What consumers need to know when shopping on Maryland's health care exchange

New online insurance marketplace set to open Tuesday

September 30, 2013|By Eileen Ambrose, The Baltimore Sun

As of Tuesday, thousands of residents will be able to log onto the state's health care exchange, the Maryland Health Connection, to browse for medical insurance and even buy a policy.

The exchange and others like it across the country are considered key to getting the uninsured insured, which in Maryland is estimated to involve as many as 800,000 people.

The Maryland exchange will feature 45 plans offered by six private carriers.

"Maryland Health Connection is not government-run health insurance. It's a store," said Becca Pearce, executive director of the Maryland Health Benefit Exchange, which runs the online marketplace. "We built a store, and the commercial carriers are putting products on our shelves."

It isn't for everyone.

Those already covered under Medicare or Medicaid don't need to buy a policy on the exchange.

If you get your insurance through your employer — which most people do — that should continue.

And the Affordable Care Act excludes some people from the mandate of buying insurance or paying a penalty. These include immigrants in the country illegally, members of Indian tribes and those whose incomes are so low that they don't have to file a tax return or find that insurance premiums eat more than 8 percent of their household income.

But those with modest incomes and no insurance — or very expensive insurance — should check out the exchange. They could be eligible for federal subsidies to help buy a policy — financial assistance only available through the exchange. Even workers with insurance on the job could receive a subsidy to purchase a policy on the exchange if they pay more than 9.5 percent of household income for self-coverage.

Final details on premiums and plans won't be available until the exchange opens for business at 8 a.m. Tuesday.

Policies will provide 10 core benefits, including prescriptions, emergency care and lab tests, as well as maternity and pediatric care. Maryland also will offer some standalone dental plans.

"There won't be a lot of variation in benefits covered, but all plans are designed differently and have different networks, different providers who are participating and different cost-sharing," said Carolyn Quattrocki, executive director of the Governor's Office of Health Care Reform.

For those who need help, the exchange will have so-called navigators who can assist with enrollment. You also can phone the exchange's call center at 855-642-8572, which will answer questions in dozens of languages.

Or you can seek the help of an insurance broker. Maryland Health Connection has trained more than 800 brokers to sell plans on the exchange, Pearce said.

Here are some things to know before shopping in this new marketplace:

Open enrollment Consumers can purchase a policy from Oct. 1 through March 31. Thereafter, you will have to wait until open enrollment each year. However, you can purchase a policy outside of open enrollment if you have a life-changing event, such as a marriage, birth of a child or you lose a job along with your insurance.

Next year's open enrollment will be shorter, running from Oct. 15 through Dec. 7, Pearce said.

Getting started You will need to set up a secure account on the exchange's website at marylandhealthconnection.gov.

If you think you may be eligible for a subsidy, you will be asked to provide financial information to determine if you qualify.

Consumers will be able to shop for coverage by searching by insurance company, type of policy or under your doctors' names to find out which insurance they accept.

"You can enter up to three or four different doctors and find out what the best match is for you based on the participation rate," Pearce said.

The system will pare down the plans, and you will be able to compare policies side-by-side, including deductibles and out-of-pocket costs.

Bronze to platinum Policies will fall under categories of bronze, silver, gold and platinum. These refer to cost-sharing or how health care costs will be divided between you and the insurance company.

Bronze policies will have lower premiums, but that's because consumers pick up a bigger share of costs. Under bronze plans, the insurer assumes 60 percent of the medical costs, with the consumer paying 40 percent. The insurer's share is 70 percent under a silver plan, 80 percent in a gold plan and 90 percent for platinum.

Still, there's a cap on how much an individual and family must pay out–of-pocket annually. Next year, the limit is $6,350 for an individual, and double that for a family.

Premiums You no longer can be charged higher premiums for being in poor health. But premiums can vary based on age, where you live and whether you smoke. Older consumers who tend to be heavier users of health care can't be charged more than three times the premium for a young adult. Smokers can be charged up to 1.5 times more than a nonsmoker.

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