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People buying their own health insurance have even more to think about this year, particularly those post-COVID-19 patients with lingering health concerns — the “long-haulers,” who join the club of Americans with preexisting conditions.
What type of plan is best for someone with an unpredictable, ongoing medical concern? That question is popping up on online chat sites dedicated to long-haulers and among people reaching out for assistance in selecting insurance coverage.
“We are hearing from a lot of people who have had COVID-19 and want to be able to deal with the long-term effects they are still suffering,” says Mark Van Arnam, director of the North Carolina Navigator Consortium, a group of organizations that offer free help to state residents enrolling in insurance.
The good news for those shopping for their own coverage is that the Affordable Care Act bars insurers from discriminating against people with medical conditions or charging them more than healthier policyholders. Former COVID-19 patients could face a range of physical or mental effects, including lung damage, heart or neurological concerns, anxiety and depression. Although some of these issues will dissipate with time, others may turn out to be long-standing problems.
So sign up, say Van Arnam and others to whom KHN reached out for tips on what people with post-COVID-19 should consider when selecting coverage. There’s no one-size-fits-all answer, they say; all emphasize the need to consider a wide range of factors.
But don’t delay. Open enrollment in ACA plans is ongoing until Dec. 15 in most states — longer in some of the 14 states and the District of Columbia that run their own marketplaces.
Here are tips if you are shopping for health insurance, especially if you are a COVID-19 long hauler or have other health issues:
Make sure to select an ACA-qualified plan
It may be tempting to consider other, often far cheaper types of coverage offered by insurers, brokers, organizations and private websites. But those non-ACA plans offer less comprehensive coverage — and are not eligible for federal subsidies that help people who qualify cover the cost of the premiums. These are key factors for patients experiencing medical problems after battling the coronavirus.
Short-term, limited-duration plans, for example — which are not sold on the Affordable Care Act exchanges — are cheaper, but the insurers offering them don’t have to accept people with preexisting conditions (or, if they do enroll those people, the plans don’t cover the members’ medical conditions). Many short-term plans don’t cover benefits such as prescription drugs or mental health care.
Another type of plan that doesn’t meet ACA requirements are “sharing ministries,” in which members agree to pay one another’s medical bills. But such payments aren’t guaranteed — and many such plans don’t cover any condition they consider preexisting.
Shop around to consider all the ACA plans available in your region.
This will help you meet your post-COVID-19 medical needs while also getting the best buy.
Comparison-shopping also lets consumers adjust their income information, which may have changed from last year, especially if they’ve been very sick, and could affect subsidy levels for those eligible for assistance in purchasing a plan.
Under the ACA, subsidies to offset premium costs are available on a sliding scale for people who earn between 100% and 400% of the federal poverty level. That range next year is $12,760 to $51,040 for an individual and $26,200 to $104,800 for a family of four.
Networks matter. Look for your doctor or hospital in the plan
One of the first things to do once you’ve narrowed down your choices of plans is to dig deeper to see if the doctors, specialists and hospitals you use are included in those plans’ networks. Also,…