Figuring out how to get health insurance for the first time, or finding a new plan in a new state or after the passing of new regulations, can feel overwhelming.
If you are not already familiar with health insurance terminology or the different sorts of basic health insurance plans you may come across in your state marketplace, you should start your research on how to get health insurance. Understanding the basics of health insurance plans is essential for being able to choose which one is best for you. In addition to quickly reviewing the most common healthcare plans, you can discover the most important features to compare when trying to choose the best healthcare plan to meet your needs. Once you have a good idea of what each health insurance plan offers in relation to the others available, it will become easier to figure out which plan prioritizes the same aspects of healthcare that you do.
To make sure you are indeed getting the best deal on health insurance available in your area, you can review the many ways that you can find affordable health insurance. While most people will begin their health insurance plan research at their state healthcare marketplace, it is important to check other additional sources of insurance plan opportunities like third-party online aggregators or individual insurance brokers. If you are employed, you may be eligible for some form of work-related health insurance. While the Affordable Care Act (ACA) does include regulations concerning an employer’s obligations to offer employees access to decent healthcare, not all employers are required to follow these regulations based on a few important criteria. There are a couple of different ways your employer may be able to provide you with subsidized health insurance. Another possible health plan is COBRA Continued Health Insurance. COBRA coverage is available to many newly unemployed workers if they had health insurance coverage during their employment. Before getting your health insurance directly from your state healthcare marketplace, make sure to check your eligibility for these other healthcare options.
With so many important details within every different type of insurance plan, it is impossible to become intimately familiar with the ins and outs of all available health insurance plans. To make it easier to choose a health care plan, you can pick out the most important features of the plans and compare them across health plans. Each individual applying for health insurance will have her own medical priorities and should make sure to keep these in mind when weighing the pros and cons of available plans. Once you are comfortable with the basic structures of each common type of healthcare plan, you can begin with the feature comparison.
Begin with whatever healthcare plan features matters the most to you. Then, start going down the list to see which plans meet at least your minimum requirements for a suitable healthcare plan. You may want to consider essential aspects like the medical insurance plan’s out-of-pocket costs, including the premium, deductible and/or copayment costs. For some plan beneficiaries, the degree of access available to plan enrollees to medical provider networks can be a deciding factor as well. Other features that could tip the scales for you in one direction or another include your freedom of choice for seeing medical specialists without a referral from a primary care doctor, the claims procedures, prescription drug policies and many more.
Especially for those of you who are shopping for health insurance in the public marketplace for the first time, the price tags of some programs can be intimidating. All health plans available through the state marketplace and available through your job should follow the regulations laid out in the Affordable Care Act (ACA) unless they are subject to certain exceptions. ACA regulations state that every individual should be able to choose their healthcare plan from at least a couple of options that were deemed “affordable” by being less than a certain percentage of the plan beneficiary’s income. For those people who find that even those healthcare programs deemed technically affordable by the ACA are still outside of their budget, some additional research may be able to turn up even more affordable options for health care. Once shopping outside of your state’s official state marketplace, however, make sure that whatever healthcare plan you are reviewing meets all the basic ACA regulations to provide you with minimum coverage benefits.
If you would like to see what private health insurance plans may be available to you by local insurance agency’s or other offers that may not be on the state health insurance marketplace, there are a few ways you can start looking. If you are not already familiar with any existing health insurance offered by your employer, learn more about it. Job-related health insurance, which is usually partially subsidized by the employer, is often a more affordable option than those found on the insurance marketplace. You can also do a quick online search through a third-party web aggregator to see if it turns anything new up. Like when searching for airline flights, this method can sometimes produce surprising results. It is also a good idea to look into any government health programs that you may be eligible for, such as Medicare, Medicaid or CHIP for your children. Independent insurance brokers with a legal responsibility to work for clients (not insurance providers) can be a big help for those of you facing complicated medical histories and needs.
While some employers are happy to spend hours talking about the health insurance they offer their loyal employees, others barely mention it and make it hard to find out the important information you are looking for. Whatever your case, if you are interested in job-related health coverage there are a few eligibility requirements that both you and your employer must meet. To be eligible, you must be a full-time employee who works at a medium to large sized company. If you work at a smaller company, your employer may still offer job-related health insurance but is not required to. If you think you and your company are eligible, talk to your employer about what healthcare programs it offers. In most cases, employers who are required to provide healthcare coverage to employees choose between an employer-subsidized program and a reimbursement scheme. In both cases, a significant part of the employee’s medical costs are covered on a regular basis by the employer.
If your medium- or large-sized employer does offer health insurance, available insurance plans must meet minimum standards of care as specified by the ACA. The primary pillars of these ACA regulations concern the affordability of the healthcare plan, the minimum value of medical coverage provided and the ways in which your employer is required to let you know about healthcare plan changes or new options. ACA policy also dictates that you can still choose to buy a private health insurance plan on the state marketplace if you are offered a certified job-related health insurance plan, but you may lose access to some tax savings. If you are switching between private plans and job-related plans, it is important to pay attention to open enrollment periods as well.
The COBRA Continued Health Insurance refers to the Consolidated Omnibus Budget Reconciliation Act, which was created to protect workers from losing their job-related healthcare coverage at the same moment that they lose their job. Not all employers offer COBRA coverage, though most companies with over 20 employees provide some form of continued healthcare coverage. Through COBRA, workers who lose a job through no grievous act of their own can extend whatever healthcare coverage they previously had through their employer for a set period of time afterwards. While COBRA continued health insurance offers a continuation of the level coverage previously offered, it does not extend the same out-of-pocket costs. COBRA health insurance plans are no longer employer-subsidized, therefore significantly increasing the costs for plan beneficiaries.
In most cases, the former employer must report the employee’s new status to the insurance provider, which should then reach out with options for COBRA continued healthcare coverage directly to the plan beneficiary. The ex-employee will have a specific window of time to decide whether to accept this plan or shop for a new plan through the public marketplace. There are a couple of different ways a newly unemployed person who would normally be eligible for COBRA coverage can lose access to these benefits, such as by committing fraud failing to report other active healthcare coverage.