Involvement helps insure affordable health insurance
Micah Trautman
MOSES LAKE - Winston Churchill, British prime minister during World War II, once famously described something as a riddle wrapped inside a mystery in an enigma. He wasn't talking about the Affordable Care Act, but he could've been.
Consumers should learn about their options - in fact, they should get all the way down to the details, even the confusing ones - to avoid expensive surprises and get the most affordable coverage, according to local insurance agents.
The ACA requires Americans to buy health insurance. People who have incomes up to 400 percent of the federal poverty level can qualify for discounts and tax credits.
Micah Trautman, health insurance specialist at Basin Insurance, and David Chandler of Chandler Insurance cited plan deductibles as an example of the advantages of evaluating details.
Under the ACA most plans available are grouped into a three-tier price structure, called gold, silver and bronze on Washington Health Finder, the state's new website designed to help people purchase insurance. The designation is based on cost and what's in the plan, with lower premiums and fewer services in a bronze plan than in a gold plan.
But in one way the bronze plan is bigger, and that's in the deductible, which is the amount the patient pays. A patient on a bronze plan will be responsible for a maximum of $6,350 in expenses, Chandler said. People need to take all those expenses, not just the monthly premiums, into account when deciding on a plan, Trautman said.
They also need to keep asking questions, when they go to the doctor and when they're contemplating treatments, Trautman said. "You need to understand and participate in the process to keep your costs down."
Hospitals, clinics, health care providers and insurers are operating within networks, and every health care provider has to be in the network, which means they have to be insured by the insurance company selected by the consumer, Chandler said. If a patient gets a knee replacement, and it turns out later the anesthesiologist isn't in the network, the patient could be responsible for that part of the bill, he said.
The law requires business owners who employ more than 50 people to offer insurance to their employees, and that could complicate health insurance choices for some families, Chandler said.
The insurance offered to employees must fit the government definition of "affordable," but there's a catch. The plan has to be affordable for the employee, and only the employee, Chandler said.
If the plan qualifies as affordable and the employer offers coverage to an employee's family, that will have an effect on the employee's ability to qualify for the discounts, Chandler said. That's true no matter what the employer-provided insurance costs for family members, he said. In those circumstances the family would not be eligible for the federal discounts, he said.
Trautman said he would recommend buying private insurance if the buyer isn't eligible for a subsidy. Both Chandler and Trautman recommended consulting an insurance agent. There is a commission built into the system, so an agent doesn't have to charge a fee although they can, Chandler said. If it's there, the fee must be disclosed up front, he said.
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