YES!! Health Insurance Exchanges were specifically designed to provide individuals and small business owners with the ability to purchase affordable health insurance regardless of age and pre-existing conditions. Aside from monthly premiums, however, your out-of-pocket expenses could be more than you expect them to be.
The exchanges will be required to offer ten essential health benefits”, which will include services like hospitalization, prescription drug benefits and physician visits. And although the benefits will be similar in the four medal plans offered by the exchanges, what you could end up paying may well be different depending upon the plan you choose.
Bronze plans cover 60% of the expenses, silver 70%, gold 80% and platinum 90% of expenses. The premiums for the bronze plans will be the lowest; premiums for the platinum plans may be the highest. Also to be factored into the overall cost: the use of network and non-network providers. If your doctor is out-of-network, the out-of-pocket spending requirement may be higher in the bronze plans than in the platinum plans. In that case, ann individual with a chronic disease, for example, may find that the over-all costs could ultimately be higher with a bronze plan.
When evaluating an exchange’s plans, it’s critical that you look closely at the prescription benefit. If you or a family member has a serious medical condition that requires specific drugs, be sure they are on the plan’s formulary. Although it would seem that if the provider is the same, the formulary should be consistent within all the plans, but this is not necessarily the case. In addition, plan formularies can change and careful review is essential when making a health insurance decision.
Many of the state insurance exchanges are beginning to list the available providers and plans. Although the exchanges don’t officially open until October 1st, now is the time to begin making a checklist of what to look for in a plan. List all dependents’ drugs, illnesses, and medical needs. Then look at what’s available versus what your needs are. If one member of your family has considerably more needs than the others, explore whether your state’s exchange will allow enrollment as an individual to help minimize the cost.
For additional information, contact EAB HealthWorks.