ACA Open Enrollment Is Here...5 Tips For Shopping Your New Options

Nov 13, 2014

Screenshot of healthcare.gov

Saturday marked the beginning of the second round of open enrollment for health insurance under the Affordable Care Act. And in New Hampshire that means a lot more options this time around for the nearly 100,000 residents without insurance.

Here's the problem: five insurers offering forty plans, each with varying premiums, deductibles, coinsurance, and co-pays. Who could blame you for being confused?

According to Dr. John Yindra, medical director of Maine Community Health Options, a co-op expanding into the New Hampshire exchange in 2015, research shows more options tend to produce more confusion.

"Even when people were given the information," says Dr. Yindra, "they had trouble conceptualizing it. It’s like, 'You mean it’s not going to cost me to see my doctor if I’m going for my diabetes? How’s that work?'"

In fact, one recent survey found people think they know more about health insurance than they actually do.

So, here are a few tips on navigating your options.

Tip #1: Get Help…For FREE.

Stephanie Dunn is an insurance broker in Alton who works for a company called Health Markets.

"Why would you do it on your own if you could have someone guide you through the process, make it simpler, faster - and it doesn’t cost you any extra?" Dunn asks.

That’s true. Insurance brokers certified by the state (here's a list of about 200 of them, listed by town) can help you find the right plan for your situation. Brokers get paid by the insurance companies – 15 bucks per enrollee per month across the board. So they have no incentive to push you toward any one company.

Tip #2: Look Past The Price Tag.

Unlike right now, every New Hampshire hospital will be covered under Obamacare in 2015. But that doesn’t mean every plan covers every hospital.

"If you have a particular hospital that you want to be attached to - if you have a particular doctor’s practice that you want to continue to use - you’re going to look at what network that doctor is included in," says Dunn. 

So get the details from HealthCare.gov, then call the insurers. They’re ready to take your call.

"We’re able to flex our staffing model so that we can ramp up through November and February," says Beth Roberts of Harvard Pilgrim Healthcare, a not-for-profit insurer  jumping into the New Hampshire exchange. "They’re being trained on how to handle prospective member calls."

Tip #3: Shoot For Silver. If You Can.

If you are within 400 percent of the federal poverty line, you’re eligible for subsidized premiums. But there’s another, less well-known subsidy. Jenny Patterson, with the New Hampshire insurance department, says if you are within 100 to 250 percent of federal poverty, you should seek out a plan rated "Silver."

"So every time you go to the doctor, you might have a co-pay, you might have a deductible – those amounts would be substantially less for someone within that income range if they bought the silver plan," says Patterson.

In the first enrollment period nearly half the people who signed up were eligible for this subsidy.

Tip #4: Enroll Again.

This tip is for those 40,000 people who signed up for insurance through the marketplace during the first enrollment period.

Even if you like the plan you bought, you have to get back on healthcare dot gov and resubmit your data. Lisa Guertin, president of Anthem in New Hampshire, says if you don’t, you may be in for a tax headache next year.

"If you are getting a subsidy, it’s extremely important to make sure you update your information so you get the right subsidy this year" says Guertin. "If you don’t do that there could be consequences of not getting as much as you should be getting and, in some cases, not getting anything at all."

And if you are starting to feel a little overwhelmed with all this information, the next tip is for you.

Tip #5: Don’t Delay. Act Now.

Open enrollment ends February 15. But if you want coverage for January 1, you need to sign up by December 15.

Stephanie Dunn, an insurance broker in Alton.
Credit Jack Rodolico

"Waiting until the last minute is a very bad idea because the volumes are going to be very high," says Tom Porlicelli, CEO of Minuteman Health, another co-op joining the marketplace. "It’s also going to be harder to find someone who has the time to help you."

Insurance broker Stephanie Dunn says her schedule is already swamped.

"All agents expect to be so busy doing open enrollments, that they’re not going to be able to be running around all over hill and dale from town to town to town. And so a lot of times phone appointments are the way to go if you’re not local to an office," says Dunn.

That’s especially true for those folks in rural areas. We'll give Dunn the last word, and final tip.

"There certainly may be a lot of emotion attached to this Obamacare issue for all of us," says Dunn. "However, it’s here, so we all have to deal with it."

Like it or not, there’s nothing confusing about that.