How To Find An Affordable Health Insurance Plan
Finding a health insurance plan that fits you and your needs doesn’t have to be a pain. When shopping for an affordable health insurance plan, it’s important to know what makes a plan affordable to you, specifically. Do you rarely utilize health care services? A high deductible, low premium plan probably makes sense for you. Are you managing a chronic illness? A health insurance plan that has higher premiums, but has lower out-of-pocket costs, will probably be more affordable in the long run.
Learn more in this guide on how to get affordable health insurance.
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Meet The Terms Of Your Policy
It is your responsibility to know and understand the terms of your insurance policy. Read the fine print carefully and ask for help, if you need it.
The information you provide must be accurate and complete. If you have any questions, contact the insurance company. Ask them to clarify the issue in writing.
Get approval from your insurer before you undergo medical treatment. Travel health insurance rarely covers routine health checkups, non-emergency care and cosmetic surgery. It may not cover mental health disorders, drug- or alcohol-related incidents, or extreme sports such as bungee jumping and rock climbing.
Get a detailed report and invoice from your doctor or hospital before leaving the country where you received medical treatment. Trying to get the proper paperwork from thousands of kilometres away can be frustrating. Always submit the original receipts for medical services or prescriptions you received abroad. Keep a copy of the documents for your files.
Carry your insurance information with you while you are travelling. Leave a copy of the information with a friend or relative at home.
What If You Have Medicaid
If your application for Medicaid is approved, then coverage will begin on either the day that you applied or the first day of the month that you applied. The specific rules will depend on your state and should be explained in your application. If you are uncertain, go to your states Medicaid website.
What If You Have COBRA?
COBRA allows you to continue your health benefits provided by your employer with no break in coverage for a year or more, typically when you lose your job. Most likely, you will be required to pay your premiums and all medical bills on your own, since your old employer will stop contributing typically burdening you with hefty costs. But you still have continuous insurance coverage.
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What Other Benefits Should I Consider
When you’re comparing health plans, look for useful tools and services that may come at no additional cost and help you save time and money, and support your health.
- Websites and mobile apps
- A health information phone line for help finding answers to your medical questions
- Discount programs to help save on health and wellness products and services
Which Type Of Health Insurance To Buy
Generally, there are twotypes of health insurance: public health insurance andprivate health insurance. Most people have some form of private health insurance, whether they purchase it through a marketplace or get it from an employer. State exchanges and the federal exchange can offer consumers both public health insurance and private health insurance.
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Types Of Individual Health Plans
Individual health insurance plans dont differ in terms of benefits. However, plans vary on costs, how theyre structured, which doctors accept them and which prescription drugs they cover.
Health plans in the ACA marketplace are divided into four metal tiers to make comparing them easier. The tiers are based on the percentage of medical costs the plans pay and the portion you pay out of pocket. Out-of-pocket costs include deductibles, copayments and coinsurance. Find out more about copays and coinsurance.
The percentages are estimates based on the amount of medical care an average person would use in a year.
- Bronze — Plan pays 60% of your health care costs. You’re responsible for 40%.
- Silver — Plan pays 70% of your health care costs. You responsible for 30%.
- Gold — Plan pays 80% of your health care costs. You responsible for 20%.
- Platinum — Plan pays 90% of your health care costs. You responsible for 10%.
Tip #: Get Trustworthy Professional Help For Free
Still feeling overwhelmed with all the ACA choices? You’re in luck. There is free, impartial professional help available to help you choose and enroll in a plan. Just put in your zip code at Healthcare.gov/localhelp and look for an “assister” a person also referred to as a health care navigator on some state websites.”
Aaron DeLaO is one such navigator, and notes that he and his fellow guides don’t work on commission they’re paid by the government. “We’re not contracted with insurance agencies,” he says. “We do it completely autonomously, impartially. It’s about what’s best for the consumer.”
In 2021, the Biden administration quadrupled the number of navigators ahead of open enrollment.
Insurance brokers can be helpful, too, says Corlette. “Brokers do get commissions, but in my experience, the good brokers want repeat customers and that means happy customers,” she says. To find a good broker, she advises, “go through either Healthcare.gov or your local state department of insurance to find somebody that’s licensed and in good standing.”
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Tip #: Know Your Deadlines
Usually you only get a few weeks in the fall to sign up. This year, the sign up period for the HealthCare.gov marketplace plans that go into effect in January 2022 starts Nov. 1, 2021 and runs until Jan.15, 2022. If you’re signing up for an employer-sponsored plan or Medicare, the deadlines will be different, but probably also in the fall. For Medicaid, you can enroll at any time of the year.
