employees, they would incur a penalty for eliminating their health plan, but the penalty might cost less than the premiums they would have to pay for their employees. If your company makes changes like these, you may need to consider seeking coverage through a different plan. Parker points out that individuals will still be able to seek out health insurance through various channels just like before, through "brokers, agents, direct to provider, and now through the exchanges" on the Marketplace. To make your decision, you'll just need to evaluate each available plan based on whatever factors are most important to you, like price or access to certain physicians and facilities.
If you are currently self-insured or uninsured, you have the same options as the ones listed above – insurance brokers, agents, insurance companies themselves, or the Marketplace can all provide you with information you need to select the most appropriate plan for you and your family. Thanks to government grants, organizations across the country are paying for Navigators, who help individuals sign up for coverage through the Marketplace exchange. These Navigators will help you sort through the variety of options out there. If you are under 30, Parker says, one of your options is "catastrophic plan designs with much higher deductibles." Your choices also include HSA qualified plans. Taking advantage of the Navigator resource or talking with an insurance broker or agent will help you look at your options and make the best decision for you.
If you are looking for a local or alternative option, you might consider seeking coverage through the insurance company created by WellStar and Piedmont hospitals. Their goal is to deliver higher quality treatment at a lower cost, and working directly with their patients on all aspects of care and reimbursement (instead of involving third-party insurers) will help them do that. Ideally, introducing this new insurance option will promote competition and drive down costs, but Parker admits, "Lower premiums due to this are yet to be seen."
Parker also mentions the alternative of concierge medicine, where "doctors have opted to go direct to patients with service packages." For example, a doctor may charge a set rate for unlimited use of their services. Parker explains, "Doctors are able to shed internal overhead cost due to spending less time and resources processing insurance claims." Not only that, but doctors practicing concierge medicine can spend more time with their patients, give them better treatment, and still make more money than by treating patients with traditional private insurance. Parker points out, "The drawback is that this type of arrangement is not accounted for in the healthcare law. Concierge medicine is not considered as having insurance." So if you choose this route for your medical care, you'll still need to pair it with some sort of traditional insurance plan.
At the end of the day, Parker says, "Individuals will be forced to become better shoppers of their healthcare." Managing costs and finding policies that contain the providers you want may prove a challenge, he cautions, but some of the old challenges (like denial based on pre-existing conditions and copays for well visits) are things of the past. No matter what route you take toward coverage, it's up to you to do your research and find what works best for you.
Where to go for more answers to your questions
For questions about the Marketplace, call (800) 318-2596
For questions about the SHOP, call (800) 706-7893
The Structured Employment Economic Development Corporation and University of Georgia (College of Family and Consumer Sciences and Cooperative Extension Service) both received grants to run Navigator programs in the state of Georgia. For more information about finding a Navigator, go to their websites: www.seedco.org/about-us/georgianavigator or www.fcs.uga.edu