Q: How Does The Affordable Care Act Help Young Adults

Before the Affordable Care Act, many health plans and issuers could remove adult children from their parents’ coverage because of their age, whether or not they were a student or where they lived. The Affordable Care Act requires plans and issuers that offer dependent child coverage to make the coverage available until the adult child reaches the age of 26. Many parents and their children who worried about losing health coverage after they graduated from college no longer have to worry.

How To Shop For Health Insurance

Note: Some parts of the Affordable Care Act are being changed or eliminated via government policies and laws. It is likely that some of the rules and regulations affecting the health insurance marketplace will continue to change over time. To stay up to date on Obamacare and other health insurance issues, visit healthcare.gov and the website of the health commissioner’s office in your state.

In America today, we all need health insurance. You do. Your kids do. It’s not a “nice to have” anymore it’s a “must-have.” And that’s the law. In most cases, parents who aren’t covered by health insurance might have to pay a fine each year. Going without also means that if someone gets sick or is injured, a family might have to pay all the bills for care received. That can cost a whole lot more than paying for coverage.

To help people get health insurance, the federal and state governments set up a health insurance marketplace . This makes it easier than ever to get coverage, but the process can seem a bit confusing.

Here’s what to do to get health insurance.

Purchasing Health Care Coverage Through The Marketplace And Reporting Changes

Each year the Health Insurance Marketplace has an open enrollment period and special enrollment periods for eligible taxpayers. For information about enrollment periods, visit HealthCare.gov or contact your state-based Marketplace.

If you enrolled in insurance coverage through the Marketplace, you should report any changes in your circumstances like changes to your household income or family size to the Marketplace when they happen. Changes in circumstances may affect your advance payments of the premium tax credit. When you report a change in circumstances, you may become eligible for a special enrollment period, which allows you to purchase health care insurance through the Marketplace outside of the open enrollment period. Visit the Marketplace at HealthCare.gov for more information about reporting changes in circumstances and special enrollment.

To estimate the effect that changes in circumstances may have upon the amount of premium tax credit that you can claim – see the Premium Tax Credit Change Estimator on our Affordable Care Act Estimator Tools page.

Find out more about the Premium Tax Credit and other tax provisions of the Affordable Care Act at IRS.gov

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Q1: May Employees Purchase Health Care Coverage For Their Adult Child On A Pre

Yes. In addition to the exclusion from income of any employer contribution towards qualifying adult child coverage, employees may pay the employee portion of the health care coverage for an adult child on a pre-tax basis through the employer’s cafeteria plan – a plan that allows employees to choose from a menu of tax-free benefit options and cash or taxable benefits. The IRS provided in guidance Notice 2010-38 that the cafeteria plan could be amended retroactively up until December 31, 2010 to permit these pre-tax salary reduction contributions.

Health Coverage For People With Disabilities

If you have a disability, you have three options for health coverage through the government.

• Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.

• Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.

• Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .

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Health Marketplace: Buying Your Own Health Insurance

Insurance you buy from a company or the marketplace is individual insurance. Itâs sold to individuals, not to members of a certain group.

You can buy individual coverage through:

• An insurance company or health maintenance organization
• A licensed health insurance agent who has a relationship with one or more insurance companies
• Healthcare.gov, the online federal health insurance Marketplace
• Theâ¯Plan Finderâ¯on Healthcare.gov for individuals and small businesses
• Aâ¯Navigatorâ¯approved to help with Marketplace enrollment

What To Look For When Choosing A Policy

The important words to remember when shopping for a policy are “premium” and “deductible.” The premium is the amount you pay each month for coverage. The deductible is the amount you need to pay each year for medical services before your health insurance kicks in. As a general rule, insurance plans with low premiums have high deductibles, and plans with high premiums have low deductibles.

These are the basic levels of coverage:

• Catastrophic insurance is designed to protect an otherwise healthy person in the event of a major injury or illness. It’s available only to people under age 30 and those who are exempt from other plans due to hardship. This type of insurance can have low premiums but very high deductibles. Plans generally cover less than 60% of the costs of health care.
• Bronze plans also have low premiums and high deductibles, but they offer better coverage than catastrophic insurance, typically paying for 60% of costs.
• Silver plans and gold plans have average-sized premiums and average-sized deductibles. Silver plans cover 70% of costs. Gold plans pay 80% of costs.
• Platinum plans, the highest level of coverage, have high premiums and low deductibles. These plans cover 90% or more of health care costs.

