My Healthcare.Gov Enrollment Experience
I am a 26-year old female who has been covered in recent years by either my parents’ policy or my student health insurance policy. When I turned 26 and decided to take a small break from my graduate program, I learned that I was no longer eligible for my parents’ policy or student coverage and that I would need a new individual health insurance plan for 2014.
As a young adult who doesn’t get job-based coverage and makes a limited income, I was excited to shop in the new Health Insurance Marketplace and learn about opportunities to make my coverage more affordable. I was also excited about the new ACA standards which would guarantee coverage for essential health benefits, free preventive care, and more robust out-of-pocket maximums. Lastly, but not by any means least, I was looking forward to a more streamlined application process that would no longer require me to supply years’ worth of detailed medical history to my prospective insurer, a time-consuming and burdensome process even for a healthy 26-year old like me.
The Process
I created my healthcare.gov account and began my application in mid-October. Initial steps included providing and confirming my e-mail address and verifying my identity via a series of security questions – a process that went very smoothly once I was able to gain that initial access to the site. The application itself consisted of a series of prompts and questions regarding my contact information, whether I wanted to apply for subsidies, my household and family characteristics, and my income, for example.
I submitted my final application in early November, and received an immediate real-time subsidy determination. Based on my estimated 2014 income, I was told that I would receive a premium subsidy of $96 a month, with access to silver-level cost-sharing reduction plans that would reduce my out-of-pocket costs.
Needless to say, I was pleased. Once I started shopping, I saw that I had 80 plans to choose from and, with the subsidy, I could buy a bronze plan for as cheap as $48 per month.
In the end, I selected a more generous, silver-level plan with a higher monthly premium, but with cost-sharing reductions which provided me with a low deductible, low out-of-pocket maximum, and a national PPO network.
From account creation to enrollment, the whole process took me about a month and a half. This extended timeline is at least partially due to some of the challenges I experienced with website functionality during this time (for example, I couldn’t actually enroll in my plan until the first week of December). It is also, however, the result of me taking the time I needed to correctly assess my income and financial circumstances before submitting my application, and then to carefully examine and consider my plan choices before making my final enrollment decision. The interface was easy to work with, and the application process was streamlined. I answered most of the questions on the application within 30 – 40 minutes, and then took additional time over the coming weeks to accurately estimate my likely income for 2014. The experience, for me, was a huge improvement over the burdensome application process in the pre-ACA individual market.
Did I Get a Good Deal?
Despite a lot of recent talk about how young adults may be disappointed by prices and coverage options in the Marketplace, I was extremely pleased with the quality and price of coverage offered to me.
My Current Pre-ACA Plan |
My 2014 ACA Plan |
$201 monthly premium |
$166 monthly premium (with subsidy) |
$300 annual deductible |
$250 annual deductible |
$3,000 OOP max (not including copays) |
$2,000 OOP max (including copays) |
$500,000 annual limit |
No annual limit |
National PPO network |
National PPO network |
OOP cost to have a baby: $1,860 |
OOP cost to have a baby: $1,640 |
OOP cost to manage type 2 diabetes: $1,420 |
OOP cost to manage type 2 diabetes: $870 |
As you can see, with my subsidy, this cost-sharing reduction plan gives me a lower monthly premium, lower deductible, and lower out-of-pocket (OOP) max than my current student policy. Additionally, I get the same national PPO network, but with no annual limits on my coverage. This is in addition to the preventive services without cost-sharing and additional protections that the ACA guarantees to consumers in 2014. In other words: I’m getting a great deal.
Highlights, Tips, and Tricks
- Brush up on your tax literacy beforehand. One of the most challenging parts of the application process, for me, was refreshing my knowledge about basic tax lingo. For example, what counts as income? What is a deduction? Who is in my household, for tax purposes? Make sure you’re familiar with basic tax concepts beforehand, and you’ll be better able to answer these questions.
- Think about your 2014 income ahead of time. If you’re like me (a student, someone who is in-between jobs, or someone who has irregular seasonal employment), you might not know with 100% certainty what income you’ll make next year. Thinking about this complex question ahead of time may enable you answer the question more quickly and accurately.
- When you’re shopping, use the Compare Plans tool. In the upper right hand corner of the shopping screen, you’ll see a tool which allows you to “Compare Plans” (see a screen shot of this feature below). This is a great way to look at plans side-by-side to compare deductibles, out-of-pocket maximums, and other features.
- Look at the plan network. There were a lot of great deals available to me in the Health Insurance Marketplace. Several of the available plans, however, had smaller or more localized networks than I would prefer. I travel a lot to see my family, so I knew I wanted a plan with a national provider network. Healthcare.gov displays this information as part of the plan subheading, along with metal tier level and whether the plan is an HMO or PPO.
- If you’re having a buggy experience, trying switching browsers. When I initially tried to create my healthcare.gov account on Mozilla Firefox, the site would not function at all. My experience improved once I switched to Internet Explorer. Hopefully this irregularity is something that will improve with time, but there’s no harm in switching it up to see what works, in the mean time!
- Use the Live Chat feature. I was able to get several of my questions answered quickly via the online chat feature in the bottom right hand corner. The representative was polite and gave me accurate information. It was a very convenient way to get a quick question addressed.
Will everyone get the same great deal that I did shopping on healthcare.gov? No. Many people will have a different shopping experience and receive a different subsidy offer based on their age, income, geographic location, and other factors. However, my experience has illustrated to me that everyone deserves to get online and at least explore their options on healthcare.gov. You never know. You may find a great deal!
Written by Megan Randall, Center for Public Policy Priorities. Cross-posted from Better Texas blog.