26 Sep Can I be sure my health insurance price is fair?

Q. I’m trying to understand what will happen with health care given what’s happening in DC. I am 55 and I have to buy my own insurance. How can I make sure my policies don’t get screwed up? How can I make sure I pay a fair price?
— Lost

A. While it looks like the latest Republicans plan to repeal Obamacare isn’t going to be successful, the future of health care is still a huge question.

No one knows what’s going to happen and there are no guarantees. Let’s look at where things stand now and what you should consider going forward.

Right now, you can get health insurance from either a group-sponsored plan or under an individual plan, said Ed Gaelick, a Chartered Life Underwriter and Chartered Financial Consultant with PSI Consultants in Glen Rock. .

You said you are 55 years old. Gaelick said assuming you are not disabled, which could mean you may qualify for Medicare before age 65, and that you’re not around the poverty level, which could mean you may qualify for Medicaid, and assuming you’re not a business owner with at least one other full-time non-owner, non-spouse employee paid on a W-2, which could mean you qualify for group insurance, you default to the individual market.

You can purchase individual insurance directly through a broker or carrier or through the Obamacare Marketplace.

Gaelick said whichever you choose, the plans and rates are exactly the same.

He said the advantage of securing coverage through the Marketplace is that it’s the only place you can qualify for a taxpayer subsidy.

“Rates are the same,” he said. “If you qualify, those rates would be reduced by any subsidy. That is a common misunderstanding of the Marketplace — thinking the insurance is `cheaper’ there. It’s not. It’s just that retail premiums are subsidized.”

In New Jersey, Gaelick said, there are very few insurance companies left.

“Aetna just pulled out of the market — individual and small group — so there are even less choices today,” he said.

There is no way to guarantee your policies “don’t get screwed up,” Gaelick said, but the Department of Banking and Insurance (DOBI) has a responsibility to protect its’ citizens and there are protection devices and rules in place.

“That doesn’t mean you won’t lose your plan or your doctor but there would likely be alternatives if your carrier pulled out as well,” Gaelick said.

As for a “fair price,” Gaelick said, “the price is the price, fair or not.”

You cannot be charged more than another 55-year-old for the same plan in your demographic area, he said.

“Where we go from here certainly does depend on how our elected officials in D.C. vote, so time will tell,” Gaelick said. “Until then, it’s business as usual, which is likely no comfort to you or many others.”

“But rest assured, you’re not alone and there are rules and laws in place to protect you,” he said.

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This post was first published in September 2017.