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Navigating The World Of Government & Private Health Insurance Plans Is Easier With Ehealth

When you leverage eHealths easy-to-use tools and exceptional service, youll arrive at the right plan faster. Not sure if your medicine is covered? You can filter your options by prescription coverage, giving you greater confidence in your search. Have questions about your application? Its knowledgeable service team will answer them, and even follow up with your insurer to make sure your coverage starts ASAP. Quote health insurance for your family or yourself the fast, free, and easy way today.

Higher Premiums More Coverage

In general, the higher your premium, the lower your out-of-pocket costs such as copays and coinsurance . A plan that pays a higher portion of your medical costs, but has higher monthly premiums, may be better if:

• You see a primary physician or a specialist frequently.

• You frequently need emergency care.

• You take expensive or brand-name medications on a regular basis.

• You’re expecting a baby, plan to have a baby or have small children.

• You have a planned surgery coming up.

• Youve been diagnosed with a chronic condition such as diabetes or cancer.

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Look For Comprehensive Coverage Benefits

The next step in buying the best health plan for the family is to ensure that the plan has all the necessary coverage benefits. Ensuring a comprehensive coverage is important so that all possible medical expenses get covered. Moreover, when considering the coverage benefits, you need to ensure that the benefits are suitable to your requirement.

For example, a newly married couple must opt for a health plan with maternity benefit. This coverage would ensure that when you have a child, the related costs of child birth would be covered by the plan and you would not face any financial burden.

Similarly, if you incur OPD expenses quite frequently, plans which cover such expenses would be beneficial.

How Do I Get Individual Health Insurance

You can get individual health insurance and compare prices from all carriers in one place with a marketplace, like eHealth. Marketplaces offer more support to help you find the right plan that suits your needs at no extra cost to you. To get coverage, simply enter some basic information and compare quotes from carriers in your state.

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Self Insured Health Plans

Many large employers are self-insured. A self-insured employer has a large pool of money and uses it to pay for the health care of employees. The employer most often contracts with insurance companies to manage the health benefits.

It is important to know if your employer is self-insured! Why? You may not have the same protections and benefits as other types of coverage. Self-insured plans do not have to follow California laws on essential health benefits, complaints, and coverage.

Self-insured plans issued by private companies follow the Federal Employee Retirement Income Security Act of 1974 and are regulated by the U.S. Department of Labor, Employee Benefits Security Administration . Visit the Ask EBSA page for more information or call them at 1-866-444-3272.

Comparing Health Insurance Plans: Hmo Vs Ppo Vs Epo Vs Pos

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Consider Whether You Want A Referral System Of Care

Plans that require referrals

If you choose an HMO or POS plan, which require referrals, you typically must see a primary care physician before scheduling a procedure or visiting a specialist. Because of this requirement, many people prefer other plans. However, by limiting your choices to providers they’ve contracted with, HMOs do tend to be the cheapest type of health plan.

A benefit of HMO and POS plans is that theres one primary doctor managing your overall medical care, which can result in greater familiarity with your needs and continuity of medical records. If you do choose a POS plan and go out-of-network, make sure to get the referral from your doctor ahead of time to reduce out-of-pocket costs.

Plans that don’t require referrals

If you would rather see specialists without a referral, you might be happier with an EPO or a PPO. An EPO may help keep costs low as long as you find providers in-network this is more likely to be the case in a larger metro area. A PPO might be better if you live in a remote or rural area with limited access to doctors and care, as you may be forced to go out-of-network.

Terms To Know When Quoting Individual Or Family Health Insurance

Finding a health insurance plan that covers your family and fits your budget requires a little familiarity with insurance terms. After all, if youre not sure what co-insurance or deductible means, you may not know the true cost of your health insurance. Heres a quick rundown of the most common terms youll see when comparing plans and how they shape the total cost of your plan:

• Premium: Your premium is the amount you pay on a monthly or other regularly scheduled basis to keep your coverage.
• Deductible: Your deductible is the annual amount you pay out of pocket for medical care before your insurance pays out.
• Co-pay: A co-pay is a fixed amount you pay for certain services, such as X-rays or specialist visits. Depending on the policy or insurer, your co-pay may count towards your deductible.
• Co-insurance: This is the percentage of your medical bills you pay once you reach your annual deductible. Some plans may pay for all your covered services after you meet your deductible.

