By Alan J. Murray, President and CEO of New York’s North Shore – LIJ health insurance outfit, CareConnect
1. Determine if the individual marketplace is for you. If you’re already insured through work, or receive Medicare, you are set. You don’t have to worry about signing up at all. If you are not insured through work, you’ll probably have to use the marketplace to find coverage.
2. Figure out if you are eligible for Medicaid or a Subsidy: How do I know if I’m eligible for medicaid or a subsidy? If you earn less than 138 percent of the poverty rate (about $16,000 dollars for an individual) you are eligible for Medicaid, which is also available through the exchange. If you earn less than $46,000 dollars a year for an individual ($52,920 as a married couple, or $95,400 as a family with kids), you are likely eligible for a subsidy to offset some of the cost of an individual plan.
3. Consider using an insurance broker: If you are one of the New Yorkers who isn’t insured through work or a government benefit program, the individual marketplace is for you. While signing up is simple, it can be helpful to have someone who is an expert help you through your options. Alternatively, you can use the New York State of Health insurance marketplace. 92 percent of the 1.5 million New Yorkers who signed up through the individual exchange last year report being satisfied with it. Once on the site, follow the simple process, entering your name, zip code, etc., and browse for the plans that are right for you.
4. Determine what level plan is right for you: Plans are offered along a tiered system (bronze, silver, gold, platinum). The plans range from low premium but high deductible (cheaper upfront, but which will cover a smaller percentage of medical bills) bronze plans, to higher premium but low deductable (more expensive upfront, but cover a higher percentage of medical costs). Costs will range between $515 and $1,095 a month; gold plans are $449 to $928; silver plans are $391 to $785; and bronze plans (lowest premiums but highest deductibles, maximum out-of-pocket costs, and co-pays/co-insurance) are $315 to $657.
5. What if I signed up last year? If you signed up last year you are are set to automatically re-enroll in your previous plan. While this may be convenient, it may also cost you money. Make sure that you take the time to browse the exchange and comparison shop your old plan against this year’s options. Some of the most popular plans from the previous open enrollment period have seen their premiums rise (on average, 5 percent), while others have actually gone down.
6. More questions? If you have more questions, make sure you reach out to a “Navigator” who can help guide you through the process.
About Alan J. Murray
Alan J. Murray Murray is responsible for the strategic direction and success of the North Shore-LIJ CareConnect Insurance Company, Inc. Overseeing all aspects of the business for its Medicare, Medicaid and commercial lines, he ensures that the company remains focused on its mission. Before joining North Shore-LIJ in 2012, Mr. Murray served as vice president, New York market, at UnitedHealthcare for 4 and a half years. In that role, he was responsible for building, maintenance and contracting for a network of 220 plus hospitals and more than 60,000 physicians across the state of New York. He had accountability for approximately $9 billion in medical spending across multiple lines of business.