“Are there any resources in the District for helping people make informed decisions on their health care plans?”

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Photo by PoPville flickr user Lindsey Robinett

“Dear PoPville,

I’m curious if the community might have any input or suggestions on a situation like mine.

I’m completely fed up with my employer’s health insurance plan. Every minor service costs a fortune under the plan and I’m trying to see what options I have under the DC health exchange and if it would be worth it for me to switch to one of those plans instead.

Are there any resources in the District for helping people make informed decisions on their health care plans when they are overwhelmed by and unclear on their options?”

13 Comment

  • The health exchange itself is meant to make comparing plans as easy as possible. There is a help line for more information, but you may need to call the individual providers for clarification if something you’re specifically concerned about isn’t addressed by the information on the health exchange site.
    .
    In my experience, anyone whose job is to help you select a health plan is probably working on commission and personally benefitted by health plans remaining opaque. The healthcare exchange is great because it disintermediates those people and empowers you to make your own choices, rather than abide by whatever your company’s HR team has been duped into.

    • yes. the exchange also has a search function to connect you to brokers and assisters. https://dchealthlink.com/find-expert

    • The DC healthcare exchange’s 1-800 number is a great resource. I’ve purchased insurance through them since it opened. The reps were friendly, informed and the information I received was consistent no matter how many people I asked. I felt like I had good plan/price options, but would caution you away from BCBS. I spent a ton of time challenging their rejections of basic services (primary care, contraception…). Customer service, when I could reach them, was generally useless. It was nearly impossible to figure out what my costs were supposed to be.

  • I’m not sure where they’re typically located, but during open enrollment they have health managers who can assist.

  • Mug of Glop

    When I was getting on the exchange over the summer, I called the BCBS line at the number provided, and they walked me through at least their own plans, their varied ups and downs depending on several scenarios, and helped me understand a bunch of the terms. They didn’t even try to talk me into more expensive tiers, to their additional credit. I imagine the other providers would be equally helpful on their own lines as well.

  • Yes, I second what people say to contact DC Health Link. I’m not sure the details about your employer plan- but traditionally employers contribute a fairly decent amount towards the premium so the exchange plans might not be a better deal for you. But it is worth checking out- lots of employers are moving towards high deductible plans which aren’t any better of a deal for their employees. You won’t be eligible for any financial assistance on the exchange since your employer offers you insurance (unless you meet a few very specific criteria) so that’s something else to keep in mind.

    I should also note that open enrollment isn’t until November 1- you likely won’t be eligible to purchase a plan until then unless you lose your job, get married or another “qualifying event.” https://dchealthlink.com/individuals/life-changes

    • “[T]raditionally employers contribute a fairly decent amount towards the premium so the exchange plans might not be a better deal for you” — This is what I was thinking.

    • HaileUnlikely

      This is an important point. Also, if you presently have health insurance through your employer, don’t forget that your portion of your premium is not taxed (i.e., the portion of your income that is used to pay your premium is not taxed), whereas if you buy your own policy through the exchange, the income that you later use to pay your premium is taxed, unless you qualify for a deduction based on your income. Thus, for example, if you have a $200 pre-tax deduction from your paycheck to pay for health insurance from your employer, and then you drop your employer’s health plan, your take-home pay does not go up by $200, it goes up by less than that, thus all else equal (which I know it isn’t), you need the marketplace premium to be lower than the premium on your employer-based plan in order for them to actually cost you the same amount.

    • Seconding the point about financial assistance — though DC Healthlink offers subsidies for individuals earning up to 400% of the poverty level, you probably don’t qualify for this (even if your income is at that level), because being able to get employer coverage disqualifies you from subsidies.

      Also, if you see any particular doctors or take any particular drugs, you’ll want to make sure that a new plan would cover those. The exchange offerings can be a lot narrower than employer coverage, depending on the plan.

  • You may also want to take a look at One Medical, which supplements coverage and is supposed to be really easy to get appts, charges no additional fees per-visit, etc. They take most insurance and then charge an annual fee, if I understand correctly.

  • There are some people in the district trained by DC gov’t to work as health insurance “navigators” (I think that’s their title) who work at some health care sites. I talked with one who is at Whitman Walker clinic when I was laid off and had to make a decision about going with COBRA/purchasing insurance from the exchange/or Medicaid. I learned a lot of useful information I didn’t know that helped me to decide. You can see one (at that clinic at least – there are others around DC) on a walk-in basis for no charge and get information.
    .

  • I work at Whitman-Walker Health on the Public Benefits and Insurance Navigation team, and we provide pro bono insurance counseling services to anyone – no need to be a patient. (We’re some of the aforementioned assisters that show up when you look for help through DCHL.) DC Health Link provides good summaries of plans, but we’re certified on the exchange and happy to talk through various options with you. We’re open for walk in hours Mon-Fri 8am-5pm, or you can call our PB line at 202-745-6151.

  • I would really recommend sticking with your current plan. DCHL has put me through hell in the last year and I suspect I’m not the only one who has had trouble utilizing their system. First of all, they do have brokers to help assist you in choosing a plan. They won’t tell you, though, that those people (as others pointed out here) work on commission and will try to get you to chose a plan that benefits them. They might even try to sell you life insurance! Once I actually picked a plan, something happened with their system… A miscommunication between the health care providers and DCHL. Long story short, I was left without health care for 5 months because of their incompetensies. Bottom line: Health care for everyone is a wonderful idea! Clearly we still have glitches in the system to figure out. If you are lucky enough to receive employee health care I would stick with it.