Health insurance shopping tough, but essential chore

July 07--Shopping for health insurance on the individual market can be complex and expensive.

But it is an important investment to protect the physical and financial health for you and your family.

"It's one thing you can't normally get when you need it," said Bill Phipps, a certified insurance broker for HealthMarkets in Tupelo.

People shopping on the individual market are a diverse group, said Veronica Bell, a certified insurance broker with Bell Associates in Tupelo. There are professionals, independent contractors and entrepreneurs who own their own businesses. Many work for small businesses that don't offer insurance. Others are young retirees who need a bridge until they qualify for Medicare.

People who can access health insurance through their employer can let the human resources department weigh the pros and cons of benefits, premiums, copays and networks. Those shopping on the individual market have to do their own due diligence.

"There's no one size fits all," said Justin Brock, a certified insurance broker with Brock and Credille in Tupelo.

It is important to drill down beyond premium and deductible costs to see what policies actually offer, Bell said.

"If it's only $100 a month (without subsidies or tax credits), it's likely not major medical," Bell said. "You need to know what the benefits are."

START WITH ACA

Since 2014, the first place to start is the Affordable Care Act or Obamacare marketplace. Although there has been plenty of debate, there have been no changes so far.

"As of right now, it's business as usual for 2018," Bell said.

Everyone shopping in the individual market should determine if they qualify for subsidies and tax credits to help cover the costs of health insurance. Ambetter by Magnolia is the only company offering ACA plans on the exchange where the credits and subsidies can be used.

Outside the marketplace, BlueCross BlueShield of Mississippi is the only other company in the state that offers individual market health insurance policies that meet the ACA requirements, Brock said. ACA-compliant plans are more expensive, but they are required to accept and fully cover people regardless of pre-existing conditions. They typically have the broadest coverage on the market.

Enrollment in ACA compliant plans is limited to open enrollment at the end of the year. To purchase insurance for 2018, the open enrollment period will be Nov. 1 to Dec. 15.

"You can't change mid-year for no reason," on the exchange or from BlueCross, Brock said.

However, those with a major life change like the birth of a child, a marriage or divorce, the loss of a job or a death of a spouse can purchase insurance during special enrollment period, typically 60 days after the event changed your insurance status.

OTHER OPTIONS

Beyond ACA compliant plans, there are options for pulling together plans of coverage.

Health sharing ministries may help fill the gap for some families, Brock said. It isn't insurance, but they can be a good fit for some, especially healthy families.

"For young, responsible Christian families that are healthy and who are facing massive premiums, it can be a good option," Brock said.

Health sharing ministries that meet certain requirements don't have to follow rules set for insurance by the ACA, but their members are exempt from individual mandate. Instead of being based on risk, the sharing ministries are based on shared religious or ethical values.

Families have monthly membership and a portion of costs they are responsible to pay before the ministry begins to cover costs, Brock said. The health sharing ministry then covers bills for expenses that are in accordance with their values. For example, the plans usually don't cover out-of-wedlock pregnancies or abortions.

Some health sharing ministries will accept people with pre-existing conditions, but they may not cover costs connected with the condition for a period of time, Brock said.

Hospital indemnity policies that cover a set amount of inpatient and outpatient expenses are also available. They generally exclude coverage of pre-existing conditions, but can provide a layer of protection. They will not meet the individual requirements under ACA, Phipps said.

For people who need coverage outside of open enrollment and don't qualify for special enrollment, there are short-term policies. The policies are written for three months at a time and can be renewed once under the current rules, Phipps said. They do not meet ACA requirements, and they exclude pre-existing conditions, but they do provide some coverage.

"It's better than nothing," Phipps said.

To soften the bite of high deductible plans, shoppers can look at gap plans. Gap plans are underwritten, but they pre-existing conditions aren't automatically excluded, Brock said.

"It can be adjusted," to cover all or part of a large deductible, Brock said.

EXPERT ADVICE

The internet can be a good place to start, but there's no substitute for knowledge and experience with the complex insurance market. An certified insurance broker can help shoppers ask the right questions and better understand the costs and the benefits.

"You want to have an advocate who can help you navigate," Brock said. "You want to find someone you trust."

Bell said she frequently finds her clients, especially those who are self-employed, have incorrectly calculated their net profits and do in fact qualify for assistance that reduces their premiums on the ACA exchange.

"They really need to talk to a local health insurance agency," Bell said.

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