DeLaO, the health navigator, says even if you’re already enrolled in a plan that seems fine and it’s tempting to just let it automatically renew, it’s always a good idea to annually check what else is available.
“Are you eligible for additional subsidies to lower the cost of your monthly premium?” he says. “Is there a plan that with those increased subsidies you can now get a silver plan as opposed to a bronze plan, which lowers your deductible your copayments?”
Figuring out the right plan for you doesn’t have to require a huge time commitment, he says. His team aims to get people in and out enrolled in a plan in an hour and a half. And those appointments don’t have to be in person customers can get help by phone and can often do everything they need to do to get signed up virtually.
Though signing up for health insurance can be confusing at first, it’s also very important for your wallet and your health. Hang in there and know there are people out there eager to help you make sure you get covered.
When To Buy An Individual Health Plan
You can purchase or make changes to individual health insurance during the open enrollment period. Open enrollment for most states is from . States with their own exchanges usually offer expanded open enrollment.
States with expanded open enrollment include California, Colorado, the District of Columbia, Massachusetts, Minnesota, Nevada, New Jersey and New York.
The only other time you can get individual health insurance coverage is if you have a qualifying event that launches a special enrollment period. These events may have caused you to lose your health insurance coverage. The special enrollment sign up period lasts 60 days.
Special enrollment qualifying events include:
- Getting married
- Having a baby, adopting a child or placing a child for adoption or foster care
- Becoming a U.S. citizen
- Leaving incarceration
- Losing other health coverage due to job loss, divorce, COBRA expiration or aging off a parents plan
- Losing eligibility for Medicaid or the Childrens Health Insurance Program
- Change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies
- Gaining status as a member of an Indian tribe
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When Can I Purchase Coverage
Usually, you can only purchase a new individual/family policy or make changes to your existing policy during California’s open enrollment period. That period usually begins during November and ends in January. Contact your insurer, licensed agent or the Department of Insurance for exact open enrollment dates.
You can purchase or change coverage outside of open enrollment if you have a Qualifying Life Event including, but not limited to:
- Lost or will soon lose your health insurance
- Permanently moved to California Had a baby or adopted a child
- Got married or entered into a domestic partnership
- Returned from active military service
- Gained citizenship/lawful presence
- Federally recognized American Indian or Alaska Native
For other qualifying life events, ask your insurer, licensed agent, or contact the Department of Insurance’s Consumer Hotline at 927-4357 .
You have sixty days from your qualifying life event to enroll or make changes to your policy. For example, if you adopt a child on June 1st, you will have until July 31st to enroll your child. If you miss this window, you will have to wait until the next open enrollment period.
When does my coverage start?
It is important to pay attention to enrollment deadlines to avoid gaps in your coverage.
Can I be denied coverage?
Health insurers cannot refuse to sell you a policy even if you have a pre-existing condition or are currently sick.
Can a policy limit services to people with pre-existing conditions? No
Why Adverse Selection Is Bad For Everyone
The whole system would fall apart if all of the healthy people thought to themselves, Why should I pay $6,000 per year for health insurance? Im healthy. Ill just save that $6,000 and wait until Im sick to buy health insurance.
Then, only the sick peoplethe people whose claims total more than their premiumswould enroll in health insurance. The health plan wouldnt take in enough money in premiums to pay all of the claims. If this happened, the health plan would have two options: go out of business or raise premiums.
If it goes out of business, thats bad for everyone. Wed all have fewer available options when shopping for health insurance, and there would be less competition. Fewer health insurance companies competing for business means there’s less incentive for health plans to provide good customer service and less incentive for them to keep premiums low to attract customers.
If it raises premiums, thats also bad for everyone. We’d all have to pay more for health insurance. As premiums increased, healthy people would be even more likely to think to themselves, Why pay that much for health insurance? Ill just wait until Im sick and then enroll in a health plan. This would cause premium rates to spiral upwards until nobody could afford health insurance. This is known as a death spiral, and it’s obviously a situation that has to be avoided.
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Applying For Health Insurance Doesn’t Have To Be Confusing Here’s A Handy Glossary
Whether you’re aging out of your parent’s plan and picking one for the first time, or you’re in a plan that no longer works for you and you’re ready to switch things up, or you’re uninsured and want to see if you have any workable options, there’s good news. Asking yourself a few simple questions can help you zero in on the right plan from all those on the market.
