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The devil is in the small print

November 2, 2012

A major part of the Affordable Care Act which goes into effect in 2014 is the formation of health insurance exchanges.  Currently, if you have to get your own health insurance you’re kind of screwed because it’s almost impossible to compare plans from different companies, and the premiums for individual policies is often much higher than a group plan would be.  The idea is that an individual will still be part of a group, just a non-cohesive group consisting of people who bought individual insurance through the exchange.  Also, the exchange website, and they will be all state-run websites, will give you comparison charts etc. that allow you to compare plans across different providers.

This is in general a good idea.  Beware of a couple of things though.  The plans will be tiered in terms of coverage, bronze being $60% coverage, platinum being 90% etc.  This is the percentage they will cover on average, not personally.  So if you are healthy and you have a deductible of $1000 per year and you spend $1200, you only get $200 covered, alot less than the quoted percentage (again I have to credit David Nather for this information.  See the link.)  Don’t expect the plan to cover x percentage for you personally.

Insurance companies can, and will, try to weasle out of taking sick people.  If a plan has alot of bells and whistles like coverage for gym memberships but is very restrictive on what it covers if you actually get sick, like hospitalization, this is a clue that the plan is trying to attract healthy people and turn away sick ones.  They are allowed to do this.

Illegal immigrants are not allowed to use the exchanges.  Since alot of undocumented people use emergency rooms for primary care, you and me taxpayer still end up footing the bill for these hardworking but uninsured folks.

Your employer may find it less advantageous to provide you retiree insurance.  Be prepared to use the exchanges in retirement.

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From → Health Insurance

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