Top 5 Questions About Health Insurance in 2015

Top 5 Questions About Obamacare (Affordable Care Act) in 2015


It seems as though the days are flying by and the Open Enrollment Period is slipping by quickly.  Insurance shoppers that desire to have coverage that is effective on January 1st of 2015 only have about 19 days left to obtain their coverage.  Yes, if you miss the 12/15/14 deadline you'll still be able to buy coverage for the 2015 calendar year, but your coverage will start at the beginning of February!  There is a significant price for procrastination in this new health insurance shopping environment, so don't put off this important decision.

Top 5 Questions About Health Insurance in 2015

I have received 5 or 6 questions consistently over the last month and I felt like they deserved to be highlighted as an article in our Texas Health Insurance Blog.  Let's dive in and we'll review these common questions and ensure we've documented the answers.  Remember, these are our opinions and each client and shopper's situation is different.  Make sure to call us at 713-422-2935 and we'll help you discern the best approach for your unique set of circumstances.

5) - What Insurance Company Has The Best Network?

Typically, the Blue Cross PPO tends to have the best network here in Texas.  We do like Humana's National network so when you travel you can simply log into their provider finder and find thousands of physicians in any state.  Cigna's LocalPlus network seems to be getting smaller and we've had several instances this year where doctors in their network have dropped out causing lots of frustration for policy holders.  We recommend letting us know your doctor names as we search for plans to ensure you don't need to change doctors when you obtain a new policy.

4) - What Insurance Plan Has The Best Pricing?

You knew we'd answer this question with, "it depends".  Unfortunately there isn't a blanket rule that applies to all situations.  In the old days Blue Cross was simply cheaper than everyone and United Health was the most expensive, but that doesn't hold true any more.  As we've noted before, pricing for plans is based largely on geographic factors and how the insurance companies value the health risks of a specific region.  We've noted that Humana seems to be much cheaper in San Antonio and Austin while Cigna has tried to take market share through lower pricing in the Dallas area.  These location specific calculations make it so imperative that we take the time to look at the universe of options.  Click "Contact Us" and we'll help you review your choices.

3) - Can I Lose My Subsidy or Do I Have To Pay It Back Because I Don't Make Enough?

Many clients have been very concerned about the implications of taking federal tax subsidies and credits and then losing a job which would drop their income below the 100% Federal Poverty Limit (FPL) that would qualify them to obtain coverage in the marketplace.  The IRS published a draft of their 2014 Form 8962 which provides some detail.  On page 5 of the clarifying instructions we see that a person that initially qualified to receive Adavance Premium Tax Credits (APTC) who has income that drops below 100% of the FPL can still claim the tax credits.  We're concerned about this in Texas because if a person makes too little money they are told that they qualify for Medicaid.  Texas does not typically offer Medicaid to anyone other than pregnant women and small children, so dropping below the 100% FPL is a serious matter for many in our state.  Based on the reading of the draft form, you probably won't need to pay back the premium tax credits, but our understanding of the rules suggests you'll need to report your new income for the coming year which would potentially make you ineligible for tax credits at that time.

2)  Which Carrier Has The Best RX Plan?

Based on lots of examination, I think Blue Cross has the best prescription drug plan.  They have a 5-tier prescription drug plan that has a pretty large formulary.  If you are obtaining a plan that has a high deductible that does not provide prescription drug coverage with a co-pay (you are paying the contract rate on Rx purchases till the major medical deductible is met) you will have an impossible time finding out a cost estimate for drug purchases ahead of time.  I've complained numerous times to Blue Cross with little success.  I do like Humana's drug plans, but they often have strange designs with separate Rx deductibles.

1)  What Is Different Between This Year and Last Year's Open Enrollment?

Service and Technology.  A year's passing has led to significant improvements in the computer systems at the carriers and their ability to service clients.  Last year we faced 5 hour hold times trying to fix issues caused by computer malfunctions.  This year we've had some hold times with carriers but nothing like the mess we encountered in 2013.  We've also seen lightening fast sign ups and broker systems are able to track applications quickly and accurately.  All of these improvements have helped us provide clients up to date information about their application, enrollment, and we're also able to help them avoid calls to the carriers and handle all their service needs.  Finally, the Marketplace website continues to face some trouble as our clients cannot log in many times, but the volume of complaints is certainly much better. 

Our technology is better as well.  We've purchased a new quoting system that allows us to quote all 5 major insurance providers and in January will have a new process for signing up marketplace applicants directly in our website.  

We hoped a few of these questions were helpful to you.  The major takeaway is that purchasing coverage in 2015 is complicated and Texas Health Design is here to help you find the right plan at an affordable price with your doctors.  Let's connect today, call us at 713-422-2935 or get a quote by clicking Get A Quote Now.

Jason Bohmann