With the 2015 open enrollment period on HealthCare.gov underway, JoAnn Volk, Senior Research Fellow and Project Director at the Georgetown University Center on Health Insurance Reforms, joins Sound Medicine to discuss avoidable problems, and more.
On renewing plans
"People who have coverage, whether it's inside the marketplace or outside the marketplace if they bought it on their own as an individual, they will get a notice from their insurer saying here's what your plan will look like in the next year. It may be the same plan. It may be the same plan with changes. Or it may be a whole new plan that's close. In that circumstance, you largely don't have to do anything... For those who got financial help in the marketplace, most will be able to be automatically renewed, but we would suggest that people go back and update their information."
On expected technical difficulties with the website
"They certainly worked out a lot of the kinks from last year. And even some of that did get cleared out through the year... The application itself is simpler."
On where to turn, if you're unfamiliar with the law
"Each state has some in-person help, and assistance will depend on the state you are living in. But everyone can go to HealthCare.gov and enter their state information and figure out how they can tap into local resources for in-person help. And again you can make an appointment or just walk in and someone will help you go through the process and compare plans."
On affordability of low-income plans
"For people at the lowest end of the income range for financial help, they may be able to get a plan at no or very low cost. And they may also qualify for help paying out-of-pocket costs so that they have very little they have to meet in terms of a deductible or copays when they go to the doctor. Most of the people who got aid in the marketplace did qualify for someone financial help. It's absolutely worth going into, and putting in your information and finding out."
On affordability of middle-income range
"They can qualify for financial assistance up to four times the federal poverty level, which is fairly generous. But the financial help isn't that significant. For those folks, it may make sense to buy a plan outside the marketplace. It's certainly worth figuring out how much you would get. Some people are shocked at how big the deductibles are."
On must-have information before signing up
"If you are going to go through in-person assistance a lot of them already have a check sheet of what you need to bring in, in terms of proving your identity, if you have to prove your immigration status, how to prove you income, so you can figure out if you qualify for financial help at that first appointment, and it's worth finding out from them what that list is."
On how to avoid common snags
"We anticipate fewer technology-related snags, but I think in terms of selecting a plan, there are a lot of ways people can trip up, because health insurance is a multidimensional product. It's not as simple as buying a small appliance online. It really is very complicated, and it's very personal and it requires people to project ahead what they might need in the coming year, so I think too often people focus on the single number, like the premium. They may be drawn to the very low premium plan that is among the offerings, but that may come with a huge deductible. That means they can't actually afford to get care because they will never meet the deductible. So we really encourage people to look at all the details: the premium, the deductible, what the copays are."
On who should look for coverage in the marketplace
"If you are someone who is going to qualify for financial assistance, it makes sense to go into the marketplace to buy coverage. Those are people up to four times the poverty level, which is more than 90,000 for a family of four. They will qualify for help paying the premiums and may also for some of those folks qualify for helping paying out-of-pocket costs. All the plans inside of the marketplace also have to go through a certification process, so you can be assured that they meet all of the insurance rules of the Affordable Care Act in terms of benefits and affordability, but also that all of those plans will count when you have to check the box on your taxes that you had coverage for the individual mandate."
JoAnn Volk is the Project Director at the Georgetown University Center on Health Insurance Reforms, where she's also a senior research fellow.