HealthSherpa Reduces Risk of Debt and Credit Hits by Making Affordable Plans Accessible to All

In a Nutshell: Navigating the healthcare marketplace can be difficult and confusing. Without knowing your options, you could be paying more out of pocket for health care than you need to. HealthSherpa helps by presenting affordable health care options with just a few clicks. After submitting basic information like household size, salary, and preferred physicians, you will be presented with insurance options that accommodate your specifications. The whole process only takes a few minutes and does not require an account with the website. 

Trying to find good health insurance that fits your budget is not easy. I had to deal with that after leaving my last job.

Should I spring for the more expensive plan that covers emergency room visits? Or should I get the plan my primary care physician is in-network for? These were all questions I had while trying to find the right plan for me.

HealthSherpa takes the guesswork out of finding the right plan for you by taking your answers from a short questionnaire and showing the best plans for you.

People who don’t have a good health care plan can expect to pay sky-high out-of-pocket premiums, expensive deductibles, and high copayments. 

Many low-income families and individuals don’t have access to quality health care coverage because their employer may not offer employer-sponsored health plans. That means employees shoulder hefty expenses if they or someone in their family needs medical care.

Without adequate health care coverage to pay for medical emergencies, families could face crippling debt that can lead to bankruptcy.

In fact, two-thirds of those who file for bankruptcy say medical issues are the main reason for filing.

HealthSherpa helps everyone, including those who qualify for savings, find affordable health insurance through the Affordable Care Act Marketplace.

“It’s really important to drive home the importance of making sure that your family’s covered,” the Manager of Policy and Partnerships at HealthSherpa Aleka Gürel said. “It doesn’t have to be expensive. We enrolled 3 million people this past open enrollment in ACA plans, and most of them paid less than $21 a month for coverage.”

Low-income individuals and families often have to weigh the expense of medical insurance  against keeping a roof over their heads, food on the table, and bills paid. 

Many low-wage earners will forgo purchasing health insurance if it’s not already provided by their employer to avoid the stress of dealing with mounting financial obligations on limited resources. That decision can drastically affect their health. 

But being a low-wage earner can be an advantage when qualifying for health care. When Congress passed the American Rescue Plan, health care insurance subsidies improved; during the Open Enrollment Period for 2022, 96% of HealthSherpa enrollees qualifies for financial assistance.

HealthSherpa stands by the idea that low-income families and individuals deserve access to quality and cost-effective health care. 

The organization seeks to help the public navigate the Affordable Care Act Healthcare Marketplace so they can understand the subsidies available to Americans with low incomes.

“There are two kinds of subsidies available on the ACA Marketplace. The first is the advanced premium tax credit or subsidy, which brings down your premiums,” Gürel said. “The second type of saving is called a cost-sharing reduction, and that’s extra savings for people who are on the lower scale, [which] makes your insurance cheaper when you actually use it.”

The premium tax credit allows health insurance holders to lower their monthly insurance payment or premiums when they purchase a health coverage plan through the Health Insurance Marketplace®. The tax credit is calculated based on the individual’s income and household information reported on the marketplace form.

The cost-sharing reduction reduces insured out-of-pocket expense, and there is a cap on the amount that health care plan holders pay for medical services per year. 

When the insured reaches the maximum out-of-pocket expense, the insurance plan guarantees 100% coverage of services. The cost-sharing reduction lowers deductibles, copayments, and coinsurance and is only available when individuals pick a Silver plan.

Before the American Rescue Plan Act was passed, Americans who earned more than 400% of the federal poverty level, which translates to less than $51,520 for an individual and less than $106,000 for a family of four, could not qualify for subsidies. Now, many more families qualify – even those with higher incomes.

Individuals and families with lower incomes will pay a smaller percentage of their income for the benchmark plan, such as $0 for people whose income does not surpass 150% of the federal poverty level.

Low-income people need to consider three things when choosing a health coverage plan: the provider’s network, which prescriptions are covered under the plan, and out-of-pocket costs.

Certain plans have specific provider network types like HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point of Service Plan), and EPO (Exclusive Provider Organization). 

Low-income earners should compare premiums (the amount they pay monthly), deductibles (how much the policyholder spends before the insurance provider pays), the copayments (the fixed price the patient pays the provider for services), and coinsurance (the percentage of the cost of health care service you pay ).

These provider networks may offer limited choices and charge more if the consumer wants to use a provider not listed in the plan’s network. But other plans will permit the insured to use any doctor.

Gürel suggests that those seeking insurance make a list of the doctors they see regularly and the prescriptions they use. 

HealthSherpa’s online insurance questionnaire will take that information and show the best options based on preferred treatments.

“It’s important to make sure you know whether a particular drug is covered [or] whether it’s just the generic that’s covered,” Gürel said. “If you can’t use the generic make sure the brand name is covered and make sure you understand how much you will pay for it.” 

HealthSherpa understands that shopping for the right health plan that fits the needs and budgets of individual consumers can be daunting.  

On the ACA marketplace, the average person can see 100 different options, which is excellent for the buyer because competition means prices are better; however, this can make it difficult to find the best plan for your needs.

HealthSherpa Consumer Advocates help people navigate the marketplace to understand the subsidies they qualify for and determine the best plan for their needs. Advocates have backgrounds in non-profit and social work, and use their immense understanding of ACA to help people find the right plan.

They can also calculate subsidies and tax credits that individuals and families may be eligible for, in addition to finding low or no-cost coverage through Medicaid. Advocates continue to work with their customers year-round with continual updates about their plans.

HealthSherpa has access to data sets about health care utilization and can calculate a consumer’s expected out-of-pocket expense for every plan in the marketplace. That’s how it’s able to recommend plans that  best fit an individual or family.

The Advocate Team is composed of trained Obamacare and Medicaid specialists who help customers apply for and enroll in the most affordable ACA health care plan.

People can speak with a live agent over the phone or online at its website.

“At the heart of what we and our advocates do is educate people,” Gürel said. “We go through the data and can show how, for a few extra dollars a month, a different plan with extra savings is actually a much better deal. We want people to understand what they’re eligible for and how to avoid leaving money on the table.”