It took half-a-dozen tries over several days. But Phil Sherburne struck gold on Saturday — silver actually — with family health coverage purchased on the Affordable Care Act’s online exchange.
After plugging in particulars about his family of five, the Salt Lake City business owner was able to compare 38 plans and apply for tax credits to put toward his monthly premiums. He settled on a silver-level plan from Altius that retails for about $850 a month.
Need help enrolling?
There are several options for those who need help shopping the Affordable Care Act’s online health exchange:
Online chat at healthcare.gov
Toll-free call center at 1-800-318-2596
Go to www.takecareutah.org or call 211 to find the nearest trained navigator
Find a certified insurance broker near you at bit.ly/brokerfind
Calculate your subsidy
The new online marketplace at healthcare.gov was designed to allow shoppers to find out whether they qualify for subsidies, receive them and apply them toward the cost of premiums.
Those having trouble using the site can get an estimate using an online calculator from the Henry J. Kaiser Family Foundation here: http://kff.org/interactive/subsidy-calculator/
Americans who qualify for subsidies earn between 100 percent and 400 percent of the federal poverty level. In that window, individuals earn between about $11,000 and $44,000, and a family of four has an income between $33,000 and $92,000.
After tax credits, the Sherburnes will pay just $123 a month.
"It’s a great deal. I’m thrilled to have coverage, period," said Sherburne, who was previously shut out of affordable insurance due to a pre-existing condition, a shoulder injury. "Once I got onto the site it took about an hour, start to finish."
Overwhelmed by high demand and technical glitches, healthcare.gov had a rough Oct. 1 launch. Early shoppers struggled to use the site, often getting bounced off or blocked by a "please wait" page.
Federal officials have since added server capacity and brought the website down for fixes. A week later, reports of successful shopping experiences are trickling in.
"I was able to finally get on. I could see rates and plans that are very comparable to what I have now, and for less money," said 61-year-old Sandy Crockett of Cottonwood Heights.
Read the fine print, though, warns Crockett, who formerly worked in human resources and is accustomed to vetting health plans. Many of the exchange plans have narrow provider networks, so it’s wise to examine the "provider directory" links attached to the various plans to make sure the hospitals and doctors you want are covered before buying, she said.
Judging the affordability of the 96 exchange plans available to Utahns is difficult, because prices vary depending on where a family lives, how many in the family enroll and their ages.
Prices also hinge on subsidies offered to households with incomes below 400 percent of the federal poverty level.
The median family income in Salt Lake City was $68,578 in 2012, and the average-sized family is a family of three. Such a family, under the Affordable Care Act, would qualify for an annual subsidy of $897.88, or $74.82 per month.
Put toward the purchase of the second cheapest silver plan on the exchange — Select Value Preference Benchmark Silver 1000, which retails for $7,412.88 per year — this family’s monthly insurance rate would be $542.92.
That’s about double what the average employer-insured family pays in Utah because employers typically help pay for premiums. But exchange plans include a list of must-have benefits, such as mental health care, that many employer-based plans don’t cover.
And the value of employer-based coverage has declined over the years as more of the costs are pushed onto workers in the form of high deductibles, co-insurance and co-payments.
Sherburne, self-employed and uninsured for years, found a plan with no deductible and zero co-pays.
"It’s a big deal for our family," said Sherburne, who has been paying cash for doctor visits and the occasional emergency room visit. They’ve so far avoided the kind of health calamity that forces families into bankruptcy.
Leia Bell, his wife, "this year had a bout with gall stones. The ER bill was about $3,000," he said.
Sherburne and Bell own and run Signed & Numbered, a frame store in South Salt Lake. Business is steady, but they run on lean margins and a year-and-a-half after the shop’s opening, they had to make cuts and jettison their health benefits.
Sometime later, Sherburne tore his rotator cuff playing softball, pushing rates further beyond reach.
"From that point on, I was denied by most insurers," he said. "We tried to get insurance for the business, but because of my injury they rated us up by 40 percent."
Eager to survey the exchange, Sherburne tried shopping it on the morning of Oct. 1. He couldn’t get past the home page.Next Page >
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