When you quote health insurance with eHealth, you can see each plans office visit co-pay, deductible, and monthly premium amount all at once, making comparison shopping easy.

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Covered California: California’s Healthcare Marketplace

As part of the Affordable Care Act, California created a health insurance marketplace called Covered California. Through Covered California, individuals, families, and small businesses can purchase insurance products sold by private insurers. Covered California also helps individuals and families determine if they qualify for the Medi-Cal program and subsidies from the federal government toward purchase of a private insurance plan. Visit Covered California for more information about getting coverage.

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We believe everyone should be able to make financial decisions with confidence. And while our site doesnt feature every company or financial product available on the market, were proud that the guidance we offer, the information we provide and the tools we create are objective, independent, straightforward and free.

So how do we make money? Our partners compensate us. This may influence which products we review and write about , but it in no way affects our recommendations or advice, which are grounded in thousands of hours of research. Our partners cannot pay us to guarantee favorable reviews of their products or services.Here is a list of our partners.

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Choose The Right Policy

Health insurance plans come in different variants and each variant provides a specific type of coverage. So, the next step would be to zero in on the right policy for your family.

Here are the commonly available health plans

So, ideally, you can opt for one family floater policy covering yourself, spouse and dependent children. If you have dependent parents, you may opt for a separate senior citizen policy for them.

Even in case of dependent children, remember that the family floater policy would cover them till 23 or 25 years of age. Once your children cross this age, an independent health insurance plan would be needed for them in most plans.

Also, along with an indemnity health insurance plan for your family, a critical illness plan is also recommended. The policy would cover dreaded illnesses, which have become common in recent times, and give you a lump sum benefit to meet the expensive treatment costs. So, you can opt for a critical illness policy for complete coverage for the family.

A Business Owner Who Has Employees

If you start a business and you have employees, you might be required to offer them health insurance. Even if its not required, you might decide to offer health insurance to be a competitive employer that can attract qualified job candidates. In this situation, you will be required to purchase a business health insurance plan, also known as a group plan.

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How Do I Get Health Insurance Without A Job

An estimated 49% of Americans get health insurance through their employer, but you do not necessarily have to do so. The Affordable Care Act was intended to make health insurance more accessible for all US citizens, and you don’t need to be employed to qualify for an ACA health insurance plan. Individuals with income restrictions may also qualify for a subsidy to help pay for health insurance.

You have a lot of options available, but it can also be confusing to navigate the waters by yourself. That’s where a licensed agent at eHealth can help. When working with our helpful agents and using tools like our plan comparison tool, you can find a health insurance plan that works for your budget and provides the coverage you need. eHealth’s team can also help you determine whether or not you qualify for an ACA subsidy.

Individual Versus Family Plans

An individual plan has one member, or just one person covered by the plan. Family plans cover two or more members.

Your plan’s deductible and out-of-pocket maximum are based on whether you have an individual or family plan.

The deductible and out-of-pocket maximum for a family plan is usually double of an individual plan. So if the deductible for a plan is $2,000 for a family, it’s $1,000 for an individual. If the out-of-pocket maximum for an individual plan is $6,000, it will be $12,000 for a family, no matter how many people the plan covers.

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When Can I Start Using My Insurance

Once you’ve signed up for a plan and paid the first month’s premium, you or your child can start using the insurance. The insurance company should send you and everyone covered by your policy insurance cards with your policy number and other information. If you or your child need to see a doctor or go to a hospital before you receive your card, call your insurance company first to make sure your family has been entered into their system.

You should also make sure that any doctor you choose for you or your child is in your insurance plan’s network. A network is made up of doctors, specialists, and other health care providers who have agreed to work with your insurance company when it comes to payments and services. If you take your child to a doctor who isn’t in your plan’s network, you may have to pay full price for some services.

Ask around and learn what you can about the primary care physicians in your plan’s network, and then choose a doctor you like. Once you’ve done that, schedule checkups and use your insurance to help keep your family healthy.