The Affordable Care Act- 5 Big Mistakes to Avoid

By Paul Hanlon

In March 2010 the Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA), was signed into law.  2014 saw the first enrollment by the public in the healthcare “exchanges”.  It’s been a year of learning- for everyone.  It’s a new system and as you might expect, there’s been some confusion.  As an agent on the front-lines of helping people get coverage, I’ve seen some situations that seem to repeatedly occur- and cause problems for my customers.  Here are, in my opinion and experience, the 5 biggest mistakes in navigating the Affordable Care Act (that I deal with every day):

1.   Purchasing a plan without understanding all the features.   Each plan has a number of features such as deductibles, co-pays, co- insurance and maximum out of pocket. Folks are very confused by the fact that they often have a drug deductible that is different from the deductible for their hospital stays, MRI's or outpatient surgery. You need to understand the features so you know you’re buying a policy that makes sense for you and your family.

2.   Purchasing a plan without making sure your doctors and local hospitals will accept it.  Blue Cross Blue Shield (BCBS) recently came out with a Value plan to lower monthly costs.  The drawback is that you can’t use Duke services, Duke physicians and specialists, or Walgreen's for yourprescriptions.

3.   Purchasing a plan without making sure all your drugs are covered.  You need to make sure the drugs you need are listed in the plan's formulary (list of drugs). You also need to know your co-pay for each drug.  Different plans have a different formulary.   Some can have MAC A and MAC B penalties associated with them.

4.   Cobra enrollment.   When you leave an employer where you had insurance coverage and in leaving you lose that coverage (you’re unemployed, new job doesn’t offer health insurance, there’s a gap before starting a job with coverage), you may be eligible to enroll  in COBRA.  COBRA can last up to 18 months, but you pay the whole premium (no employer subsidy).  You need to compare your COBRA offer with what you can purchase from a health insurance company on your own. You may be able to get a better deal.  This would include checking to see if you qualify for a government subsidy through the Marketplace.  Also, you may select any or all members of the family to stay on COBRA.  The former employee does not need to be on the COBRA plan.  Fully explore your options before you enroll in COBRA.

5.   Not using an agent because you assume you will pay extra for their services.  Agents such as myself are paid by the insurance company.  My services are paid by BCBSNC.  An agent knows the system, the rules, and the policy provisions.  They may even help you to reduce your monthly premium.  They can help you avoid the four big mistakes above.

The new health insurance system is a work in progress.  Changes are being made, and there’s a lot for people to learn and understand about the system.  It can work for you- if you are knowledgeable about your options.  Annual enrollment starts 11/15/2014 for plans to be effective 01/2015. Enrollment runs through 01/15/2015 for a 02/01/2015 start date.  This is the time to sign up and/or make changes.


Paul Hanlon is an authorized Blue Cross Blue Shield Agent of North Carolina with Apex Health Insurance.  He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it.  or at 919-924-6277.  To learn more visit www.ApexHealthInsurance.com..