HomeFactsDo You Have To Get Health Insurance

Do You Have To Get Health Insurance

How Do I Apply For The Premium Tax Credit Health Insurance Subsidy

How To Get Medical Care If You Do Not Have Health Insurance

Apply for the premium tax credit through your states health insurance exchange. If you get your health insurance anywhere else, you cant get the premium tax credit.

If you’re uncomfortable applying on your own for health insurance through your state’s exchange, you can get help from a licensed health insurance broker who is certified by the exchange, or from an enrollment assister/navigator. These folks can help you enroll in a plan and complete the financial eligibility verification process to determine whether you’re eligible for a subsidy.

If you’re in a state that uses HealthCare.gov as its exchange , you can use this tool to find an exchange-certified broker who can help you pick a health plan. If you already know what plan you want and just need someone to help you with the enrollment process, there are also navigators and enrollment counselors who can assist you, and you can use the same tool to find them. If you’re in a state that runs its own exchange, the exchange website will have a tool that will help you find enrollment assisters in your area .

Who Does The Individual Mandate Apply To And Who Is Exempt

Almost all U.S. citizens who did not have health insurance between 2010 and 2018 may still owe a penalty fee next year or in the future based on the individual mandate. This fee comes in the form of an extra tax you must pay for the time you didnt have coverage. People who qualify for a health coverage exemption for past years includes anyone who:

  • Was incarcerated.
  • Had an income that was so low that filing a tax return was not a requirement.
  • Were members of a Native American tribe.
  • Had a religion that objects to having health insurance.
  • Belonged to a healthcare sharing ministry.
  • Was in the U.S. illegally.
  • Qualified for a hardship exemption.
  • Paid more than a certain percentage of their income to their health insurance. The IRS set the exact percentage each year.

You can also visit HealthCare.gov to learn more about exemptions from the individual mandate and how to apply for an exemption if you qualify.

Starting in 2019, though, you do not have to pay any kind of penalty fee or tax if you do not have coverage, regardless of whether or not you qualify for an individual mandate exemption. However, there are a few states that still enforce the individual mandate which well talk about below.

Types Of Plans Networks And The New Balance Billing Protection Law

There are many different types of health insurance plans. Almost every plan comes with a defined network of health care providers that your insurance company prefers. These plans will make you pay much more to purchase health services from a provider who is not included in the network. Out-of-network charges can be very large, and some health plans dont cover out-of-network services at all. These surprise bills or balance bills can come as a shocking surprise to patients after receiving services either for emergencies or for procedures in which they werent aware that one or more providers were out-of-network.

When selecting a plan, it is very important to make sure that your regular doctors or other providers are included in the network. To shop for plans, click here to use Healthplanfinder. The website has a Smart Planfinder tool to help you choose a plan by searching for your providers, facilities and prescriptions. More information about using this tool is in What Benefits Must Be Covered? below.

Insurance companies and providers are required to post information about their networks on their websites. They must also post a notice that describes your rights under this law. Learn more from the Office of Insurance Commissioner.

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When Should You Enroll In A Plan

Usually, you will need to enroll in health insurance and renew your coverage during an open enrollment period. The period for state residents to enroll in 2021 coverage through the Washington State Health Benefit Exchange is .

Apply by December 15 for coverage starting January 1, and apply by January 15 for coverage starting February 1. While Open Enrollment dates are the same on and off the Exchange, some health plans accept enrollment later in the month for coverage starting the next month if you purchase off-Exchange.

You can only enroll in insurance outside of the open enrollment period if your household has a qualifying event or special circumstance that makes you eligible for a special enrollment period.

What Types Of Coverage Exist

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Health insurance coverage comes in three major types: employer-sponsored health insurance , individual or private plans and Medicare/Medicaid. In the last decade, the number of private employers offering employer-sponsored insurance decreased significantly, from 61.6% in 2008 to 47.3% in 2018, according to the Agency for Healthcare and Research Policy. In 2010, President Obama signed the Affordable Care Act into law, which made private health insurance significantly more accessible to uninsured Americans and expanded eligibility to Medicaid.

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Ways To Get Individual Health Insurance

  • An online shopping site such as HealthMarkets
  • A licensed agent in person or over the phone, also available from HealthMarkets
  • A government-run insurance exchange
  • Directly from an insurance company
  • State-funded programs for low-income residents
  • Its important to learn about all of your options on how to get health insuranceas well as the details of what different types of plans can offer. If you’re trying to learn about how to get Medicare, check out our information on Medicare Eligibility.

    What Is Covered According To The Affordable Care Act

    Care an expectant mother or her baby receives is considered essential health benefits. That means that health plans are required to cover the cost of care for both you and your newborn, with the exception of some grandfathered plans.

