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Your Healthcare Exchange 4-1-1

Posted on October 3, 2013

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Does healthcare policy talk send chills down your spine? Policy changes and their implications can be confusing and overwhelming, but they’re important for us to understand so we can advocate for ourselves. We’re not policy experts at the Colon Cancer Alliance, but we are here to help you find the information you need.

The Affordable Care Act’s healthcare exchange system opened for enrollment on Tuesday, October 1. You’ll also hear it called the Health Insurance Marketplace, and its goal is to provide one-stop shopping for affordable insurance coverage. This may have a big impact for you, especially if you’re currently uninsured, so we’ve broken down what’s happening and what you need to know.

What’s Happening?

The Affordable Care Act requires all Americans to have health insurance coverage starting in 2014. For those of us who aren’t covered through our employer, Medicare or Medicaid, we’ll have to find insurance through another option.

That’s where the healthcare exchanges come in: each state has developed an exchange where you can shop for coverage and make apples-to-apples comparisons for the plans available to you. It’s still possible for you to shop through private insurance carriers, but the exchanges are a good way to navigate and compare multiple insurance plans. You may even be eligible for a subsidy to make healthcare more affordable.

What You Need to Know

  • Open enrollment for the exchanges started on October 1, 2013
  • If you have insurance through work, Medicaid or Medicare, you most likely won’t need to shop for coverage at the exchanges
  • Insurance coverage through the exchanges starts January 1, 2014
  • Coverage options will vary state by state, and even within states – visit the Department of Health and Human Services website to see what’s happening in your state
  • If you’re currently uninsured, you have six months to decide on insurance coverage – if you’re still uninsured on March 31, 2014, you will face fines
  • If you already are insured through your employer, you can keep your current coverage
  • Starting in 2014, you cannot be denied coverage or charged more for a pre-existing health condition, such as a colon cancer diagnosis
  • There will be subsidies for those who qualify based on their yearly income – the Congressional Budget Office predicts that 6 out of 7 people who enroll in the exchanges will qualify for subsidies

HealthCare.gov is an excellent resource for you to learn more about the exchanges and to start shopping for options in your own state. They even have a live chat and a toll-free number (800-318-2596) to answer your questions 24 hours a day, 7 days a week.

Know Your Vocab

Healthcare exchanges are going to change the game for us as insurance consumers. We’ll need to consider things a little differently than we’re used to when we start comparing plan options. Keep these terms on your radar.

  • Cost sharing: The portion of covered healthcare costs you pay out of pocket.
  • Deductible: A cost sharing charge; the amount of money you owe for healthcare services before your insurance starts to pay.
  • Copay: Another cost sharing charge; a set amount that you pay for a covered health service. For example, you might have to pay $30 for a doctor’s visit while your insurance pays the remainder of the doctor’s fee.
  • Coinsurance: A new cost sharing method; it means you would owe a percentage of healthcare costs as opposed to a fixed amount.  So, if your coinsurance rate is 30% and you need a service that costs $1000, you will owe $300 plus any applicable deductibles.

A Few Pointers

It’s important to think carefully when you start navigating these healthcare exchanges. A few of our pointers:

  • Think and plan ahead: What kind of doctors do you see? What kind of drugs do you use? Are your doctors in the network?
  • Look beyond the premium and pay attention to cost sharing – a plan with a low premium may end up costing you more because of higher cost sharing
  • Understand the vocab and important distinctions (e.g. coinsurance vs. copay) – HealthCare.gov’s Glossary is great tool for this

We don’t have all the answers at the Colon Cancer Alliance, but we will do our best to help you get the information you need. Do you have questions? Call our free Helpline (877) 422-2030. 

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