what is the best approach to choosing an ACA plan when you are not quite Medicare age, is there a system or a designated professional service provider that can help with navigating the choices minefield?
First, go talk to an insurance agent. If you can find an agent that you pay a consulting fee for their expertise instead of the agent collecting commission based on what they sell to you, that would be ideal. If you can’t find an agent that you can work with, call a navigator.
If you know roughly what meds you need and what doctors and hospitals you highly value, you’ll want to wait until open enrollment begins and then use the plan assistance tools on either your states’ marketplcae (Healhcare.gov or a state specific website) or use a third party vendor. I use HealthSherpa.com all the time as I like their user interface and user experience. Disclaimer, I talk with the Health Sherpa folks and I have a data request in with them that I need to check in with my co-author to see if we’re still at all interested in the question. But you can enter your meds and desired docs and hospitals into a search tool which will present only plans that have all of the desired criteria. I think that would be useful to narrow down the possibility space to where the decision can be reduced with a decent degree of confidence to trade-offs of premiums, cost-sharing and insurer-specific characteristics.
I want to broaden this out a little bit now.
Choosing insurance is tough.
I think about insurance way too much. I am quite confident that if I had to buy insurance on a competitive ACA exchange that I won’t make a horrendous choice. I am quite confident that I am unlikely to make an optimal choice. I’ll be leaving money or at least exposure to money on the table prospectively. And I’m okay with that. I’m human with all of the foibles that entails even as I think about insurance and insurance choice too frequently and too deeply. So if this is where I’m at assessing my personal decision making capacity, please don’t expect to make perfect choices and give yourself grace. The objective is to avoid absolutely shitty choices and being indifferent to perfect choices compared to pretty damn good choices.
With that said, the big things to consider when making a choice for an ACA plan are the following considerations:
a) Am I subsidy eligible, not quite subsidy eligible but could engineer my income down to subsidy eligibility, or soooo not subsidy eligible?
b) What do I prioritize — minimum monthly expenditures or minimum OH SHIT total expenditures or something in between?
C) How much medical services do I know that I need next year? What drugs, doctors visits, surgeries/treatments am I 95% likely to need. Will the insurer allow me to get those services at a reasonable cost?
D) How important is it that I keep my docs/hospitals? This is going to vary a lot by your situation. Right now at this point in my life, I minimally value this as I see my PCP once every couple of years and that is it. I don’t have a long-standing relationship with a doctor who understands me and my medical concerns as I have minimal current medical concerns. However my mom who is a medical zebra with several 1 in a million conditions in her chart, greatly values stability as she has a team of docs who know her and her history very well.
E) What do I value in optionality? One of the big advantages of a large network vs. a small network is option value. We don’t know our unknown future health states. A large network is more likely to have the right docs/hospitals in-network and readily accessible than a small network (not always the case but usually the case).
F) What are the reputations of the insurers involved? Does Insurer A have a reputation of running people through the ringer on everything while Insurer B is easy to work with? That is valuable distinctions that can justify paying a bit more per month for a better experience.
These are the basic questions I would be asking myself if I had to buy a plan on the ACA exchange.
As open enrollment creeps ever closer, please feel free to ask questions in comments or e-mail me and I will help point you in the right direction if I can.