So I just go to the Obamacare website and pick a plan then?

July 22, 2016 12:21 PM

My health care co-op has folded and I need to get new insurance. Is there any benefit or reason to see a health insurance broker, or do the plans listed on the ACA website cover all the choices I have available? Is there anything I should do other than simply shop on the ACA website and compare plans?

I had insurance through my employer, got laid off, Cobra was too expensive, so I picked out a plan on the ACA website, and now that plan is folding so I need to shop all over again. Last time I was in a rush because I needed to see a doctor, but now I have some time to really think about it.

I don't have major health care needs - I'm in my early 30s and the only medications I need are birth control, nasal sprays and a generic betablocker. I have some thyroid issues I just need to test every several months. But I like the peace of mind in having a plan that will allow me to get diagnostic tests I may need without paying high fees. So, I definitely prefer a plan with no (or low) deductible so that there is a less of a barrier to me seeing doctors. I don't see doctors a ton, but enough that I think it's worth it to pay a higher premium for smaller co-pays.

Can I get everything I need just by browsing the ACA website? Or are there any plans out there I may not see on the ACA website? (My state, Oregon, does not have its own exchange website - it's all done through the federal one.) Anything I need to do other than simply browse the website and compare the plans?

Thank you!

posted by AspirinPill to Health & Fitness (15 answers total)

You can certainly check with insurers (and there are independent insurance brokers who might shop around for you) to see if anybody is offering either features you especially want or some kind of deal for you that you find more appealing than the exchange. You may not do any better there, though.
posted by Lyn Never at 12:53 PM on July 22, 2016

In Oregon, you can also look into Direct Primary Care. They appear to be pretty pro DPC as they passed legislation and have a website for finding a DPC provider. When paired with a high deductible plan or health savings account, this option is ACA compliant. Source
posted by Michele in California at 1:01 PM on July 22, 2016

I found ehealthinsurance.com to be a bit easier to use than the federal exchange for Oregon.

If you choose a low deductible plan, the higher premiums more than offset the lower out of pocket costs. If you don't need much healthcare it's likely cheaper to go with a high deductible plan.
posted by monotreme at 1:27 PM on July 22, 2016

I used an insurance broker last time. Doesn't cost you anything and they should present all of the ACA plans along with other individual plans. When I did this in 2014 I discovered that ACA plans, while slightly cheaper than non-ACA plans, didn't have as broad a network as I wanted -- specifically at the time Children's Hospital wasn't covered. Were I young and single I'd have opted for an ACA plan.
I also found I could save a fair amount of money using an HSA. This is only a good option if you have money saved up that you can use to seed the account. Otherwise you'll feel the pinch at every doctor visit.
posted by rouftop at 1:51 PM on July 22, 2016

There are plans that aren't listed on the ACA website, but if you're not looking for anything special and find something on the ACA exchange that meets your needs I wouldn't bother searching too hard for other plans.
posted by MsMolly at 2:47 PM on July 22, 2016

Be sure and put your correct income, if you don't and you qualify for a subsidy you will be paying part of it back at tax time. I had to estimate our income because my husband's income fluctuates and I estimated what our annual income would be. We had to pay the subsidy we got back at tax time because we made more than I estimated.
posted by just asking at 3:39 PM on July 22, 2016 [1 favorite]

You need to buy from the exchange to qualify for subsidies, so if you are getting subsidies, that's where you should go.
posted by rockindata at 6:25 PM on July 22, 2016

You should definitely go to an insurance broker if you don't qualify for the subsidies.

1. They are free.
2. They have access to plans that are not on the ACA website.
3. There are some care-providers that do not provide the same services to patients with ACA plans. Many patients have found that having an ACA plan makes them Class B Citizens and it's not worth the savings (assuming they're not getting the subsidy).

My insurance broker also knew an incredible amount of information that I had no idea was even a thing. For example, he explained that insurers maintain a special list of very cheap drugs. The one Rx drug that I take appears on that list in some plans, and does not appear on that list in others. I did not know such a special list existed. But he did, and by choosing a plan that included my one drug I saved $60 a month, and could factor that into my choice of insurers.

Your broker can also talk you through the question of whether to get an HSA, which can be a good place to stash retirement money (if you can cover your medical expenses otherwise). This is an interesting side benefit to an HSA and one worth discussing with a professional.
posted by Capri at 9:37 AM on July 23, 2016 [1 favorite]

Seconding using a broker. They're free, they can answer all of your questions and can suggest a plan that best fits your personal needs.
posted by bizwank at 12:29 PM on July 23, 2016

As one who worked in the insurance industry, I'd question the statement the a broker is free. However, his commissions are included in the price, so you can compare directly to an ACA plan.

A high deductible plan will be cheaper, but since you have to pay out of pocket until you meet the deductible, it's easy to still think like you can't afford to go to the doctor. I'd advise setting aside some money out of every paycheck as "doctor money" to use until you meet the deductible. If you don't use it this year, you can set aside less next year.
posted by SemiSalt at 1:12 PM on July 23, 2016

Response by poster: Follow-up question if anyone is still reading. How, um, do I find health insurance brokers? Like, how does that work? I don't qualify for any subsidies, so thanks all.
posted by AspirinPill at 3:59 PM on July 23, 2016

Google, Yelp, asking friends. It's pretty much the same as getting an independent broker for car insurance, find someone whose sales pitch you like or lives near your neighborhood or is your friend's sister's old roommate. There might be a slim chance you get some kind of service like that if you have a nice credit card or credit union, too.
posted by Lyn Never at 4:14 PM on July 23, 2016

Response by poster: Well everyone was saying insurance brokers are free. If it costs money and I need to use a credit card, I won't go to one.
posted by AspirinPill at 4:27 PM on July 23, 2016

They are free, or paid by the insurance company anyway. I wasn't suggesting you had to pay, I was saying you may already get insurance broker services as part of some other service you are already using, like a bank or credit card or AAA or your car/house insurance or club membership, which would mean you could just use them instead of having to go hunt for one.
posted by Lyn Never at 7:02 PM on July 23, 2016

Sorry I wasn't more clear. I found a broker through my state's healthcare exchange site; they had a whole list, I checked a few out and selected one that had good reviews and called them. I got a total of about 30 minutes of phone time with a person there (over 3 calls) and they sent a follow-up email with a link to buy the plan I had decided on, which I assume gave them some sort of commission. I didn't pay them anything directly and the plan they linked to cost exactly the same as it did through the healthcare.gov site. Your posting history suggests you're in Oregon; if so, I belive this page should get you started: http://healthcare.oregon.gov/Pages/get-help.aspx
posted by bizwank at 11:32 PM on July 24, 2016