WITH so much attention being paid to the troubled debut of the Obama administration’s health insurance exchanges, another alternative has largely gone unnoticed: unless you live in Washington, D.C., or Vermont, you can also buy insurance outside the exchanges — by going directly to insurance brokers, agents or company Web sites.
In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.
Of course, the main attraction of the exchange is that plans sold there may come with subsidies that can substantially lower your monthly premiums. (Premium credits are for people making up to $46,000 for an individual and up to $94,000 for a family of four.)
Web-based brokers, like US Benefit Solutions, are supposed to be able to help consumers enroll in subsidy-eligible plans by connecting to the federal marketplace to verify the consumer’s income, under government guidelines issued last spring. But that isn’t happening yet at USBS, in part because the company is still testing its system, said a spokesman, Nate Purpura.
However, the site offers more than a thousand plans from 60 insurance companies that you can buy if you aren’t looking for subsidies.
To have their plans qualified to be sold on exchanges, insurers must follow rules like marketing their plans fairly, and must offer at least one plan in the “silver” and “gold” categories. Such plans have higher premiums, but lower out-of-pocket costs, than plans in the lower “bronze” category.
Plans sold off the exchange are also supposed to follow the same tiers as those used on the public exchanges, to indicate the level of costs you will incur.
Whether or not the policies you will find off the exchange are a better deal for you than the on-exchange plans isn’t clear yet, and will vary by market. “I don’t think we have a good sense of that,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry group. But, he added, it makes sense to check.
Another possible reason for shopping off the exchanges is if the networks offered by the plans you find there don’t include your own doctor or hospital, said Sara R. Collins, a health policy expert at the Commonwealth Fund. In some cases, insurers are seeking to control costs by narrowing the networks of plans offered on the exchanges.
Of course, there’s still time to sign up through the exchanges set up by the federal government, assuming the army of technical experts being brought in to help can make good on President Obama’s pledge to fix the problems plaguing Healthcare.gov, the federal exchange portal.
On the exchanges, you have until Dec. 15 to enroll in coverage that starts Jan. 1. (Under new rules announced this week, you can enroll as late as March 31 for coverage starting after Jan. 1 and still avoid fines.) And if you live in one of the states running its own exchange, like New York or Minnesota, enrollment is said to be running more smoothly.
In the meantime, you can also try enrolling by telephone, at 1-800-318-2596, or you can print out a paper form at healthcare.gov and apply by mail. The site also lists locations by ZIP code where you can get in-person help.
Here are some questions to consider.
¦ How do I find health insurance policies off the public marketplaces?
You can use the “See plans and prices in your area” feature on Healthcare.gov to see which insurers offer plans in your state, then contact them yourself to see what else they offer. But not all insurers have plans on the exchanges, so you also can try commercial hubs, like www.usbenefitsolutions.com
I searched on Healthcare.gov and eHealthinsurance.com for bronze plans in my state, Arkansas, for an individual under 50. Healthcare.gov said the lowest premium (without any credits) was a plan from QualChoice Health Insurance for $171 a month. On eHealthinsurance, the lowest bronze plan was $223 a month, from Arkansas Blue Cross Blue Shield. (EHealthinsurance didn’t show me any plans from QualChoice.)
¦ Where can I find a local broker or agent that sells insurance plans?
Check the Web site for US Benefit Solutions. Keep in mind that agents won’t necessarily show you all available policies, just the ones from insurers they work with.
¦ If I have an individual plan already, can I keep it?
Maybe. Generally, plans that take effect for 2014 must meet the law’s requirements. But there’s a loophole in most states: if your insurer allows you to renew your current policy early — before Jan. 1 — you may be able to keep it for 12 more months without penalty.
A handful of states limit this option. Insurers selling plans on California’s state-run exchange, for instance, aren’t allowed to offer renewals of 2013 plans. So ask your insurer. And note that if you go this route, your plan won’t necessarily have the Affordable Care Act’s mandated benefits.
¦ Can I buy one of these 2013 plans now for coverage next year, if I don’t have one already?
Yes — if you qualify, says Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. You’re not guaranteed coverage with these plans, so insurers can deny your application if you’re sick. However, many shoppers at www.usbenefitsolutions.com are considering 2013 plans, says Carrie McLean, head of customer care at the site. Premiums may be lower, she said, since the plans don’t have to offer all the benefits required by the new law.