South Carolinians shopping on the Health Insurance Marketplace starting Oct. 1 will have to choose among 52 plans. The variables among plans could be enough to make your head spin.
Insurance agents with experience deciphering those variables want to help, and their advice won’t cost you anything. In fact, the price of an agent commission is included in Affordable Care Act policies, so you might as well take advantage of their expertise, agents say. You almost certainly will need some advice.
“I could do a spreadsheet of five different plans, and they all look the same,” said Tammie King, vice president of Insurance Management Group. “But I can see the nuances in those plans.”
Under the Affordable Care Act, almost everyone is required to have health insurance in 2014. The new Health Insurance Marketplace, the federal government’s shopping exchange, was designed to provide insurance choices for those currently uninsured and those covered by individual policies. People covered under a group policy, which is the majority of South Carolinians, can skip the new market.
The rates for 2014 plans won’t be available until Oct. 1, but the S.C. Department of Insurance has released a few details. Four companies will be offering a total of 52 policies in South Carolina through the Health Insurance Marketplace.
Policy basics are simple. A bronze plan covers 60 percent of medical expenses, requiring you to pay the other 40 percent out of pocket. Silver plans cover 70 percent, gold 80 percent, platinum 90 percent. Higher percentage of coverage also means higher premiums up front. There’s a catastrophic plan with available only for people 29 and younger with even lower premiums.
If you decide to go with a silver plan, you’ll have 17 plans to choose from. But one silver plan might have fewer physicians in its network than another silver plan, which can mean higher expenses if you go to an out-of-network physician. One plan might pay a portion of a gym membership to encourage better health.
Agents and brokers are studying those plans so they can be ready to offer opinions when prices finally are announced on Oct. 1, said Steve Hinson, who specializes in individual policies at Insurance Management Group in Columbia. Don’t call agents yet, though.
“We’re all in a quandary now because we don’t know the rates,” Hinson said.
Most of the recent attention has been on the various community groups offering help in signing up for the marketplace. The federal government provided $67 millions in grants to what they call navigators, who are required to have 20 hours of training in the mechanics of the marketplace. Members in another group, known as certified application counselors, are required to have five hours of training.
Both of those groups are tasked with walking people through the process of registering and determining individual tax subsidies, but not with providing advice on the best policy at the end of the process.
“Those (navigators) are fine, but it’s a two-stop process,” Hinson said.
Registering and coming up with a tax subsidy estimate is one step. Shopping for a policy is another, Hinson said. And navigators aren’t trained, or allowed, to offer opinions on the second part.
“The rates are the same (whether you use a navigator or an insurance agent), so there’s not any reason not to use an agent,” Hinson said.
Consumer advocates warn that, as with any kind of insurance, agents can have a bias toward certain companies or products. In the Health Insurance Marketplace, however, all of the costs for the plans should be easy to find.
Lathran Woodard is CEO of the S.C. Primary Health Care Association, which scored a grant to pay for certified application counselors at 21 health centers in the state. She expects many of the low-income patients who come to the federally qualified health centers for care will be more likely to sign up at the centers than to contact insurance agents.
“Y’all have your own swim lane,” Woodard told agents at the meeting last week. “I don’t want to swim in that lane. ... My concern is getting people insured.”
Some insurance agents might not offer the service. It takes time and training to get certified to sell on the marketplace, and the commissions are smaller than what they now get for selling most individual policies. But because provisions of the Affordable Care Act that require coverage for everyone, agents don’t have to worry about the underwriting process they used to utilize to get individual policies approved, Hinson said.
The S.C. Department of Insurance has warned consumers to be wary of scammers who might pose as insurance agents and steal personal identification information. Shoppers should stick with agents from established companies.
Agents who are certified to sell on the new marketplace will have computers set up for customers in their offices. The process should take about an hour, if a customer comes prepared with identification information and an estimate of 2014 household income and if the healthcare.gov website is operating smoothly. Because glitches are expected in the online system those first few days, some agents suggest shoppers wait a few weeks before signing up.
You need to sign up by Dec. 15 to have coverage beginning Jan. 1. The Health Insurance Marketplace will continue selling 2014 policies until March 31. Because the penalty for not having insurance in 2014 includes a three-month grace period, you can sign up by March 15 and avoid the penalty.
For those comfortable with online registration, there’s another option. Healthaviator.com offers online chats with agents using its service to register on the new marketplace.
Health Insurance Marketplace
Number of policies offered in South Carolina, by category.
Learn more about the Affordable Care Act