Does Insurance Make You Blue? Part 2: The Exchange
This is the second post in a series on Health Insurance Basics. Since open enrollment starts on November 1, we are taking a look at the Washington HealthPlanFinder, otherwise known as the Exchange.
There are many definitions of ‘exchange’, but when it comes to health insurance, we are talking about ‘a store or shop specializing in merchandise usually of a particular type’ (Merriman-Webster). In particular, for Washington residents it’s the Washington HealthPlanFinder. You can find it at WAHealthPlanFinder.org.
The Exchange tends to foster feelings of fear and anxiety in many people. It’s hard to use, it’s complicated, it’s overwhelming….and if you logon only once or twice a year, who can expect you to remember your password?
And don’t get me started on passwords. The Exchange makes crazy demands when it comes to passwords, but if you can get past that hurdle you might just be home free. Well, home free if you are single, have a W2 job, don’t have any deductions, and never see the doctor. Jobs, families and medical needs don’t fit into neat boxes for most of us. If you manage to complete your application successfully, you will then need to pick one plan out of 100. Yikes!
Why the Exchange?
Now that I’ve painted such a rosy picture of the Exchange, why would you possibly want to use it to buy your insurance?
Money: Advance tax credits are available for many people to help reduce the cost of their insurance. The Exchange is the only place to get these credits.
Options: The Exchange is a good place to compare plans from different companies side by side.
Doctors: The Exchange allows you to input your doctor’s name and search for plans that cover your doctor.
Preference: Many companies use the Exchange as their only method of selling their plans. Want a Premera policy? In 2017 the only place to get Premera individual coverage is on the Exchange.
Necessity: If your family income is under 138% of the Federal Poverty Level, you must apply on the Exchange to receive Washington Apple Health (free and low cost coverage through Medicaid).
How do you Apply on the Exchange?
Once you have decided that you need to use the Exchange, what do you need to do? First you need to gather the personal information for everyone in your (tax) household. If you are a grad student living with 6 other people in a house, they don’t count. But if you are divorced and your son is your tax dependent he counts, even if he doesn’t live with you.
Names, birthdates, and social security numbers
All income related information (wages, employers, addresses)
Doctors and providers you want to maintain a relationship with
Any prescriptions you take
What income are you supposed to report? Last year’s? This year’s? The tax credits are advance tax credits, so that means the Exchange wants your income for the current year. So if you are applying for coverage in 2017, they want your 2017 income.
Not sure what your income is going to be in 2017? You can use the previous year as a starting point. Self-employed with a fluctuating income? Use your income from the previous year if it seems in line with your current income. And it’s ok to use an average – if you get paid $6000 every 3 months, you can report $2000 per month. You can update your income at any time, so use the most accurate information you can.
How do you Pick a Plan?
Congratulations, now you’ve made it through the application! Now what!?! You may have over 100 plans to choose from. What should you do?
The quick and easy answer: Call your AGENT! Yes, we still exist, and yes, we can help you for free! Agents are paid on commission, so it costs nothing to talk to an agent and get their help.
Here are some things that will help your agent figure out which plan makes the most sense for you:
Who are your doctors? Both those you want to keep, and those you would be willing to switch.
Do you have hospitals or clinics you like to use?
What are your prescriptions? Are they generic or brand name?
Do you have any medical conditions or chronic diseases?
What is your budget? Do you want to pay more per month, but less when you see the doctor? Do you want to keep your monthly premium as low as possible?
Do you want an HSA plan? (Not sure what that is? We will address this in another blog post)
Do you need dental or vision coverage?
What Happens Next?
What happens after you apply and pick a plan? The Exchange will process your application and send your information to your selected insurance company. If all goes well, you will hear something (snail mail/email) from the company in a week to 10 days. You should receive billing information, plan information, and eventually an ID card.
Do not assume all is well. If you haven’t paid for your plan it is not in force! On occasion there have been problems with the first bill and payment – if you don’t get an initial bill from the insurance company you need to contact them and find out how to pay for the coverage. Most carriers will accept a payment over the phone.
When should I logon to my account on the Exchange?
You may only have to logon to the Exchange once or twice a year. But if you have a change in income (of at least $150 per month) or household (marriage, birth, death) then it is important to report it on the Exchange. Your tax credit may change or you may have the opportunity to pick a different plan based on your new circumstances.
The Exchange also may ask that you logon to upload documents regarding your income or to verify your information for renewal of coverage.
If you have an agent on the Exchange, your agent has the ability to make changes and updates for you! And why not take advantage of that – agents spend a lot of time on the Exchange, and are familiar with how things work – we can make things a lot easier for you. That’s why we are here!
Do you have other questions about the Exchange (the Washington HealthPlanFinder)? Give us a call, or send us an email. We are here to help!