TONY WILSON: Health care exchange website lacking in health plan details

Tony Wilson

Tony Wilson

“What are we going to do?”

That question is the most asked question I’ve answered over the past few weeks, and while the answer isn’t crystal clear just yet, I can offer some advice on what individuals and families should consider as they make their health insurance coverage decisions for next year.

As I mentioned in last week’s column, we, too, were one of the families to receive a letter about our health insurance plan cancellation. Our current plan does not meet the requirements of the Affordable Care Act, so Blue Cross Blue Shield — like many carriers — is being forced to cancel our plan in order to comply with the law.

We have a $10,000 catastrophic plan with low office visit copays ($25) to our primary care physicians, and low copays for generic and certain brand name drugs. It meets our family’s needs quite well.

Beginning in January, plans for small groups (those with less than 50 employees) cannot — even of their own free will — have a plan, except in limited situations, with a deductible higher than $2,000 for an individual and $4,000 for a family.

Knowing our small group plan was going away, we started shopping the individual market because I do not mind a higher deductible plan, which are allowed under the law in the individual market. High deductible plans tend to keep more of my money in my pocket versus paying higher premiums for lower deductible plans.

We did the same thing many people across this great state are doing — we turned to healthcare.gov.

I will say that while the website is still experiencing “glitches” the good news is I was at least able to check the plan options available to my family and the rates for those options on the Exchange. The bad news is I found out later the rates were inaccurate, but more on that next week.

After entering some basic family information, I found that there were 34 total plans available to us from Blue Cross Blue Shield, Humana and Kaiser Permanente. (When I went back to the site at a later date and entered the same information I found there were 29 plan options. Not sure what happened to the other five options.)

Like the small group market, individual and family plans beginning next year must limit the total out-of-pocket costs of deductible, coinsurance and copays to $6,350 for an individual and $12,700 for a family. Carriers can offer plan options with less out-of-pocket costs, and these options were available on healthcare.gov. These plans do come with higher premiums.

My search results showed a Humana $6,350 deductible plan as one of my options, and it had the lowest cost. However, the website provided no additional information on the plan details.

I noticed on the website that this plan is listed as a catastrophic plan. Under the ACA’s provisions, these plans are only available to people under 30 and those with a verified financial hardship.

I am aware of the catastrophic plan age and financial requirement because I am a broker. However, the average visitor to the website may not know this, and it needs to be outlined clearly and concisely for website visitors because if you are not eligible for this option you need to know that you need to move to the next option.

The next option for us with the lowest monthly premium was another plan from Humana — the $6,300 National Preferred Bronze plan.

While I could see the monthly premium, I could not review the plan’s details via a summary of benefits and coverage nor could I click on a link to search the provider network associated with Humana’s plan option. This is a website “glitch.”

Being able to review the plan components is critical, and making sure your providers are in the associated network is a must. What are the copays for office visits? What copays for prescription drugs? Are our doctors in the network?

This definitely needs to be among the “glitches” the website vendor is working on, and the Department of Health and Human Services must demand this information be included for the consumer.

I would never advise a client to purchase a plan based solely on price, and in order for you to do your due diligence you need to have the tools available. Healthcare.gov needs to add these tools in the on-going upgrade.

Next week we will take a look at healthcare.gov’s pricing “glitch.”

Questions or comments? Feel free to email me at twilson@nfp.com.

Tony L. Wilson is a partner with NUVISION Financial Corporation based in Conyers. NUVISION is a subsidiary of National Financial Partners Corp. (NFP), which provides benefits solutions for companies.