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Selecting a health plan through the exchange marketplace

2013 <-- SELECTING AN INSURANCE PLAN Through Health Insurance Exchange Marketplaces 84 MILLION people were uninsured or underinsured last year.' Americans can now use state health insurance Exchange Marketplaces to select insurance plans. Many Americans will be eligible to get a discount to help them buy insurance. WHAT ARE HEALTH INSURANCE EXCHANGE MARKETPLACES? g ONE-STOP 2 ONLINE SHOPPING FOR HEALTH INSURANCE + All plans in the insurance Exchange Marketplaces must provide a minimum amount of coverage, prove they deliver quality care through accreditation and report quality information. Each state has its own Exchange Marketplace. To find information about the Exchange in your state, visit WHO IS ELIGIBLE FOR THE EXCHANGE MARKETPLACE? Live in the United States. YOU Be a U.S. citizen/have legal immigration status. MUST Not be currently incarcerated. Not be eligible for Medicare. To be eligible for subsidies, you must not have access to high-quality, affordable insurance through your job. HELPFUL E HINT E If you are not sure if your job offers quality, affordable coverage that meets minimum standards, ask your employer. WHAT SHOULD I CONSIDER WHEN I CHOOSE A PLAN ON THE EXCHANGE MARKETPLACE? COVERAGE LEVEL Plans in the Exchange Marketplace are separated into four levels: Bronze, Silver, Gold and Platimum. These levels are based on how you and the plan you select will split health care costs. 90% 80% 70% 60% The Exchange Marketplaces let you choose a type of plan (HMO, PPO, POS and so on). Think about which type of plan will be best for you. For example, HMOS limit you to certain doctors in their network, but your premium may TYPE OF PLAN HMO PPO POS be lower. PPOS usually have more doctors in their network, but there are different costs for different providers. A POS plan combines elements of HMOS and PPOS. MONTHLY PREMIUM Your monthly premium is what you pay each month, regardless of whether you see a doctor. It is a fee for having health insurance coverage. OUT-OF-POCKET COSTS Out-of-pocket cost is the difference between what health care services cost and what your insurance covers. This difference is paid by you. Costs include the deductible (the amount you must pay before benefits kick in) and the copay (the amount you pay for each doctor visit or other service). HELPFUL E HINT E Compare the total cost you pay (monthly premium + potential out-of-pocket costs) with benefits you receive. This will help you determine overall value. Platinum plans will usually have higher monthly premiums but lower costs when you get care. Bronze plans will usually have lower monthly premiums but higher costs when you get care. HOW DO I PICK A GOOD PLAN? HEALTH PLAN (NCQA LOOK FOR ACCREDITATION ACCREDITATION Look for the NCQA seal. NCQA accredits health plans with strong consumer protections and a commitment to quality. NCQA is the only accreditor with experience grading health plans and telling the public about health plan quality. MEMBER SURVEY RESULTS Some Exchanges have information about customer satisfaction that plans gave the government when they became accredited. Overall plan rating Ease of getting needed care Overall rating of care received Want more information on health plan quality? Find full ratings of health plans at B+ (NCQA Measuring quality. Improving health care. © 2013 National Committee for Quality Assurance. All Rights Reserved. "Callins, S.R., Robertson, R., Garber, T. Michelle, M.D. 2012. Insuring the future: Current trends in health coverage and the effects of implementing the Affordable Care Act. Commonwealth Fund. Retrieved from Publications/Fund%20Report/2013/ Apr/1681_Collins_insuring_future_biennial_survey_2012_FINAL.pdf

Selecting a health plan through the exchange marketplace

shared by NCQA on Dec 26
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What is the health insurance exchange marketplace and what should you look for when selecting a plan?




Ron Griffel


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