4 tips for buying insurance without subsidy help

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The health care overhaul is expected to help millions of uninsured obtain coverage, but that assistance has limits.

Individuals who do not have the option to obtain insurance from their employer, and who make more than about $46,000 – or a family of four bringing in more than $94,200 – will not be eligible for income-based tax credits under the new health care law.

The enrollment period for the nation’s new health insurance system started Oct. 1. Here are some shopping tips to consider if you make too much to land a helping hand from the overhaul with next year’s insurance bill.


Ask your insurer if you can renew your current plan early.

That could enable you to keep your coverage for another year and avoid some initial sticker shock triggered by the health care overhaul. Insurers have warned for months that some people – younger customers in particular – may see substantial hikes in the rates due to the overhaul’s coverage requirements.

The law requires that all plans cover certain essential health benefits, such as mental health and maternity care. Although that will lead to more comprehensive coverage, it will come with a price tag. So if your plan doesn’t cover those benefits this year, you should be prepared to see an increase in your bill.

The overhaul also limits the difference between what insurers can charge customers in different age brackets. That may contribute to a premium hike next year for a 20-something, while someone in their 50s may see a decrease.

Brokers warn that customers who are considering an early renewal should first look at what options they would have otherwise. They may find a plan that suits them better than their current coverage.


The overhaul features the launch of state-based insurance exchanges that can help individuals use their tax credits or subsidies to buy coverage. These exchanges are designed to help shoppers compare different policies with a few clicks of the computer mouse, but they don’t give a complete picture of insurance options.

These public exchanges only show plans for which subsidies can be used. An insurer may offer other plans in your state

Plans will be sold based on four coverage levels – bronze, silver, gold and platinum – that correspond to the extent of the insurance provided. Bronze-level plans will have relatively lower premiums, with the insurer picking up 60 percent of the patient’s medical costs. Platinum plans will be more expensive, but the insurer will pick up 90 percent.

An insurer may sell gold- or silver-level plans on a state’s exchange and then offer a platinum-level plan off the exchange.

Aside from looking beyond the public exchanges, shoppers also should search beyond their current insurer.


Don’t let price be the only factor you consider if you can’t get a tax credit to help with the premium.

Think about how much health care you need. You may want the cheaper premium, but if you are going to have a baby, you probably don’t want to be stuck paying 40 percent of a bill that could top $10,000.

Also check to see whether your preferred doctors are in the plan’s network of coverage providers. Care received from a provider outside a plan’s network can be much more expensive.

Independent insurance brokers can help you sort through these details and understand a policy’s limitations. For instance, an insurer may cover autism treatments, and the broker could help you figure out whether that includes care you might need such as applied behavior analysis, said Susan Rider, an insurance broker with Indianapolis-based Gregory & Appel Insurance.


The overhaul created an annual open enrollment period when people can sign up for coverage. If you miss this year’s period, which runs until the end of March, you may wind up uninsured for 2014 and could face a fine.

The law requires almost everyone to have health insurance. Fines start as low as $95 the first year but go up after that.

Outside the open enrollment window, your only option to find coverage may be if you have a major life change such as getting married, having a child or losing a job, said Carrie McLean, director of customer care at eHealthInsurance, a private health insurance exchange owned by eHealth Inc.

Customers have until Dec. 15 to sign up if they want coverage to start Jan. 1. They then have until the end of March to sign up and avoid paying a penalty for going without coverage in 2014.

You may wind up qualifying for subsidy help if your income drops or you become unemployed during the year.

The nonprofit Kaiser Family Foundation, which studies health care issues, offers a calculator on its website that helps consumers figure out what sort of subsidy they might receive. You can find it at http://bit.ly/13YLrxq .