How to survive the health marketplace

A health fair

It’s a cold, rainy Friday afternoon, and the woman on the other end of the line has clearly had a long day working the phones at the New York State health insurance marketplace. She mumbles at top speed through her scripted interrogation. When she gets to the part asking if I have access to any kind of health insurance through my employer, I stifle a laugh. It’s funny.

I know that plenty of people have this magical thing called employer-sponsored health insurance. About 49 percent of the U.S. population, in fact — a fortunate demographic that includes my mom, my doctor and my congressman. It’s another world, though, and not the one I live in.

I’ve been self-employed for so long that the idea of a company putting up cash money for me to go to the doctor sounds like something out of a utopian sci-fi novel. For many of my working friends, too — small business owners, writers and hustlers of the modern-day gig economy — health insurance and healthcare have long been something to scrape together, or to do without.


People in my situation — working, and earning too much to qualify for most forms of government assistance, but without access to an employer plan — have been notoriously underinsured for a long time. Our ranks are growing. According to a January report from the Treasury Department, the number of people reporting self-employment income rose more than 30 percent between 2001 and 2014.

Getting more workers outside the realm of “regular” employment insured is just one of the quixotic goals of the Affordable Care Act, also known as Obamacare. The U.S. healthcare system is fiendishly complicated. In a constantly changing landscape, it’s tough even to figure out exactly what effects the law is having on healthcare in America. But as the numbers come in, it seems the ACA is making a dent. Self-employed workers are buying marketplace plans at three times the rate of regular wage-earners, according to that Treasury report. On a broader level, the percentage of Americans who are uninsured has dropped precipitously since the ACA’s major provisions went into effect. The law may be imperfect, but it is working.

Let’s not sugarcoat it: Marketplace plans aren’t great. Insurance on the individual market was expensive before Obamacare, and it still is, although subsidies do help ease the pain. If you’re used to sharing the cost of health insurance with your employer, the pricetags for plans on the New York State of Health will come as a rude shock. Deductibles for the more affordable plans are high, and “gold” or “platinum” plans that cover the lion’s share of medical expenses come with expensive premiums.

More troublingly, several state insurance exchanges have hit unexpected turbulence in getting off the ground. In 2015, the nonprofit Health Republic, one of the more popular insurers on the New York State marketplace, shut down abruptly after accumulating tens of millions of dollars in losses, leaving hundreds of thousands of enrollees (including yours truly) scrambling to get new insurance coverage mid-year. With some factions in federal government actively seeking to kneecap the ACA’s marketplaces for political purposes, there may be more unforeseen woes ahead.

For all its myriad flaws and aggravations, Obamacare has brought health coverage within reach for many – and given consumers new options they’re loath to give up. With Congress poised in March on the precipice of a failed effort to repeal the ACA, the nation’s capital heard it loud and clear: the roar of millions of registered voters realizing all at once that, as messed-up as the health insurance landscape is, it could be worse.

On that happy note: If you’re planning on shopping for coverage through New York State of Health, here are three basic tips for getting the most out of it.

Plan ahead

Your best bet for getting coverage for the upcoming year is to shop for coverage during the open enrollment period. For 2018 plans, that’s November 1 through December 15 (that’s six weeks less than the time applicants had last year, thanks to new regulations from the Trump administration that cut the enrollment period in half).

If you have recently had a major life event like the loss of job-based insurance, the birth of a child, a marriage or divorce, you’ll be able to sign up for a marketplace plan anytime through special enrollment. If you’re not sure whether you qualify for special enrollment, contact the marketplace and ask.

Be patient

Applying for insurance through the marketplace takes time, whether you’re filling out the application online, over the phone or with help from a broker. Set aside a chunk of time to deal with the process.

If you have irregular paychecks and tax returns that vary wildly from year to year, you’ll have to be especially scrupulous in calculating your income – mistakes made during your application could cost you next year at tax time. Claiming a subsidy will save you on premiums in the short term, but if your income proves to be higher than you expected you’ll have to pay it back with your federal tax filing.

If your household income puts you in the realm of Medicaid eligibility, you should be prepared to produce proof of your income: pay stubs, tax returns, business records or letters from employers.

Find help

Got a question? Call the New York State Health Exchange. Its phone bank is sometimes prone to long wait times and inexplicable connection problems, but you can get real, live, knowledgeable human beings on the phone who can be invaluable in helping you through the application process.

You can also find free help in your community. On the website of the New York State Health Exchange is an online list of “navigators.” Their job it is to provide free in-person help to applicants signing up for marketplace plans. Navigators often schedule appointment hours at local libraries, clinics and other community centers. Check the online list to find one near you.

I confess that I dread having to wrangle with the New York marketplace. It’s byzantine, it’s tedious, it’s a mess of red tape. I have to wade into it every time my income goes up or down. And they’ll have to pry it from my cold, dead hands – because as aggravating as it is, it beats the hell out of having no insurance at all.