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December 15, 2013

Tips for health care buyers

CHICAGO — Experts offer guidance for buying health insurance under new health care law:

DEADLINES: Dec. 23 to sign up for coverage by Jan. 1. Enrollment continues through March 31. Miss that deadline and pay a penalty for next year of $95 or 1 percent of your income, whichever is higher.

COSTS: Unless you’re poor and qualify for Medicaid, you’ll pay a monthly “premium” fee to an insurance company for coverage. Before the company covers actual medical costs, you may have to pay a certain amount called a deductible, in addition to a possible set fee for a doctor visit (copay) or a percentage of the cost of a medical service (coinsurance). These costs are outlined on HealthCare.gov, a federal government website, for each insurance plan. Click on “See plans before I apply.”

FINE PRINT: Lynn Quincy of Consumers Union suggests narrowing your options to five plans, then going to each insurer’s website to read the benefits summary for each. You’ll see what’s not covered, such as hearing aids and acupuncture. Pay attention to the coverage examples, which spell out what the patient pays and what the plan pays for two situations: having a baby and managing Type 2 diabetes. The examples will show how the deductible, copays and coinsurance work.

DOCTORS: If your doctor or hospital isn’t contracted in the health plan’s network, you’ll pay much more. Tracy Watts at Mercer, a major benefits consulting firm, advises checking with your preferred doctors to see which health plans they’ll accept.   

MEDICATIONS: Health plans have lists of drugs they prefer and will cover. If your prescription drug isn’t on the list, you’ll pay more. Check with the insurer to make sure your medications are on the list.

GET HELP: Illinois has 900 trained enrollment counselors across the state, called navigators, to help people get signed up. Many insurance brokers also are certified to help. Find a navigator at GetCovered

Illinois.gov, a state government website. Or call 866-311-1119 for the help desk.

TAX CREDITS: Federal tax credits will help make premiums more affordable for households earning between 100 percent and 400 percent of the federal poverty line. That’s $11,490 to $45,960 for an individual, $23,550 to $94,200 for a family of four. See if you qualify by applying at HealthCare.gov.

EXTRA HELP: If your household income is less than 250 percent of the federal poverty level (about $59,000 for a family of four), you also may qualify for lower out-of-pocket costs when you buy a silver plan on the marketplace.

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