    Even if you are pregnant before you obtain coverage, the ACA ensures that your pre and post-partum care will be covered. To this end, it is important to remember that you are entitled to a minimum hospital stay of 48 hours for both you and your baby. This timeline was determined and is protected by the Newbornsand Mothers Health Protection Act of 1996.

    Additionally, as long as a child is enrolled within 30 days of birth or adoption, no limitations can be placed on care regardless of any condition with which your child may be born.

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    Compulsory Health Insurance: Start Of Coverage

    Health insurance is compulsory from the time you register with a Dutch municipality or start working for a Dutch employer. You have 4 months to take out health insurance. In the meantime, you will be covered under the standard health insurance package.

    If you take out insurance within 4 months, you will have to pay premiums afterwards for those first months you were covered.

    Preventative Care And Early Intervention

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    When you don’t have insurance, you may avoid getting treated for minor issues which can escalate into bigger problems quickly. Preventive medicine and quick treatment are the best ways to avoid expensive hospital stays.

    If you have insurance, then you won’t need to worry about this as much. Additionally, if you put off going in for treatment and wind up developing a serious medical condition, you may have a difficult time finding health insurance after you have not had any for so long.

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    Tips For Buying Health Insurance

    Keep these things in mind when shopping for a health insurance plan:

  • How do you use health insurance? Are you one of those people who never goes to the doctor? Or, do you find yourself getting sick a few times every year? Are you active in taking preventive care measures? What does your family health history look like? Planning on having a baby? When shopping for health insurance, assess how much you expect to be relying on it.
  • What is your budget? This does not only include how much of a monthly premium you can afford but also extends to out-of-pocket expenses such as deductibles, copayments, and coinsurance.
  • What kind of plan do you want? Would you prefer the flexibility of a PPO? Would you like more directed care from an HMO? Personal preference plays a pivotal role in choosing a health insurance plan.
  • Compare quotes. Health plan quotes come free and under no obligation. Compare costs of similar plans that youre interested in to see where you can save money.
  • Examples Of Potential Health Insurance Plans

    While the array of potential options is fairly complex when it comes to health insurance, plans can be categorized into a few different types.

    Traditional or fee-for-service plans are the original type of health insurance. You can go to any doctor, hospital, or specialist you’d like, but in exchange, you’ll pay more expenses out of pocket, have a deductible, and may only receive 80% coverage on remaining medical bills.

    Managed Care insurance plansinclude Preferred Provider Organizations , Point-of-Service , and Health Maintenance Organizations . All of these plans work only with providers in a closed network. In exchange, patients pay lower premiums and have lower or no copays. PPO and POS insurance allows patients to go to providers outside their network and self-refer to a specialist, while PPOs are the lowest-cost plans, but don’t pay for any out-of-network visits, and patients must be referred to specialists by their doctor.

    High-deductible insurance plans, sometimes known as catastrophic plans,are much lower in cost than other insurance plans, although you’ll have to pay a large amount of out-of-pocket money if you need care, so it still makes sense to put money aside each month, even if it’s into your own savings account instead of paid as a premium for insurance.

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    How Do I Avoid The Individual Mandate Tax

    To avoid this penalty and protect yourself from the potential financial burden of unexpected medical expenses, you can enroll in a health insurance plan during the open enrollment period. For 2021 coverage, the national open enrollment period will take place from November 1st 2020 through December 15th 2020. Some states have extended this period. To learn about your states open enrollment period, read our article, 2021 Obamacare Open Enrollment Dates by State.

    If you lose your insurance in the middle of the year, you may qualify for a special enrollment period to purchase an ACA-compliant plan on the public exchange. You may buy an ACA-compliant plan outside the public exchange anytime. Depending on which state you live in, you may be able to enroll in short-term health insurance to help fill any coverage gaps you may experience throughout the year.

    Your health and financial well-being are important to us. As the largest online health insurance broker, eHealth offers a variety of health insurance plans to fulfill your coverage needs, wherever you live in the United States. These include on and off exchange ACA-compliant plans, major medical insurance, and short-term health insurance. Let us help you explore your coverage options now. Simply click Individual & Family Health Insurance to find affordable insurance. Our licensed insurance agents are here to help you and share their expertise as you consider your choices.

    Do I Have To Get Health Insurance For My Baby Before It Is Born

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    The topic of insurance can be a complicated and confusing conversation. The great news is you dont have to worry about getting health insurance coverage for your baby before he or she is born.

    With the Affordable Care Act , new parentswhether by birth or adoptionhave 30 days to obtain coverage for their new baby. Expenses incurred within those 30 days will be covered retroactively.

