Health insurance shopping on the health exchange is in full swing and you have until December 15 to keep shopping. Most areas of the country have a robust number of plans and choices available and the Healthcare.gov website has become more user friendly making it easier to pick the right coverage.
Many people like to have an agent to shop for them. If you do this, double check what the agent recommends. A significant number of agents are only allowed to sell one insurance carrier and may not tell you about your other options. Also, if your income is below 250% poverty level, you qualify for reduced deductibles and out of pocket expenses, but only if you choose a silver plan. The agent may fail to point this out to you. It is important for you to know your options and compare your choices. This is a step by step guide to shopping for coverage on HealthCare.gov.
To get started, you will need a list of your doctors and medications and an estimate of your income for 2019.
If your income is over 400% poverty level, you won’t get a tax credit to help pay for insurance. In this case, you’ll just need a list of your doctors and medications. FamiliesUSA has a chart that shows current poverty level guidelines based on number of family members. ABC for Health, Inc. has a nice federal poverty level calculator.
How to estimate your 2019 income
Income is a combination of the following:
- Gross wages, assuming you don’t have deductions for retirement plans.
- Any money you take out of retirement plans, such as your IRA or 401k.
- Interest income, dividends, and capital gains from savings or brokerage accounts. This also includes any tax-free income from municipal bonds.
- Social security income.
- Any other income included on your tax return, such as rental income or other business income.
How to shop for insurance on HealthCare.gov without logging into your account
In the HealthCare.gov home page, on the upper left-hand corner, click “Get Coverage”.
On the bottom of the new page, click “See Plans & Prices – Preview Now”.
- Enter your zip code
- Choose “No” on “Are you enrolled in a 2018 Marketplace health plan?” Even if you are enrolled, remember you are just shopping and choosing yes will take you on a different path.
- Enter the people in your household
- Enter ages, sex, and “other information” that helps the site determine special situations. If you are eligible for health insurance through work, Medicare, Medicaid, or CHIP, it will not show you the other plans. If you are just shopping, don’t click on this choice.
- Enter your estimated household income. If you were not able to figure this out from my instructions, this page on the query provides tools to estimate your income.
Once you hit enter, the website will determine if you qualify for a credit, the amount of the credit, and if you get cost sharing subsidies. For example, I used a 62-year-old female with income of $19,000 per year. Her premium tax credit is $984 per month – that is a tax credit of $11,808 per year! She also qualifies for cost sharing subsidies ONLY if she gets a silver plan.
Click “Continue to Plans”. A pop-up will provide information on how to compare plans. Close this pop-up. You will now see all the plans available to you. My example person has 49 plans available. It is now time to narrow the results. Click “See if providers and drugs are covered”.
Type in the name of your providers. A drop down will start to populate with a list of choices. Select the appropriate choice. Click “View/Edit Selections” to add more doctors. Realize that the more doctors you add, the less likely any one insurer will cover all those doctors. Pick the doctors who are most important to you such as your primary care doctor.
You can then proceed to adding your medications by clicking “Add a drug”. Type in the name of the drug, select the drug and the appropriate dose. If you need to add more drugs, continue to click “View/Edit Selections” until you have added all your medications. Just like doctors, the more prescriptions you take, the less likely you will find one insurance plan that will cover them all. You may have to work with your doctor to change your prescriptions to drugs that are on the insurance company’s formulary.
Once you are done adding doctors and drugs, click “See Plans”. The site will still show the total number of plans available, like the 49 in my example, but it will now list how many providers and medications you take are covered in each plan. In my example, the shopper has two doctors and three medications. None of the plans covered all her medications or doctors, so she will have to choose the plan that does the best job. A number of plans covered both doctors, so these will be her most likely choice.
Now it is time to refine the choices, so click “Refine Results”. You will have the opportunity to narrow the results by the level of plan (bronze, silver, gold, or platinum), deductible and premium amount, health plan types – HMO or EPO, and if the plan is eligible for a health savings account.
I suggest you start with the level of plan, health plan type, and doctors and drugs covered. If you love your primary care doctor and trust her to do referrals for specialists, you can choose an HMO. If you want the choice to go to a specialist directly, choose the EPO. However, for purposes of shopping, I suggest you leave these options unchecked so you can compare prices. For my example, I chose Silver plans because she gets a cost sharing subsidy, and clicked all her doctors and prescription drugs. Then click “Apply Filters” at the bottom.
This winnowed my choices down to 24 plans. The next step is to scroll through the plans and determine which covers the most providers and drugs at an affordable price. You can then click “Compare” in each plan for up to three plans to compare the details. Once you are done, click “3 Plans to Compare”.
In my example, only one insurance company covered both doctors. I chose three of those plans to compare. One had dental and vision coverage, so it may pay to investigate if the increased premium is worth the extra coverage.
Shopping for insurance is hard, and as you can see by my example, the choices are not optimal. Until our politicians fix the system, which is likely never, you have to deal with what is given. Take a moment to call or email your representatives and encourage them to fix our broken system.