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Accessing health insurance coverage will not change with the January 1 Affordable Care Act changes, but there will be different options available. The current marketplace is managed by insurance companies who provide plan designs, administration and claims payment. Plans will continue to be administered and managed by insurance companies, but plan designs will need to meet federal guidelines to guarantee they meet the “actuarial value” standards required by the Affordable Care Act.

For individual coverage, plans can be accessed in the public exchange or off the exchange in the private sector. There will be less insurance carriers providing plans in the public exchange and, while identical plans will be available in the private sector, it is expected that the private sector will provide additional plans not available in the public exchange. So, what’s the difference and why would someone select the exchange over a private plan?

There are individuals who will qualify for a federal subsidy and / or a federal tax credit if they enroll in the public exchange which will not be available off the exchange. Our next article will cover this most important information, but for now let us look at what to look for when determining where to shop.

Plans will differ somewhat in benefit design, premiums and networks. Be sure to compare benefits such as deductibles, copays and co-insurance limits in all plans you research. Premium structures will be different among carriers so look carefully at the actual cost for you and your family. Look carefully at the provider network each plan uses as well as list of approved prescriptions. All providers and prescriptions will not be in all plans.

Health insurance decisions have always been impacted by plan design and premiums.  Now we all need to look very carefully at the network of providers and the lists of approved prescriptions for each plan.  The restrictions we chafe at today will likely be increased in the new plans so do your homework and be sure you know what you are signing up for.