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Health Care Reform:

Health Insurance & Affordable Care Act

Complex Personal Issues Cloud Insurance Decisions

WebMD News from Kaiser Health News

By Michelle Andrews

Mon, Dec 19 2011

If the volume of email from readers of this column is any indication, people are beginning to focus on how the health care overhaul will affect them.

With the opening of the online health insurance marketplaces less than a month away, consumers with job-based coverage want to know if they can buy a plan there (answer: yes, but they may not qualify for subsidies); those with individual coverage want to know how the plans will compare with what they currently have (answer: generally better coverage and potentially higher premiums, offset by subsidies); and those who have been unable to afford a plan or turned down because they have medical problems want to know if the marketplaces will provide better options than they currently have (answer: they should).

As I read through the emails, what’s striking is the complexity of some of the health insurance dilemmas people are trying to sort out. Getting them answers will be no simple task. The so-called enrollment assisters whose job it will be to help people understand their options and compare plans-navigators, certified application counselors, brokers and others--are going to have their work cut out for them.

Expect families, with their sometimes complicated legal and financial connections, to present especially messy insurance snarls to untangle, say experts.

"People are not going to fit the template, and the more you get into family coverage, the more complicated the questions are going to be," says Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

Consider the self-employed divorced couple whose annual income ranges between $30,000 and $200,000 and who split custody of their children. They want to know whether they’ll qualify for subsidized coverage on the exchanges, but "the forms don't address these things," they write.

Or what about the woman who asked about coverage options for an infant whose parents are each covered under their respective parents' health plans. (One of the law's popular provisions allows adult children to stay on their parents' insurance until age 26, even if they're married and financially independent.) The couple's child has been covered since birth under the state's CHIP plan for low-income kids, but one of the young adult parents recently received a raise and the couple’s income now exceeds the eligibility threshold for CHIP. Neither of the young adult parents has access to health insurance through their own job. What coverage options does their baby have?

"This will be a steep learning curve," says Sabrina Corlette, project director for Georgetown University's Center on Health Insurance Reforms. She likened it to the launch of the Medicare Part D prescription drug program in 2006, when beneficiaries tried to enroll in the new benefit and initially encountered snags in getting accurate information. 

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