By Janet Trautwein
The Affordable Care Act’s health insurance exchanges opened for business earlier last month. Now, millions of Americans who do not get coverage through work have the opportunity to shop for policies that will take effect in 2016. But they only have a few months to do so. This open enrollment period will end on January 31, 2016.
Those who currently lack insurance should sign up without delay. And those who have had coverage this year should investigate whether there’s a better deal available to them for coverage that will kick in next year. Picking a plan can be complicated, but it’s worth it — and there’s help available to ensure that consumers make wise decisions for themselves and their families.
There are many advantages to getting covered. The most important, of course, is that insurance ensures access to medical care. Robust coverage can be a life-saver in the event of a serious medical emergency.
But insurance also keeps people from having to pay the Affordable Care Act’s penalty for not maintaining coverage — a penalty that increases dramatically in 2016.
This year, those who were uninsured paid either $325 per adult and $162.50 per child, up to a maximum of $975, or 2 percent of their income — whichever was greater. In 2016, those who don’t secure coverage will pay much more. The per-person rates will more than double to $695 per adult and $347.50 per child, up to a maximum of $2,085. Wealthier uninsured will have to pay 2.5 percent of their incomes.That’s a lot of money to spend on not getting insurance.
Additionally, federal tax credits subsidizing coverage are available through the exchanges for low-income individuals who need help paying for their policies. This year, 85 percent of those who bought private plans on the exchanges got financial assistance.
However, the online insurance exchanges can be very complex. Fortunately, buyers who find themselves overwhelmed can seek the expert counsel of a licensed, professional insurance broker. The easiest way to do so is via a free tool available online, at agent-finder.org.
Brokers are specifically trained to help consumers work their way through the maze of plans, coverage levels, deductibles, networks, and premiums. Nearly three-quarters spend most of their time explaining coverage to clients, according to the Kaiser Family Foundation. And nearly two-thirds of brokers devote significant time to resolving claims questions or disputes with insurance carriers.
Brokers also yield results for their clients. According to research from the University of Minnesota, premiums are 13 percent lower in areas where there are the most brokers, compared with those with the fewest.
It’s no wonder that nearly 84 percent of shoppers who got assistance purchasing exchange coverage in 2014 rated their agent or broker as “helpful.” No other enrollment assistance group received a higher satisfaction rate.
Selecting a health plan can be confusing. But help is readily available. And the Affordable Care Act provides incentives for buying insurance — carrots in the form of subsidies to those with low incomes, and sticks in the form of penalties for those who fail to sign up. During this open enrollment season, getting covered should be a no-brainer.
Janet Trautwein is CEO of the National Association of Health Underwriters. To learn more, visit www.BrokersMakingaDifference.org