Help for the health insurance season

The national enrollment period for health insurance through the exchanges is taking place now, with a Jan. 31 deadline, and if you are confused I don’t blame you. But it may not be all that intimidating. Some practical information:

An exchange is where you go to get health insurance if you don’t have coverage through Medicare, Medicaid, or another plan such as an employer’s group plan. In New Mexico, the exchange is called “bewellnm.com.”

You can go to the website and click on a link to find help online, by phone or in person in your part of the state. Scroll down to the blue-green box that says “get started today” and click on “I need help with my application.” From there you can click on “Find a broker” or “Find a counselor.” Enter your zip code or your county and you will see a list of the people in your area.

Or skip the computer and phone 1-855-996-6449.

Either an insurance broker or an enrollment counselor has the knowledge to help you through the enrollment process. They are located throughout New Mexico.

(The recommendations here are from a training program given by the Office of the Superintendent of Insurance and BeWellNM.)

If you already have coverage through the exchange (except for Presbyterian), you can do nothing and let it roll over for another year, but it’s recommended that you review your plan to see whether your needs or the plan’s provisions have changed.

For individual coverage, there are four options through the exchange: Blue Cross Blue Shield, Molina, Christus, or New Mexico Health Connections, which is a relatively new in-state nonprofit health insurer.

Each of these four offers a few plans. The major differences: Some plans will cost you less in premium, but you might have to pay more in deductibles and co-pays. If you are in good health and have few medical needs, the lowest premium might be your best option.

If you change plans, you might lose access to a particular doctor. If that is important to you, you can check before changing.

Presbyterian has dropped out of the exchange this year. If you already have coverage with Presbyterian through the exchange, and you don’t switch, you will be enrolled in another plan, but you can change later.

If you have Presbyterian coverage that isn’t through the exchange, this does not affect you.

Your cost could be going up, but so could your subsidy. A calculator on the website can tell you how much your subsidy might be.

When you are covered through the exchange, there is no lifetime maximum benefit. If you develop a serious illness that turns out to be costly, your access to benefits will never run out. Outside the exchange, it is possible for a plan to have a lifetime limit.

If, based on your income, you are eligible for Medicaid, the website will figure that out. You’ll be advised to get help enrolling in Medicaid. For Medicaid information, one place to check would be the nearest office of the Income Support Division of the state Human Services Department.

There is a special exchange program for Native Americans. They may continue to use the Indian Health Service and also get benefits through the exchange for services not available through IHS.

The election won’t affect the system in 2017, Insurance Superintendent John Franchini assures me.

The President-elect and both houses of Congress will be Republican, and have said they want to repeal the Affordable Care Act. However, even if they do, Franchini said approvals already in place will keep the system stable through 2017 and probably beyond.

No doubt it’s a clumsy system, but using the exchanges is no more difficult than selecting a Medicare supplement or private insurance. Whenever Congress gets around to it, the system will benefit from an overhaul, not a repeal.

Triple Spaced Again, © New Mexico News Services 2016

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