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The Health Insurance Marketplace: One Nurse's Journey

Nurses General Nursing Article   posted

Specializes in Emergency Department.

Join me on a journey as I try to navigate the Health Insurance Marketplace to gain a new perspective on what patients go through when trying to purchase health insurance. In the first article of two a article series, learn how to access the Marketplace, see what questions and concerns I was able to generate and learn how to take the challenge of accessing the Health Insurance Marketplace for yourself.

The Health Insurance Marketplace: One Nurse's Journey
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As nurses, we are fortunate enough to have health insurance provided to us by the hospitals we work for. Now, this might not be the case for all, but the vast majority of nurses are able to obtain health insurance with minimal difficulty. Currently, this is the season when open enrollment and after a couple of clicks and light reading, our benefits are all set for the next year. Not bad, right?

Now for the rest of America, this process is not as smooth. To further educate myself on a struggle that my patients will be facing, I embarked on a journey that has given me a new perspective around the difficulties Americans go through when they are enrolling for Health Insurance. Given that it is currently open enrollment for Americans on the Health Insurance Marketplace, the journey began with some investigating. I wanted to act as if I did not have Health Insurance and access the Health Insurance Marketplace to browse around and see what my options would be.

I wanted to have the feeling of literally, walking in my patients' shoes. To do this I followed these steps:

  • Go to the Health Insurance Marketplace at healthcare.gov
  • Click on the "Get Started" button
  • Select the state you currently live in
  • Click on "See Plans & Pricing"
  • Enter your zip code

From this point, you will get a disclaimer notifying you that this is just an estimate with basic information and these prices are subject to change. For our purposes, we will be able to get a good idea of the challenges our patients will face when they are completing this process. Also, have some fun when you are plugging the demographics into the Marketplace. Plug in demographics that you believe represent the majority of the patient population you serve as a nurse.

  • Enter your household income
  • Enter your age
  • Click "add person"
  • Click "continue to plans"

Viola! You are now in business and the real challenge begins. After I entered in all of my data, I yielded 131 different Health Insurance plans to choose between. You would think this is great news, but even as a healthcare professional, I immediately felt overwhelmed. I had so many plans to choose from, I did not know where to start! I could only imagine how the rest of America would feel, let alone someone that already has a hard time maneuvering around technology. Moving forward, I have not even selected a plan yet, still on the initial screen, and I was able to come up with a list questions. Questions both that I could see Americans having, along with questions I had myself.

Here is the list I was able to generate:

  1. Bronze, Silver, Gold, Platinum and Catastrophic? What is the difference?
  2. What are the percentages of each and what do they mean?
  3. PPO, HMO, POS and EPO? Ok, I have at least heard of two of those, don't ask me what they really mean though.
  4. Does it matter what insurance company is selling my plan?
  5. What is the difference between a deductible and an out of pocket maximum?
  6. Copayment?
  7. Coinsurance?

Along with the questions I was able to think of that my patients might be asking themselves:

  1. I wondered the stress it must cause patients to take in all of these numbers?
  2. Can my patients afford this?
  3. What would they have to change in their lives to purchase one of these plans?
  4. How could I help them do this?
  5. How much liquid cash does my patient have, just for medical expenses alone?
  6. Are they fearful of choosing the wrong plan? Can they change their mind?

Before I discuss this any further and share with you my findings and recommendations, I want my fellow nurses to do some exploring of their own. Join in on the journey and walk in the shoes of your fellow Americans applying for Health Insurance. Follow the steps above, go through the process and test this out for yourself. After you have completed this, click on the link below to be directed to my next article where I will discuss what I have learned and ways as nurses we can have an impact on improving this process. Along with offering educational information nurses will be able to discuss with their patients to ensure that they are as informed about the Health Insurance Marketplace as possible.

To see the conclusion of my journey, read The Health Insurance Marketplace: What We Learned and How We Can Educate Our Patients

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tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thanks for this suggestion for us to try to navigate the marketplace.

I have navigated the Marketplace. Due to a few physical ailments, I am not able to work at the present time. In my case, I qualified for my state's Medicaid program. No cost to me, but I had to choose a MCP (Managed Care Plan) to administer the healthcare. After I choose my PCP and MCP, I was sent my insurance card with neither of my choices on there. They had chosen for me, even though I made my choices well before the date specified. The resolution involved calling the state Medicaid ffice and informing the CSR of my choices and then they sent me a new card. The differences I have noticed from having regular Medicaid versus the MCP is just about everything has to have a preauthorization, which will also get you a denial for whatever service you need to have done.

I did a simple appeal over the phone to a CSR at the MCP, and the denial was reversed. It's better than having nothing at this point.

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative.

I like our system. Someone gets sick or hurt, they will either get taken into the hospital by a friend or ambulance. If its an accident the cost of the ambulance will be covered by ACC, if its a medical emergency the person will have to pay $80.

The only other costs may be a taxi/ambulance home from hospital

I was between insurances. I checked out the marketplace. Or at least, I attempted to....I began registration, I was asked a lot of personal information....as in...."which high school did you attend out of the following high schools" etc. That upset me. I'm waaay post high school. "Which bank do you use for your checking/savings account out of the following...?" Huh? Becoming very, very creepy!! After inputting everyone's info, over and over again, the website froze, and I was unable to continue. Six more attempts over 3 weeks. Hours and HOURS. Nothing. Called the marketplace number for assistance...informed it would be bumped up to a specialist and I would get a call back within 5 working days. No call back. Contacted an insurance rep. She attempted to register my family...no luck...it froze in the process. She called them. No assistance. I attempted again. Froze again. Then, an insurance agent let me know how much my deductibles would be and my premiums. Eeeeek. That was the end of that for me.

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