How to Get Health Insurance

The Open Enrollment Period is a limited amount of time to choose the right health plan for your household, and picking the wrong coverage can cost you. Policyholders can find affordable health plans through the federal or state marketplace, a private insurer or their employer. Each option has its pros and cons, depending on your needs. Below is a guide on how to get health insurance and which option is your best bet.

What Should You Consider When Choosing a Health Plan?

Finding a health plan can be easier than you think. Knowing which variables you should consider can make it a little easier:

Factor

What it is

What you should consider

Deductible

What you must pay before your health insurance kicks in and covers the costs for doctor visits and medical services.

If you have a lot of medical expenses, like surgery or specialist visits, it may be in your best interest to choose a low deductible so your coverage begins sooner.

Providers

Your primary care doctor and specialists that you see.

Most insurance providers charge more for out-of-network providers, so if you’re trying to save on costs, make sure your doctors are in-network.

Plan

PPO, HMO, EPO and POS, are some of the different types of plans.

Determine which plan has facilities, doctors and limits that work for your needs.

Network

Facilities, hospitals, labs and medical care providers that have negotiated lower rates to work with your insurer.

If you have a specific doctor or hospital in mind, find out if they are in your plan’s network.

The “metal” categories

Many insurance plans have four categories: Bronze, Silver, Gold and Platinum. These tiers reflect the level of coverage and out-of-pocket costs.

You can determine how much coverage you want your plan to provide.

Prescription medication

Any prescriptions or medications that your doctor has prescribed for you.

Different insurers require different copays for covered medication. Go over your plan to see if your prescriptions are covered.

Additional benefits

Added benefits that custom-tailor your health plan to your needs, such as discounts, access to an online platform, mobile apps and more.

Even if you don’t use your insurance often, it’s nice to know that you can speak to an agent 24/7 or can change your coverage online any time you want.

Buying a private health insurance plan allows you consistent coverage that is not dependent on your job.

How To Get Health Insurance

There are several ways to get health insurance:

  • Your parent’s health insurance plan if you are under 26.
  • Group coverage from your job or your spouse’s job.
  • Health insurance plan purchased through the Marketplace.
  • Medicaid
  • Medicare
  • CHIP (Children's Health Insurance Program)
  • TRICARE or Veterans Health Administration for military personnel.
  • Through your state if they provide health insurance plans.
  • Temporary continued coverage from your former employer via COBRA.

Get health insurance through your employer

Many people get their health insurance coverage through their job. If this is the case, you won’t need to go through the government Marketplace or private insurers, unless you are interested in supplemental coverage.

Buy through the Health Insurance Marketplace

Some people can qualify for premium tax credits or subsidies depending on their eligibility and income when buying a health plan through the marketplace. Policyholders can opt for a marketplace policy even if they have work-sponsored insurance through their employer but they may not qualify for subsidies.

Buy private insurance through an agent or a broker

If you want a truly customized health plan, buying a private health insurance plan allows you more options and consistent coverage that is not dependent on your job. However, it will cost more than a plan through an employer.

Buy through an insurance brokerage

Health insurance brokerages can help you compare and contrast different health plans to find the best plan for you available based on the information you provide. Even then you will be sifting through a limited number of options, based on how many insurers work with your broker.

Buy through a group plan

Group plans can be more cost-effective than individual plans if you qualify for one through your union, employer or other association.

Find Affordable Health Insurance Rates

How Do You Get Health Insurance if You’re Retired?

Medicare

Medicare is only available for those 65 and older. Seniors with Medicare can get their health coverage through a Medicare Advantage Plan, which is the private version of medicare.  Medicare Advantage Plans are offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. Retirees may choose to look for comprehensive coverage health plans with low costs since healthcare costs tend to increase as they age. Even those who are eligible for Medicare may choose to purchase supplemental insurance to help with out-of-pocket costs.

If you decide to retire but aren’t yet eligible for Medicare, you can still get private health insurance or through the marketplace.

Employer-Based Insurance

If you lose your health insurance offered to you through your employer, you may be offered continued coverage through COBRA or other options to continue your health insurance coverage after retirement, especially if you work in the public sector.

Self-employed workers who run their own businesses can purchase flexible, individual health insurance.

How Do You Get Health Insurance if You Have a Disability?

If you have a disability or are terminally ill, live in a group home or long-term care facility, need help daily or have a condition that prevents you from working you may qualify for Medicare or Medicaid. Medicaid provides free or low-cost medical benefits to people with disabilities. Medicare provides medical health insurance to people under 65 with certain disabilities and at any age with end-stage renal disease. If you don’t qualify for health coverage through these programs, the ACA marketplace offers different options based on your income for those with disabilities who don’t qualify for health benefits and need coverage. You can also buy private health insurance and private Medicare (Medicare Advantage).

How To Get Health Insurance if You’re Self-Employed

Self-employed workers who run their businesses can purchase flexible, individual health insurance. You are considered self-employed if you own a business that produces income but doesn’t have any other employees (freelancers, independent contractors, consultants and more.) You may even qualify for a marketplace plan with government subsidies, depending on your income.

How To Get Health Insurance After Open Enrollment

Open Enrollment for Individual and Family plans starts November 1 and ends January 15. Your plan’s effective date can vary based on when you submitted your application. In many cases, you may have to wait until the next Open Enrollment period. However, there are times outside the Open Enrollment period when you can sign up for health insurance, like after certain life events, such as:

  • Losing healthcare coverage
  • Having a baby
  • Getting married
  • Adopting a child
  • Retiring

FAQS

How much does health insurance typically cost?

While costs can vary depending on your health plan, the average monthly cost in 2020 for health insurance was $456 for an individual and $1,152 for a family.

Can you get health insurance after open enrollment?

If you missed the Open Enrollment Period you may still qualify for a Special Enrollment Period, especially after eligible life changes like divorce, getting married or losing a job that provided health insurance.

Can you get health insurance without a job?

You can still qualify for individual or family health insurance through the marketplace depending on your household size. You may also qualify for free or low-cost coverage through CHIP and Medicaid.

Key Takeaways

  • The best time to purchase comprehensive, affordable health insurance is during Open Enrollment; however, you can enroll during a special enrollment period if you face a qualifying event.
  • You can buy individual or family coverage through the ACA marketplace if you qualify or directly from a private health insurance carrier.

Get Health Insurance Coverage When You Need It

Shopping around for the best insurance policies that fit your budget, lifestyle and household needs is a great way to lower your healthcare costs and premiums by comparing plans and benefits. SmartFinancial can help. Just enter your zip code below and go over a few brief questions or speak with a licensed insurance agent at 855.214.2291.

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