Right now, I’m gazing at the cover of the 142-page Individual Enrollment Agreement that arrived in the mail from my new health insurer, CareFirst BlueCrossBlueshield.
The sleek, longhaired woman in the picture is smiling brightly. I’m not feeling her joy.
I’ve been stewing about health insurance since October — ever since my husband, Cliff (a freelance TV documentary producer/editor), and I were notified by our health insurance provider, Assurant Health, that our plan was canceled.
But we’re grateful we were able to land new coverage in just two weeks. (I’ll explain how in a minute.) You have until March 31 to sign up for coverage that starts in 2014 or risk owing a penalty. The December deadline was for coverage beginning Jan. 1, 2014; if you enroll through the federal marketplace by Jan. 15, coverage will start Feb. 1.
(MORE: What to Do If Your Health Insurance is Canceled)
Shocked to Lose Health Coverage
I have to admit, however, that I was fuming when we lost our coverage. I had been a big supporter of the new Affordable Care Act — aka Obamacare — and was completely shocked to be on the losing end of it.
For some reason, I never suspected our insurer would lop us off because our plan didn’t meet the new minimum benefit standards set by the Affordable Care Act. (Assurant actually opted to stop writing all coverage in the District of Columbia where we live.)
Cliff and I are among the millions of Americans (many who are self-employed like us) who’ve been required to get new policies if we want to have health insurance. About 12 million Americans, or 5 percent of the population, purchase their own individual policies; they aren’t covered through their employers, Medicare or Medicaid.
Sticker Shock In Our Home
Our sticker shock is real. We’ll shell out $7,800 this year for our new plan covering Cliff, who’ll be 60 in April, and me, 53. That’s $1,380 more than we paid for our Assurant coverage last year. We won’t qualify for federal aid to pay for the premiums; a two-person household qualifies for a subsidy only if it earns less than $62,040. (The Kaiser Family Foundation has an online subsidy calculator hat will give you an estimate of your subsidy amount.)
The good news: Our out-of-pocket annual family deductibles will be $4,600 lower for in-network providers than with our previous plan, although they’ll be nearly $1,000 higher for out-of-network doctors.
(MORE: 6 Things Boomers Need to Know About Obamacare)
It’s not just the self-employed who are paying more for health insurance this year. About half (47 percent) of Americans with employer-based plans say more money is being taken out of their paychecks for coverage than a year ago, according to a Bankrate.com report. More than half of females with employer-based coverage (52 percent) report higher out-of-pocket expenses, while just 35 percent of males do.
Here’s what we did to land our new health coverage:
First stop, the public insurance exchange. Even though I’ve written a lot about health insurance, I was flummoxed by HealthCare.gov, the government’s site hosting the public insurance exchange for most states. The site is now working much better than when I tried, though.
Most of the plans I found there were HMOs and, although the premiums were a little cheaper than what we paid Assurant, we wouldn’t be able to go to the doctors we’ve used for years — including our primary physician, allergist, eye doctor and dermatologist. (My gynecologist stopped accepting health insurance years ago.)
So none of these health providers seemed worth it. Our chief goal was to find an insurer our doctors would honor.
In addition, the HMO and PPO exchange plans came with deductibles slightly higher than the $10,000 Assurant had required.
(MORE: How to Make an Obamacare Insurance Exchange Work for You)
Next stop, an insurance agent. After our experience with HealthCare.gov, Cliff and I realized we needed a health insurance Sherpa. Since we earn too much to receive a federal subsidy, we knew we’d be allowed to buy coverage through an insurance agent or broker.
I contacted a broker who helped us navigate the terrain two years ago when we switched from an employer-provided health plan to self-employment.
Thankfully, our agent did the painful legwork and advised us to go straight to insurers writing individual policies in D.C., skipping the exchanges for now.
Alas, the one we found, CareFirst, wasn’t accepted by our primary physician. But the allergist, dermatologist and eye doctor were on the list. So we’d need to budget to pay more for some services, but we could rest comfortably knowing we’d be insured if a medical catastrophe hit.
We filled out the simple online application and were accepted for coverage a week later.
Side note: A funny thing happened when I went to my primary doc for my annual physical just before my existing policy expired. He told me he would no longer accept Assurant in 2014. So even if we hadn’t been canceled, our visits would no longer be covered.
Third stop, an attitude adjustment. During our urgent health-policy shopping experience, I saw first hand that not everything would cost me more in 2014. Flu shots, mammogram screenings for women over 40 every one to two years and osteoporosis screenings for women over 60, aren’t subject to deductibles or co-pays, even in high-deductible plans. (Healthcare.gov has a rundown of the law’s preventive coverage provisions.)
Money-Saving Advice for Health Insurance Shoppers
If you need to shop for a health insurance policy now here’s my advice on how to keep your costs down:
Compare premiums, deductibles and out-of-pocket costs from multiple insurers. Start by going to Healthcare.gov or the site for your state exchange.
After I did that, I used a broker to save time and angst (you can look for one at the National Association of Health Underwriters website). But you can shop on your own at such websites as ehealthInsurance.com, Getinsured.com, GoHealthinsurance.com, Healthcompare.com, Insure.com and Netquote.com. Check to see whether your preferred doctors are in-network.
Open a tax-advantaged Health Savings Account (HSA). This financial tool works in conjunction with a health insurance policy to help you save money for future health costs and keep those expenses down.
With an HSA, you contribute pre-tax earnings to a tax-deferred investment account and then make tax-free withdrawals for medical expenses. You’ll pay a small annual fee of about $45 for an HSA from a no-load mutual fund company like Fidelity or Vanguard.
You can contribute up to $3,300 to an HSA for individual coverage in 2014 (up to $4,300 if you’re 55 or older). For families, the limit on contributions is $6,550; $7,550 if you’re 55 or older. You can find a list of insurers offering HSA plans at HSAInside.com.
Ask healthcare providers for a discount. Hospitals and doctors might be willing to cut you a break, especially if insurance won’t be footing much or any of the bill. Check out websites such as Fairhealthconsumer.org, Healthcarebluebook.com and Newchoicehealth.com to compare the cost of medical procedures so you understand how much wiggle room you might have.
Resolve to eat healthier and exercise more in 2014. Physical fitness is the best way to save on medical bills over the long haul.
Cliff is now religious about making his morning juice — kale, carrots, blueberries and more all whirled together in the blender. Looks disgusting, but tastes great.
Sláinte. (That’s the Scottish and Irish toast for “good health.”)
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- How to Get the Most Out of Your Health Savings Account
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