The Affordable Care Act helped millions of people gain access to health insurance, but this new system may not be as cut-and-dry as some believe. Marketplace plans aren’t the only option for buying insurance, and people need to consider a few facts before signing up for an ACA plan.
1. Paying premiums may require more effort.
According to HealthCare.com, some enrollees may find that they don’t actually have coverage because “there have been glitches in the enrollment systems for both state-based and federally facilitated health insurance exchanges.” These glitches impact automatic withdrawal of premium payments. Enrollees who take advantage of automatic deductions of their premium payments may need to check to ensure that payments are processing correctly from their bank account.
2. Prescription drug coverage could change.
People who take prescriptions may need to re-evaluate their coverage before enrolling in a marketplace plan. While prescription drugs are covered under the ACA’s essential benefits provision, not all plans are created equal. Enrollees may need to switch to generic versions of their medication or alternative brands.
3. Grandfathered plans might not offer enough benefits.
Health plans in existence before March 23, 2010 have been “grandfathered” under Obamacare, but these plans may not offer the coverage that people need. The marketplace insists that these plans “haven’t been changed in ways that substantially cut benefits or increase costs for consumers,” but enrollees might want to verify with their insurer whether a grandfathered plan is comparable to a new one.
4. Rates may not stay consistent.
The ACA allowed everyone to apply for insurance regardless of medical condition, and the surge of newly insured, high-risk applicants forced many insurers to increase rates across the board for all enrollees. While some people won’t experience a significant rate increase, others may need to investigate to make sure their plans stay affordable.
5. High-deductible plans may not save as much as people think.
High-deductible plans work well for people with minor medical issues who use medical care infrequently, but these plans won’t work for people with chronic medical concerns or expensive issues. Enrollees should consider the total cost of their medical care needs before choosing a high-deductible, low-premium option.
6. Provider networks change over time.
Both providers and insurers can update participation status. For example, a mental health professional may be willing to work with an insurer, but the insurer isn’t accepting new mental health professionals. Marketplace enrollees should make sure that their preferred providers are covered before signing up for a new plan.
7. Job-based coverage meets the requirement.
Job-based plans already meet the ACA requirement of minimum essential coverage, but some employees may choose a marketplace plan instead. In November 2013, the Detroit Free Press noted, “If you choose a marketplace plan, you [sic] employer doesn’t have to contribute to your premium.” This stipulation could affect how employees view cost on the marketplace.
8. Marketplace plans aren’t necessarily the most affordable.
Subsidies make insurance accessible for the first time in decades, but not everyone qualifies for financial assistance from the government. For people who can’t afford insurance but don’t qualify for subsidies, shopping off-marketplace may be a better and more cost-effective option for insurance.