Starting in 2014, the federal government will require you to
buy health insurance
. That's when the individual mandate goes into effect under the
Affordable Care Act.
Upheld by the U.S. Supreme Court in June, the mandate requires
a bunch of exceptions
) to have health insurance, whether it's through an
employer-sponsored plan, government-funded health insurance
program, such as Medicare or Medicaid, or a private individual
Worried about where you'll find a health plan? Here's where to
look in 2014:
The Affordable Care Act requires states to set up competitive
health insurance marketplaces called exchanges. The federal
government will set up the exchanges in states that don't set up
their own. (See
How health insurance exchanges will work
The exchanges will offer websites where you can compare health
insurance plans and prices and buy coverage online. You'll also be
able to see whether you qualify for government-funded insurance
programs or government subsidies to help you afford health
"It's a pretty impressive platform to set up," says Dan Maynard,
president of Connecture Inc., a Milwaukee area-based software
company that's designing the online-sales systems for exchanges in
Maryland and Minnesota.
The websites will include self-service tools to guide you
through the process of enrolling in government programs, if you're
eligible, or choosing a private health plan based on your
In most cases exchanges will include call centers, where you can
phone for help in choosing and enrolling in a plan, Maynard says.
All exchanges will work with so-called "navigators." These are
groups and professionals in the community who can help you enroll
in a health insurance plan through a state exchange. Insurance
brokers, consumer advocates and non-profit groups could serve as
navigators, and some state exchanges might have community outreach
"Each state is going to approach it a little differently,"
Companies and brokers
An estimated 30 million Americans are uninsured now. That's a
lot of folks to hit the insurance market all at once, especially as
new regulations go into effect, such as premium subsidies for
people who meet certain low- and moderate-income requirements.
"Not everybody speaks insurance-ese," says Carol Taylor,
director of compliance and government affairs at Beacon Benefit
Consulting in Jacksonville and Orlando, Fla. "It's going to be
very, very complex. Agents are still going to have a consultative
Even though consumers will be able to shop for themselves
through the exchanges, many will want some personal help from an
insurance agent to sort through the options, she says.
Aetna, one of the largest health insurers, remains committed to
brokers and will offer incentive programs to build stronger
relationships, and develop new technology to make it easier for
brokers to work with the carrier, says Barbara DeMaio, head of
individual business for Aetna.
Health insurance companies will also sell plans directly to
consumers through their own websites and call centers.
DeMaio says Aetna expects that most of its business will
continue to come through brokers and directly to the company in
2014. Sales through state exchanges will grow as the new
marketplaces get established.
health insurance companies are opening retail
where you can shop for a policy, check on claims and get one-on-one
health education coaching:
- Highmark Blue Cross Blue Shield just opened its newest
Highmark Direct store in Erie, Penn., the company's ninth retail
outlet in the state
- Blue Cross and Blue Shield of Florida has opened 10 Florida
Blue Centers in the state.
- Last year, UnitedHealthcare opened a 16,000-square-foot
center in New York, which the company says will serve as a model
for future centers. The insurer operates several other smaller
- Aetna continues to market high-deductible health plans
through Costco, the members-only warehouse retailer, in nine
states. Costco employees provide brochures that describe the
health insurance program, and Costco members can go online or
call to sign up for a plan. Aetna plans to expand this program to
Besides the state-sponsored exchanges, a variety of private
exchanges will serve as marketplaces where you can compare health
plans and buy coverage.
Private exchanges have been around for decades. Nonprofits or
companies, rather than the state or federal governments, own and
run private exchanges. Some private exchanges feature plans from a
single health insurer. Others let you compare plans from competing
health insurance companies. In some cases your employer might
contribute a certain amount of money for you to purchase insurance
and then send you to a private exchange to pick out a plan.
Why have private exchanges when state-run exchanges will open in
2014? The private exchanges give health insurers another channel to
market their products. In Massachusetts, where a government-run
exchange has operated since the state reformed its health care
system, health insurers have continued to market to groups and
individuals through privately run exchanges.
Meanwhile, no matter where they're sold, all health plans will
have to live up to minimum standards of coverage set by the
Affordable Care Act. That means you will qualify for coverage even
if you have a health condition, and plans must provide certain