I spent some time on the Healthcare.gov website this morning, and found some great resources that could be particularly helpful for people with pre-existing conditions who are unable to obtain coverage in the individual market. The website was set up in conjunction with the PPACA and was designed to help people navigate the myriad of health insurance options available, along with the changes that will happen over the next few years as the provisions of the PPACA go into effect.
The site is relatively easy to navigate. If you’re looking for health insurance, there’s a tab you can click on to find insurance options. From there, it asks you to choose a state, and then provide some basic information about yourself (health status, pregnancy, veteran, senior, young adult, self employed, etc.). It asks if you’re losing coverage that you have through work, and for your age range. It also asks whether you have problems affording health insurance, although I couldn’t tell that this answer had any impact on the options that were presented for me.
Once you make your selections, the site provides several options. One of them is “health insurance plans for individuals and families” and you can click on that link to see what specific options are available to you. I was particularly interested in this one, since this is the niche market that we primarily serve. The site pulled up a wide range of individual carriers, although some of them were not particularly well-known companies. The private options seemed to pull up even when I answered the questions in a way that should have made me ineligible for a private individual plan (for example, when I said that I was pregnant, it still provided numerous individual plans for me – none of which currently accepts pregnant applicants). I did notice that for Colorado, Cigna was never listed as an option, and some of the other big carriers here were included but only with a few plans (for example, Anthem Blue Cross Blue Shield was included, but with only three plans available, and Aetna was listed with only one plan available – both of these carriers have numerous plans available to individuals in Colorado). For most of the individual plans listed, the link to “view plan benefits” didn’t work for me. This may be a work in progress, and it’s possible that the individual options section will be more inclusive and contain working links in the future. But for now, it seemed that Healthcare.gov might not be the best place to start if you’re looking for private health insurance in the individual market. Brokers who work with multiple health insurance carriers can provide detailed information about the various options available, and there’s no charge for their services. For the time being, I would say that knowledgeable brokers are a better option for health people who want to compare options for individual coverage.
But… that’s not everybody. People with serious pre-existing conditions will still find it difficult to obtain individual health insurance until 2014, regardless of how good their broker is (people with less serious medical conditions may be able to get private coverage, and this is where a good broker can be particularly helpful in terms of understanding the different underwriting guidelines the various carriers use). People who are unable to afford private health insurance but don’t qualify for Medicaid are in a bind too. For people with health conditions and financial constraints, Healthcare.gov can provide a lot of resources. It can also be a great reference tool for agents who want to help those clients but aren’t sure where to turn.
A couple examples:
One of the questions the site asks is whether you’ve been diagnosed with breast or cervical cancer. If you select yes, one of the options that appears is for a program that allows uninsured women who are otherwise not eligible for Medicaid to be enrolled in the program if they have been diagnosed with breast or cervical cancer (or precancerous condition) through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This is a great resource for women who might otherwise forgo care or be less likely to survive than their insured counterparts simply because they don’t have health insurance.
Another good resource provided by Healthcare.gov is information about Hill-Burton medical facilities that are obligated to provide free or reduced-cost care based on a patient’s income. They have a list of 193 facilities across the country, including seven in Colorado (in Antonito, Collbran, Colorado Springs, Greeley, San Luis and two in Cortez) where people with qualifying incomes can go for free or reduced-cost care.
In addition to resources for finding health insurance and affordable care, Healthcare.gov also provides tools for comparing quality of care at hospitals, nursing homes and dialysis centers. The site also provides information about preventive care and details about how the PPACA will impact health care and health insurance availability. Overall, it’s a good resource for individuals, but it would seem to be an especially good resource for brokers who are trying to help clients who aren’t able to get individual health insurance (either because they can’t afford it or because of their medical history). Instead of just referring clients straight to a state high risk pool like Cover Colorado, brokers may be able to provide more detailed options using Healthcare.gov.