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Confused About Health Insurance? Look to your Health Insurance Marketplace

by Nicole Duritz


Journalist Edward R. Murrow once said, “Anyone who isn’t confused doesn’t understand the situation.”

Nearly half of the American public says they do not have enough information to understand how the Affordable Care Act will affect them and their family, according to an August 2013 Kaiser Family Foundation report. (For that matter, they may not even know what the Affordable Care Act is – they know it as “Obamacare.”)

The thing is, health care has always been confusing: Even the 86 percent of Americans lucky enough to have insurance have always had to worry about what would be covered if they needed medical care, what out of pocket costs they would incur, and whether or not they would be dropped in the middle of an illness if they hit a cap on coverage – or worse, just made an honest mistake on their insurance application.

Obamacare was actually designed to take some of the confusion and unpredictability out of the equation.

Even if you are already insured, the health care law provides critical new benefits and protections . For example, did you know that your insurance company can no longer drop your coverage because of an honest error on your application? That was a common method of purging the sick from the rolls of insurance companies. Nor can insurance companies put lifetime or annual caps on essential medical services. This benefit has already helped about 1.2 million people in New Jersey.

The law also makes it possible to keep your children on your family plan until they reach age 26 – an invaluable protection as this younger generation struggles to find their footing in the new economy.  So far, 3 million adult children have taken advantage of this benefit including 73,000 in New Jersey.

And all insurance plans are now required to provide more preventive care such as health screenings for certain cancers, diabetes and heart disease.

Many organizations like AARP offer free tools such as, and that can help you better understand the benefits and protections of the health care law for you and your family.

The Affordable Care Act also offers protections – and convenience – for those who are uninsured or looking for health coverage. The law created the online Health Insurance Marketplace, a new way to comparison shop for health plans. And, depending on your income, financial help may be available to help cover some of the costs.

You can shop online through the Health Insurance Marketplace during open enrollment from Oct. 1 through March 31, 2014. To access the New Jersey Marketplace visit If you have questions about your coverage options or signing up, assistance is also available via phone at 1-800-318-2596 or in person.

When you’re shopping for health plans in the Marketplace, keep in mind the three Cs: Coverage, Costs and Compare

1. Coverage.  Although all insurance plans offered in the Marketplace are now required to cover important health care services, like emergency care, hospitalization, physician’s services and prescription drugs – there are still other factors you should consider when purchasing health coverage:

  • What services do you and your family need? For example if you need orthopedic care you’ll want to select a plan that offers this coverage.
  • Does the plan limit which doctor or hospital you can use? If you have a favorite doctor, make sure they’re part of the network you select. Otherwise you may have to pay more for those services.
  • What happens if you need health care while away from home? If you spend a lot of time out of New Jersey, you’ll want to find a plan that covers health services in other states.
  • Does the plan cover the prescription drugs you need? Prescription drug costs add up fast – especially if you end up needing to take them regularly or for prolonged periods.


2. Costs. Most health insurance plans have a monthly premium which is a fee that you pay the insurer for your health insurance coverage. You also need to consider the other costs that a health plan might not cover. Be sure to get a clear picture of your costs before selecting a plan.

  • Is there a deductible?  Deductibles – the amount you have to pay for health services each year before your coverage kicks in – vary and have a direct impact on your out-of-pocket costs.
  • Are there coinsurance or copayment requirements? These are the costs you pay each time you visit the doctor or use certain services and they also vary by plan. Be sure to factor in these costs before making a decision.
  • Is there coverage for out-of-network providers? You may have to pay more – sometimes as much as 100 percent of the costs – if you use an out-of-network provider. So if you have a favorite doctor, make sure they participate in the plan you select.


3. Comparisons. will allow you to directly compare the costs and coverage of health plans in your state, find out about financial help, and get your health coverage questions answered.

Remember, open enrollment for the Health Insurance Marketplace runs from October 1, 2013 through March 31, 2014. After that, if you still don’t have coverage in place, you may have to pay a tax penalty.  Sign up by December 15 and you can start getting coverage by January 1.

It may feel confusing right now, but all you need to do is take that first step by visiting The time you invest in researching your options will pay off with the peace of mind that comes with knowing you and your family are covered.


Nicole Duritz is Vice President of the Health & Family issues team in the Education and Outreach group at AARP.  She leads AARP’s educational and outreach efforts on health education issues, including Medicare, the health law, prescription drug affordability, long-term care, and prevention and wellness.  She can be reached at

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