How Do I Get Health Insurance?
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You can typically obtain health insurance by enrolling through your employer or purchasing an individual policy on your state's marketplace. Other options may include Medicare and Medicaid.
Whether you're shopping for health insurance for the first time, changing plans or need coverage because you moved or switched jobs, this article will outline the steps for how to get health insurance.
How To Get Health Insurance in 4 Steps
Having health insurance can be a significant contributor to maintaining a healthy life. Follow these steps to purchase health insurance coverage
1. Assess Your Healthcare Needs
Assessing your healthcare needs is a crucial step in selecting the right health insurance plan as it helps you determine the type of coverage you require and the healthcare services you are likely to use. This may involve considering factors such as your medical history, family history, current health status, prescription medications and expected healthcare expenses. You may also need a plan with additional benefits such as vision or dental coverage.
2. Understand Your Options and Compare Plans
There are various types of health insurance plans, such as HMOs, PPOs, EPOs and POS plans, as well as government-funded programs like Medicare and Medicaid, each with different features, costs and limitations. In addition to the type of health insurance, you should also understand where to buy coverage, such as from the ACA marketplace, your employer or Medicare (more on these later).
Finally, you should consider which plan tier to choose. Health insurance tiers, such as bronze, silver, gold and platinum, will dictate your plan costs. Bronze plans typically have lower monthly premiums but higher out-of-pocket costs, while platinum plans have higher premiums but lower out-of-pocket costs. The plan tiers can help consumers choose a plan that balances their healthcare needs with their budget.
3. Enroll in a Plan
Individual health coverage plans can be purchased through your state's ACA (Affordable Care Act) marketplace or directly from a health insurance company. The ACA marketplace, also known as the health insurance exchange, is an online marketplace where individuals and families can shop for health insurance plans that meet the requirements of the ACA.
Alternatively, you can also consult an insurance broker or agent who can help you navigate the process of selecting and purchasing health insurance. They can provide advice on the different types of health plans available, compare plan benefits and costs and help you choose a plan that fits your needs and budget.
Employees should review their employer's health insurance options and coverage details and ask their HR representative any questions or concerns they may have about the plans or enrollment process.
4. Maintain Your Coverage
After buying your policy, you should pay your insurance premiums on time and keep your coverage up-to-date. If you miss multiple payments, your health insurance policy may be canceled and you will no longer have coverage when you receive healthcare services.
If you have health insurance coverage through your employer and you quit or are terminated, you may be able to keep your employer-sponsored health insurance for a limited period under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Keep in mind that your employer will typically stop subsidizing the cost. That means you are usually required to pay the entire premium. Your employer should provide you with additional information regarding COBRA before or on your last day of employment.
When Should I Enroll for Health Insurance?
Generally, you should enroll in healthcare during open enrollment. Otherwise, you may have to pay a fine depending on which state you live in. Massachusetts, New Jersey, California, Rhode Island and the District of Columbia currently have laws requiring healthcare coverage and failing to enroll may result in a penalty. However, there is currently no federal law mandating healthcare coverage.
Open enrollment is a yearly period that begins in the fall when individuals can purchase or switch health plans. The start and end dates of enrollment can differ by state but usually occur from November 1 to January 15.
Special Enrollment Period (SEP)
If you don't purchase health insurance during open enrollment, you may still be able to buy it later if you experience a qualifying life event, such as getting married or having a child. Such an event will trigger a special enrollment period, which usually lasts for 60 days before and 60 days after the life event, although it may vary in some cases.
Medicare Open Enrollment
Medicare's open enrollment is from October 15th to December 7th each year, with coverage beginning January 1st. Medicare Advantage plans have a separate enrollment period from January 1st to March 31st.
During these periods, you can join, switch or drop a Medicare plan and if your current plan doesn't provide the coverage you need, consider changing to a more suitable plan. If your current coverage is satisfactory, you will be automatically re-enrolled as long as you keep paying your premiums.
What Types of Health Insurance Coverages Are There?
There are several options for health insurance coverage, from employer-based coverage to buying an individual plan on the ACA marketplace. In addition, individuals may qualify for federal healthcare programs, like Medicare or Medicaid.
- Employer-based insurance: Employers may offer group health insurance plans as part of their employee benefits package. The monthly premium is usually paid to the carrier by the employer, while the employee may be required to pay a portion of the cost through a payroll deduction.
- ACA marketplace plan: A health insurance plan purchased from the ACA marketplace is a type of individual or family health insurance plan that meets the standards and regulations set forth by the Affordable Care Act and is offered by private insurance companies through the federal or state health insurance exchange.
- Plan purchased directly from a health insurance company: A health insurance plan purchased directly from an insurance company may not cover all of the essential health benefits required by the ACA. A short-term plan is one such example and is usually purchased as temporary coverage until the individual can buy an ACA marketplace plan during open enrollment.
- Medicare: Medicare is a government-funded health coverage program that caters to U.S. citizens aged 65 years or older and those with qualifying conditions.
- Medicare Advantage Plan: Medicare enrollees can opt to purchase a Medicare Advantage (Part C), which is a health insurance policy that adheres to Medicare regulations but is offered through private insurance companies and may provide additional benefits, like vision and dental coverage.
- Medicaid: If you want to know how to get health insurance without a job, Medicaid may be worth considering. A government-run healthcare program, Medicaid provides affordable health coverage for low-income individuals and families, as well as pregnant individuals or those with qualifying disabilities. Eligibility for Medicaid will primarily consider your household size and income in relation to the federal poverty level.
How Much Is Health Insurance?
According to the Kaiser Family Foundation, the cost of a silver plan is $405 per month for a 30-year-old individual making $70,000 per year with no dependents and does not smoke. Several factors can influence the cost of health coverage, including:
- Out-of-pocket costs: For example, a plan with a higher deductible and lower monthly premium may be less expensive than a plan with a lower deductible and higher monthly premium.
- Level of coverage: You will pay extra for additional benefits like vision and dental coverage.
- Age: Generally, older individuals may pay more for health insurance than younger individuals because they are more likely to require medical care.
- Health status: If you have pre-existing health conditions or a history of medical issues, you will likely pay more for healthcare.
- Zip code: Factors such as the cost of living and local healthcare costs can impact the price of health insurance.
- Tobacco use: You may pay more for health insurance because you are at a higher risk for health problems.
- Subsidies: Based on your income, you may be able to reduce the cost of health insurance.
On the other hand, the cost of Medicare is more clear-cut. There are three main types of Medicare coverage. Medicare Part A (hospital care) has no monthly premium for individuals who have paid Medicare taxes for at least 10 years but you will need to pay for Part B (doctor services) and Part D (prescription drug coverage) separately. The cost for Part B is $164.90 per month as of 2023 and Part D prices may vary.