TONY WILSON: Do your homework before choosing a health care plan on the Exchange

Tony Wilson

Tony Wilson

The October event we look the most forward to at our house is my wife’s birthday.

That is, until this October.

Tuesday marked the much anticipated October opening of the Federally Facilitated Marketplace (FFM) for Georgians. The FFM (also referred to as the Exchange) is a cornerstone of the Patient Protection and Affordable Care Act (PPACA).

The Exchange is a web portal that allows Georgians another option when purchasing health insurance coverage. (Well, it would allow Georgians another option if the site actually worked.)

As we’ve discussed before in this space, Georgia is one of 30-plus states that opted for the federal government to open and operate the Exchange instead of the state building and operating its own Exchange. You can access the Exchange at www.healthcare.gov. (E-mail me at twilson@nfp.com with your feedback on your experience with the website.)

I have spent a great deal of time over the past few months explaining to clients, business groups, friends and neighbors what the Exchange is and how it will work. And in each instance I’ve tried to leave people with the same advice — stay calm.

While the Exchange opened on Oct. 1 those seeking medical coverage options do not need to make a decision on Oct. 1. Coverage, if elected through a carrier on the Exchange, will not be effective until Jan. 1, 2014.

If an Exchange plan is the best option for you based on your specific situation, you have until Dec. 15 to enroll for that Jan. 1 effective date. The point is, you have some time.

Exchanges vary from state to state in terms of which carriers opt to participate or not. For Georgia, there should be 68 plan options from five different carriers on the Exchange. That’s hard to confirm since I haven’t be able to log into the website the past two days.

Those who live in the Atlanta area should have access to all 68 plan options, while those outside the Atlanta area will be able to access 50 of the plan options. Several of the carriers in the Exchange will offer HMO plans, and those HMO plans are approved for certain counties in Georgia. Those plans can only be offered to residents in those approved counties.

Reviewing 68 plan options (or even 50) can be a daunting task. In fact, it can be overwhelming for many. Even approaching it from the perspective of simply looking at plan options from the carrier you feel the most comfortable with can be intimidating.

Let’s say you want to focus only on plan options from BCBS. That carrier has three plan options for small businesses and 13 plan options for individuals. It will take some time to review 13 plan options and find the one that best meets your particular situation.

Again, stay calm. (And maybe keep a paper bag handy in case you start to hyperventilate.)

Certified FFM brokers (like me) and designated navigators also can provide assistance as you review your options. The Exchange does have a Live Chat feature, too. (Although its usage is spotty.)

If you decide to look into the Exchange plans here are a few tips for you:

  1. Make sure your health care provider is in the network for the plan you are considering. Networks do vary with Exchange plans — even from plan to plan offered by the same carrier. Many networks are smaller on Exchange plans.

  2. Check the drug formulary for your prescriptions. Carriers in the Exchange can offer a more narrow listing of prescriptions on certain plans.

  3. Speaking of prescriptions, check your pharmacy’s participation with the Exchange plan, too. You don’t want to find out as you are trying to get a prescription filled that the pharmacy is not participating.

  4. Use a particular hospital? Check the network for that hospital’s participation, too. One low-cost plan I previewed allowed access for non-emergency situations to only one hospital.

I am looking at an Exchange plan as an option for my family. Hopefully, next week I’ll be able to report on what I find.

Oh, and for those of you wondering about Shelly’s birthday, she’ll be 29 (again).

Questions or comments? Feel free to e-mail 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.