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Finding a health insurance plan that aligns with your budget can be a daunting task. Explore the following avenues to ensure you and your family are adequately protected with the right health insurance coverage.
Exploring Health Insurance Coverage Options
There are four primary types of health insurance coverage: employer-sponsored health insurance, individual or private plans, Medicare, and Medicaid.
According to the Kaiser Family Foundation, more than half (56%) of private sector employees have coverage through employer-sponsored health insurance plans.
Individual health insurance, separate from employer offerings, has become more prevalent since the Affordable Care Act (ACA) implementation in 2014. This legislation established a health insurance marketplace, allowing consumers to compare plans, access premium tax credits, and subsidies to lower costs.
- Insurance through an employer:
- Employer-sponsored group health insurance is selected and mainly funded by your employer.
- Plans may cover dependents, such as spouses and children.
- Employers contribute significantly to health insurance premiums, with employees typically paying premiums on a pre-tax basis.
- Individual health insurance:
- Purchased for yourself or your family through the ACA marketplace or directly from an insurance company.
- Offers flexibility to choose plans that align with your preferences and includes the option to change jobs without losing coverage.
- Annual renewal and adjustment of plans are possible.
- Medicare:
- A federal program providing health insurance for those over 65, individuals under 65 with specific conditions, such as disability, end-stage renal disease, or ALS.
- Medicaid:
- A jointly administered state and federal program providing health insurance to eligible low-income individuals, pregnant women, children, people with disabilities, and elderly adults.
5 Ways to Obtain Health Insurance:
- ACA Health Insurance Marketplace:
- Allows individuals, families, and small businesses to access and compare plans.
- Offers opportunities to enroll during open or special enrollment periods.
- Health Insurance Broker or Agent:
- Assists in navigating insurance options without charging fees.
- Licensed professionals who can provide personalized guidance.
- Directly from a Health Insurance Company:
- Allows individuals to explore plans that suit their needs and budget.
- May bypass ACA marketplace benefits.
- Membership Organizations and Association Health Plans:
- Eligible for those without employer-provided insurance.
- Group health plans offered through professional or trade organizations. Be cautious of health care-sharing ministries and “health services discount” plans, as they do not provide comprehensive coverage.
When to Sign Up for Health Insurance:
- Open enrollment for private health insurance through the federal marketplace occurs annually from Nov. 1 to Jan. 15.
- Special enrollment periods are available for qualifying life events, lasting 60 days after the event.
Short-term Health Insurance Plans:
- Available outside open enrollment but may not meet ACA coverage requirements.
- Regulated for up to 364 days with the option to renew, not available in every state.
Health Insurance Costs:
- Unsubsidized ACA marketplace premiums vary by age.
- Average monthly costs for individuals range from $365 (21-year-old) to $994 (60-year-old).
Common Health Insurance Scams:
- Beware of robocalls and phishing emails promoting “comprehensive” health plans.
- During open enrollment, be cautious of callers impersonating marketplace representatives offering special rates.
FAQs:
- Retired Individuals (age 65 and over): Eligible for Medicare; options include Original Medicare or Medicare Advantage from private insurers.
- Individuals with Disabilities: Coverage available through Medicare, Medicaid, or ACA marketplace with potential subsidies.
- Self-employed Individuals: Options include ACA marketplace, direct purchase from insurance companies, or eligibility for Medicare or Medicaid.