Here are some tips on where to look and how to get trustworthy advice and help if you need it.
Buyer Beware: New Cheaper Insurance Policies May Have Big Coverage Gaps
“Unfortunately, there are a lot of con artists out there who take advantage of the fact that people recognize health insurance is something that they should get,” says Corlette. She tells people: “Just go straight to Healthcare.gov. No matter what state you live in, you can go through that portal.” Any plan you find there will cover the ACA’s 10 essential benefits such as free preventive care and hospital coverage.
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Benefits Of Having A Health Insurance Policy
Signing Up For Affordable Care Act Insurance Is Simple With Ehealth
Buying government health insurance online can be challenging. eHealth makes it easy to apply at no cost to you, providing an application guarantee and ensuring your application gets in on time. Plus, you’ll have access to the widest selection of plans available online, as well as tools that make sure your prescriptions are covered and your doctors are in network.
Get the latest updates on government health care.
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How Much Flexibility Do You Want In Your Plan
When choosing an individual health plan, you want to consider the type of benefit design. Health maintenance organization plans are the most common plan design in the individual market. eHealth estimated that 49% of individuals plans are HMOs.
HMOs include restricted provider networks. HMO members can only see doctors and get care from facilities in those networks. Also, you need a primary care provider referral to see a specialist.
Exclusive provider organization plans make up one-third of individual market plans. These plans dont allow you to get care outside of the network, but you also dont need a referral to see a specialist.
Preferred provider organization plans are the most common type of plan in the employer-sponsored health insurance market. Forty-seven percent of employer-sponsored health plan members have a PPO. However, only 16% of individual health insurance plans are PPOs.
PPOs are more flexible. You can see doctors both in your network and outside the network. You dont have to get referrals to see specialists. However, PPOs have much higher premiums than HMOs, so you pay more for that flexibility.
What If I Dont Have A Qualifying Life Event
If you missed open enrollment and arenât eligible for a special enrollment period, you still have a few options.
Medicaid: This federal and state insurance program is open year-round. Eligibility is based mostly on income, pregnancy, disability, age and household circumstances. Three dozen states and the District of Columbia cover all residents who earn less than 133% of the poverty level.
Off-exchange insurance: Some private insurers sell these plans year-round. While they adhere to ACA rules, they arenât eligible for premium subsidies.
Short-term health plans: Unregulated by the ACA, these are more of a stopgap measure until you can get into a regular health plan. Short-term health plans donât provide full coverage and may not cover pre-existing conditions.
Health care sharing ministries: These faith-based alternatives arenât regulated by the ACA or subject to its rules. Members pay a monthly sharing amount, analogous to a premium, and agree to abide by ministry rules, such as attending worship services or avoiding ânon-Biblical lifestyles and choices.â
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How To Cancel Health Insurance
Unlike enrolling in health insurance, you can cancel your health insurance at any time. You may choose to cancel your existing plan if you become eligible for health coverage in another way, like through your job.
To cancel, contact your insurance provider or the health insurance marketplace where you purchased your plan. You can usually either cancel immediately or choose a specific date to end your coverage. You may need to fill out some forms to make the cancellation official.
However, its very important to make sure you have other plans in place for your medical care. Remember while you can usually cancel your health insurance anytime, you cant usually enroll anytime: only during annual open enrollment or a special enrollment period.
Before canceling your health insurance plan, make sure youve thought through what youll do if you need medical care and how youll pay for it.
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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What Are The Advantages Of Individual Health Insurance
Withemployer-sponsored health insurance, your employer shops and chooses healthcoverage for you. Your employer also decides your share of the total premiumcost for group health coverage. Your employers decisions are usually based ondelivering health insurance that meets the needs of most employees and fallswithin the companys budget. They choose your coverage options and you choosefrom there. However, when shopping for your own health insurance which isalso called individual health insurance youre in charge of choosing yourhealth insurance plan.
- You choose the insurance company and the plan that best suits your personal needs and budget. You may be less likely to pay for benefits you dont need or pay out-of-pocket for health care that is not covered by your plan.
- You can verify your preferred hospitals, healthcare providers, and medications are included in your health plan choice prior to enrollment.
- Your coverage is not tied to your job, so you can change jobs without potentially losing your health insurance
- You may qualify for federal or state assistance in order to afford your health insurance