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Health exchange shopping tips for uninsured boomers and early retirees

Published 9:45am Friday, September 6, 2013

Every state will have a marketplace, but each state can choose how it will operate. Seventeen states and the District of Columbia will run their own state-based marketplace, seven states will partner with the federal government and 26 states will offer federal marketplaces. The differences between federal and state programs will be subtle. You will be able to access your state’s marketplace at Healthcare.gov.

Policy choices

To make shopping and comparing a little easier, the health plans will be divided into four different levels – bronze, silver, gold and platinum.  The bronze plan will have the lowest monthly premiums, but the highest out-of-pocket costs when you need care, while the platinum plans will have the highest premiums with the lowest out-of-pocket costs.

You will also have a variety of health insurance companies to select from. To help you evaluate insurers, the nonprofit National Committee for Quality Assurance offers online report cards at ncqa.org that can help you narrow your choices.

Because most plans will be managed-care policies such as HMOs or PPOs that require you to get your care within a network of providers, you’ll want to make sure the doctors and hospitals you typically use are covered in the plans you’re considering. The new marketplace plans are expected to offer fewer choices of health-care providers, and who’s included may vary quite a bit.

You also need to find out what happens if you want to use a doctor or hospital outside a plan’s network. Will you have to get a referral or pay more to get these services or will it even be covered at all?

Also check the plan’s formulary, which is the list of prescription drugs they cover, to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.

Get help

If you need some help with all this, the Marketplace Help Center offers a toll-free helpline at 800-318-2596. Or, if you’d rather get face-to-face assistance, there will be designated centers set up with trained and certified navigators, counselors and application assistors to help you, along with insurance agents and brokers. To find help in your area, call the Marketplace Help Center after Oct. 1 for a referral.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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