1. 5527 POINTS
    Marlin McKelvy
    President, Consumer Directed Benefit Solutions, Memphis, Tennessee
    Congratulations! You have asked the question that millions of Americans are struggling with and will be struggling with for years to come.  Without being self-serving to my industry, find yourself an experienced and well qualified health insurance agent to shop the market for you and to explain the fine details of the options available to you.  The Affordable Care Act (ObamaCare) has accomplished what many thought impossible - making health insurance more expensive and even more complicated to understand than it already was.

    Buying health insurance online, whether it's through the government marketplaces or private sites, is not like shopping around for the best deal on a hotel room or an airplane ticket.  You will encounter a bizarre world of seemingly similar looking insurance products with wildly different prices or similarly priced products with wildly different benefit designs.  I guide people through this maze and it really doesn't matter if they have a 10th grade education or a PhD, they are amazed at the subtle differences I have to point out that make the real differences in the health insurance products they purchase.

    For example, one insurance carrier here in Tennessee offers identical insurance products in the government marketplace but has three different PPO network options attached to them.  The average person would look at these products, determine that the benefits are the same and so why not pick the one with the lowest monthly premium?  What they have painfully learned later is that they have enrolled in a health plan with a very narrow network of doctors, hospitals and pharmacies.  The hospital a few miles from their house that they assumed was in-network because it is part of the overall health system they have been familiar with in the past turns out not to be included in this narrow network product and instead they may have to go across town or to another county (in more rural areas) to go to an in-network hospital.  Another major carrier uses terms like "Local Preferred" and "National Preferred" to differentiate their products.  A quick scan of the benefit summaries reveals only slight differences in office visit & prescription copays, deductibles and out-of-pocket maximums but unless you really dig deep you won't be able to figure out one limits your pharmacy choices significantly while the other does not.  Other insurance companies whose plans people have been familiar with and even enrolled in for years have found that these company's products have transformed into products that now require primary care referrals for visits to specialists and other services or that they provide little or no coverage outside of their immediate geographic area.

    Just this week I spent about 3 hours explaining his different options to a man in his early 30's who is smart enough to run his own business and who has been my customer for 6 years.  The next morning he had his mother call me so I could explain the same things to her so she could help him feel good about his final decision.  This is the reality of what the average consumer is now faced with in today's health insurance marketplace.

    My advice, it's a jungle out there.  Don't go in without a trained guide and beware of these so called "navigators" and "assistants"  they are unlicensed, poorly trained (perhaps good intentioned) individuals who can do little more than read the same material on a computer that you can see.
    Answered on August 2, 2014
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