Be Well: Choosing Right Exchange Health Plan Can Be Tricky

U.S. Health and Human Services Secretary Kathleen Sebelius speaks at a health center with Cleveland Mayor Frank Jackson.
U.S. Health and Human Services Secretary Kathleen Sebelius speaks at a health center with Cleveland Mayor Frank Jackson.

As the March 31 enrollment deadline approaches, navigators who assist people in the process confirm that is working. But experts agree, consumers still should set aside plenty of time to sign up.

It can take hours to fill out the initial application and, afterwards, consumers still may not be clear on what exactly they'd be getting for their money because there are lots and lots of options.

"Through the market place, we now have new choices. Forty-five qualified health plans are selling insurance here in the Cleveland area, that's a lot of choice," says U.S. Health and Human Services Secretary Kathleen Sebelius said while visiting Cleveland earlier this year.

According to the Web site, there are are seven insurance companies selling multiple policies on the exchange for Cleveland-area residents - that includes Medical Mutual, Anthem, SummaCare, CareSource and others. Altogether, the number of plans to choose from add up to more than 40, depending on your household needs.

How to begin choosing?
The first step would be to decide how much you can afford and what kind of deductible you want to pay before the insurance kicks in. This will help you pick between Bronze, Silver or Gold plans. And those deductibles can be pretty high: from $4,000 to more than $6,000 on the Bronze plans. So it's incredibly important to take some time and calculate how much you spend each year on medical bills and pick the category that best fits your experience.

Make sure your physician and drugs are covered.
In addition, check to see if your doctor or drugs you take are covered on the plan. Many of the plans available on the exchange have smaller physician networks than they do for employer plans.
For example, in the Cleveland market, the only exchange plans that provide access to Cleveland Clinic doctors are those with Medical Mutual.

How do you check networks and formulary?

Elizabeth Carpenter, a director at the national consulting company Avalere, says checking coverage can be tricky.

"It really in some instances depends on the carrier. In some instances there are direct links to a provider search tool. In some instances, you would have to go to the carriers web site to get more information and try to kind of search out what network is being associated with the plan being offered on the exchange. And the same thing goes for the drug formularies," she says.

Tribble tested Carpenter's assertion. She typed in a hypothetical scenario of a single woman, aged 35. Forty-two different plans were offered. Some of the companies, such as SummaCare, CareSource and Medical Mutual provided links to documents or online search portals.

But others did not. The Kaiser plan didn't offer a link to search for drugs. And the HealthSpan offering I saw linked me to a page that required me to have a membership ID number in order to search for drugs. So those would be an instance where I'd have to pick up the phone to the insurer and hope I could find someone who could answer my question… it gets complicated really quick.

Could you just call your doctor to see if they are in network?

Carpenter said no. Not all doctors' offices will know which plan they are participating in.

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