    This means that if your baby is born on the first of the month, you have until the 30th of that month to let your insurance company know your childs name, date of birth, and social security number.

    Insurance companies understand that your baby will undergo standard tests and immunizations before the 30th of the month. Those expenses incurred during your childs first 30 days will be eligible for coverage as long as you enroll by day 30. So dont worry about that first check-up and immunizations youll have plenty of time to cover it.

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    Health Insurance For $10 Or Less A Month You May Qualify For New Discounts

    If you have a chronic medical condition or are simply more risk averse, you might instead choose a plan that has dialed up the amount of the premium. You’ll be forking over quite a bit more than for the other plan every month, but your costs will be more predictable you’ll likely have a lower deductible and lower coinsurance rate. That way, you can go to a lot of appointments and pick up a lot of prescriptions and still have manageable monthly costs.

    Which plans are available and affordable to you will vary a lot depending on where you live, your income and who’s in your household and on your insurance policy. With the pandemic, Congress passed new temporary funding to cover more out-of-pocket costs for people depending on your income, you may qualify for plans with premiums of $10 or less per month on HealthCare.gov or onyour state’s ACA insurance exchange.

    Health Insurance And The Affordable Care Act

    As of 2019, you will no longer have to pay a penalty on your federal tax return if you’re not insured, as the fine was rescinded for the 2019 tax year, though some states may still have mandates.

    Even though there’s no longer a penalty, you’re protecting both your health and your financial status by taking out a health insurance policy.

    There are health insurance exchanges or marketplaces in each state that you can use to , or you can look at other options such as your employer’s health care plan or health share ministries.

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    What Is Health Insurance

    Health insurance is a contract between an insurance provider and an insured party that requires the provider to cover medical expenses related to illnesses, injuries or other conditions. These expenses may include doctor visits and consultations, hospitalization, emergency services, surgery, laboratory tests, prescription medication, maternity and newborn care, mental health, ambulance rides and rehabilitation services. Health insurance may also cover some dental expenses, though separate dental insurance is common.

    Health insurance generally doesnt cover cosmetic procedures like plastic surgery, laser hair removal or body contouring, nor does it cover fertility treatments, off-label prescription use or new and experimental technologies. Exactly what health insurance does cover varies by plan, provider and state.

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    If you’re pretty healthy, any of a variety of plans might work. But if you or your spouse or dependent family member has particular ongoing health needs , that information can be really useful in helping you narrow the field to your best health insurance choice. “If there’s a plan that doesn’t have your provider or your medications in-network, those can be eliminated,” he says.

    Sometimes you can enter in your medications or doctors’ names while you search for plans online to filter out plans that won’t cover them. You can also just call the insurance company and ask: Is my provider in-network for this plan I’m considering? Is my medicine on the plan’s formulary ?

    There are also two major different types of plans to consider. “You may have a choice between what’s called an HMO or a PPO,” says Corlette. A Health Maintenance Organization tends to have a strict network of providers if you see a provider outside of the network, the costs are all on you. A Preferred Provider Organization “will give you a lot broader choice of providers it might be a little bit more expensive to see than an out-of-network provider, but they’ll still cover some of that cost,” she explains.

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    How Health Insurance Coverage Works

    When you have insurance, you pay some costs and your insurance plan pays some:

    • Premium: A premium is a fixed amount you pay to your insurance plan, usually every month. You pay this even if you do not use medical care that month.
    • Deductible: If you need medical care, a deductible is the amount you pay for care before the insurance company starts to pay its share. Once you meet your deductible, your insurance company begins to cover some costs of your care. Some plans have lower deductibles, like $250. Some have higher deductibles, like $2,000. Many plans provide preventive services, and sometimes other care, before youve met your deductible.
    • Co-pay: A co-pay is a fixed amount you will pay for a medical service. For example, a visit to the doctors office might cost $150 if you didnt have coverage. With health insurance, you may pay only $25 and the health plan would pay the rest.
    • Co-insurance: Co-insurance is similar to co-pay, except its a percentage of costs you pay. For instance, you may pay 20% of the cost of a $200 medical bill. So you would pay $40 and the health plan would pay the rest.

    What Is The Affordable Care Act

    The Affordable Care Act provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. Under the ACA:

    • You may be able to purchase health care coverage through a state or federal marketplace that offers a choice of plans.

    • Insurers can’t refuse coverage based on gender or a pre-existing condition.

    • There are no lifetime or annual limits on coverage.

    • Young adults can stay on their familys insurance plan until age 26.

    • Seniors who hit the Medicare Prescription Drug Plan coverage gap or “donut hole” can get a discount on medications.

    Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.

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