Health Insurance Exchanges: Helping Patients Find the Best Fit

When health insurance exchanges open for business Oct. 1, healthcare providers should be ready to dispense advice to patients, especially those with serious medical conditions, on which plan to buy.

Kaiser Health News published an excellent story by Michelle Andrews aimed at consumers with serious health problems, but the lessons learned from it should be added to the tool kit of healthcare providers who will be consulting with seriously ill patients. As we have reported previously, hospitals and physicians should already be beefing up their Patient Financial Services staff and departments to help patients sign up for mandatory health insurance.

Healthcare providers have the most touch points with seriously ill patients, and therefore it makes sense to provide counsel to those patients before they select whether to purchase the Bronze, Silver, Gold, or Platinum plan on the exchanges. Andrews’s article contains several common-sense approaches for consumers, but that advice should also be part of a patient’s discussions with Patient Financial Services. Among the points covered by Andrews:

• Recommend the plan with least total out-of-pocket cost. “Even though the premium for a platinum plan will generally be higher than that of a bronze plan, the out-of-pocket spending cap may be significantly lower since platinum plans must cover 90 percent of expenses,” writes Andrews.
• Consider purchasing separate plans for family members with serious health issues. “If only one member of a family has high medical expenses, families may want to consider splitting coverage between different plans,” Andrews writes. By purchasing a platinum plan for one member and a bronze plan for the rest of the family, significant out-of-pocket savings can be realized. However, the U.S. Department of Health and Human Services is considering banning this practice, writes Andrews.
• Factor in tax credits and cost sharing. “Tax credits to help cover the cost of the premiums for plans sold on the exchanges will be available to people with incomes up to 400 percent of the federal poverty level ($45,960 for an individual in 2013), and cost-sharing subsidies will reduce the out-of-pocket costs for people with incomes up to 250 percent of poverty ($28,725 for an individual in 2013),” writes Andrews. Tax credits can be applied to any plan, however the cost-sharing subsidies only apply to bronze and silver plans.

By helping patients “do the math,” a healthcare provider can help beneficiaries get the plan that provides the best coverage for the lowest possible cost.