GUEST COMMENTARY: Focus on choosing ACA health care plan

2013-12-13T00:00:00Z GUEST COMMENTARY: Focus on choosing ACA health care planBy Michele Guadalupe nwitimes.com
December 13, 2013 12:00 am  • 

Just weeks into the Affordable Care Act open enrollment process, one thing is clear: Choosing a health care plan through the Indiana Health Insurance Marketplace is a big decision that will have a significant impact on the lives of all Hoosiers.

Far too many patients across our state suffer from debilitating chronic illness. For these individuals, in particular, selecting the right insurance policy is critical to their quality of life.

Fortunately, many organizations throughout the state are educating Indiana citizens about the new health care options available to them under the ACA. Individuals would be wise to thoroughly research the plans available, and consider how best to move forward with a plan that best meets their health care needs.

Health insurance policies can be complex — so much so that many Hoosiers tend to avoid the specifics of their plans, attending solely to their co-pays and deductibles.

However, throughout my 10 years in the health care industry, including my current role as vice president of advocacy and health policy of the Arthritis Foundation of Indiana, I have learned these intricate details are of most importance. The specifics of any given insurance policy can ultimately play a significant role in a patient’s ability to live a healthy, active life.

In Indiana, more than 880,000 Hoosiers are uninsured. Between now and March 31, these citizens will be searching the market for one of four insurance carriers offering 241 different plans available through the state health exchange.

In choosing one of these plans, there are several key considerations to keep in mind.

First of all, it's crucial to remember there is no rush. After all, the health plan you choose today cannot be changed until January 2015.

It's then critically important to fully consider the coverage specifics of each policy. The details of each plan may not be immediately obvious. For example, the plan tiers – bronze, silver, gold and platinum – are not ranked based on benefit design. They relate only to the amount of cost-sharing offered within each tier.

The many insurance options will differ on the providers and treatments they cover and how much patients are expected to pay out of pocket. Access to doctors in a plan network is one particularly significant piece of information. Physicians — especially specialists — may be limited in plans purchased on the health exchange. Hoosiers are advised to know which providers are covered under the plan they select.

Hoosiers should also be aware of available premium support subsidies. These are available to individuals enrolled in any level qualified health plan who earn up to 400 percent of the federal poverty level and do not have an offer of employer coverage that meets the government’s affordability standards.

Finally, Hoosiers should be aware that to avoid paying the penalty for not having insurance, they must enroll in a plan by March 15. Consumers cannot be uninsured for longer than three months without being subject to the penalty.

In Indiana, more than 1,356,000 people are affected by arthritis, and another 3.6 million suffer from a chronic disease. With the right health insurance plan that affords patients access to good physicians and prescription medications, every patient has a chance to lead a normal, productive life.

I encourage Hoosiers, particularly those with life-altering diseases like arthritis, to seek out the right information to address their individual needs when signing up for a plan through the Indiana Health Insurance Marketplace.

Michele Guadalupe is the vice president of advocacy and public policy at the Arthritis Foundation of Indiana. The opinions are the writer's.

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