Looking for a new health insurance plan or trying to improve your existing one? Take a deep breath and take your time. There are many factors to keep in mind before deciding on a plan. By understanding some key guidelines, you can gain a better understanding of how health insurance coverage works and how you should approach your new plan to get the best services at the lowest price.
Regardless of the plan you choose, be sure you work with a trustworthy health insurance company that puts an emphasis on convenient and digital-first management of your plan. Prioritizing your physical and mental health means you need a plan with access to specialists who understand you and can create a personal, comprehensive approach to your health. Having easy access to services that fit your needs means you can be confident that you have the right insurance company working for you.
#1: Before You Do Anything Else, Check for Employer Coverage
Some employers are required to offer health insurance coverage to their full-time employees. Specifically, due to the employer mandate in the Affordable Care Act (ACA), employers with 50 or more full-time or full-time equivalent employees must offer health insurance coverage to their full-time employees or face a financial penalty.
Employer plans are ideal for two reasons:
- You get health insurance under a group plan. Group health insurance plans are more cost-effective for insurance companies, and those savings go back into your pocket. In other words, group health insurance plans are cheaper than individual plans.
- Your employer pays a portion of your monthly premium. Employers generally must pay at least 50% of your premium, but some pay more—up to 73% for families and 83% for individuals—to stay competitive in attracting work talent.
As of 2020, 157 million people used employer-sponsored health insurance because of the benefits described above. If you are a full-time employee, be sure to check whether or not your workplace offers insurance plans, assuming you meet the ACA’s criteria for a full-time employee.
#2: Employers Don’t Need to Offer Coverage to Spouses, But Often Do
Due to the employer mandate in the ACA, employers are required to extend healthcare coverage options to the dependents of full-time employees who are under the age of 26. However, employers are not required to extend coverage to the spouses of full-time employees.
That being said, many employers still do so in order to increase employee satisfaction. If you aren’t a full-time employee but your spouse is, be sure to ask about getting onto the group health plan from their workplace to receive the two key benefits described in the previous section.
#3: The Type of Plan You Pick Matters
No matter where you get your health insurance from, you’ll likely have options to choose from regarding the specifics of your plan. These options will affect many elements in your healthcare coverage, including your premiums, deductible, and where you can or cannot go for healthcare services if you wish to receive coverage.
Rushing through the process and picking the wrong type of plan can lead to unnecessary additional expenses down the line.
Visit our page explaining the 5 most common types of health insurance plans so that you can get the best plan for you in particular—the one that has the lowest costs while still providing all of the coverage for all of the healthcare services you might need.
#4: Small Business Health Coverage Usually Has Less Flexibility
Paying for employees’ monthly health insurance premiums is a big expense for employers. As such, many small businesses—that do not have the financial flexibility that large corporations do—look for ways to reduce monthly premium expenses.
One of the most common ways to accomplish this goal is by offering high-deductible health plans (HDHPs). This particular type of plan has very low monthly premiums, but significant deductibles that need to be met every year before full coverage kicks in.
Overall, if you work for a small business and see HDHPs as your only workplace coverage option, that’s not out of the ordinary.
#5: High Deductible Plans Might Benefit From Gap Coverage
HDHPs are usually acceptable when individuals make infrequent use of healthcare services. In this case, the lower monthly premium is an attractive option.
If you are an individual who makes frequent use of healthcare services, the idea of paying a high deductible every year might sound worse than paying a higher monthly premium. However, if you work for a small business, you may be limited to HDHPs.
In this case, you may opt to purchase gap health insurance coverage. Gap coverage “bridges the gap” between high-deductible plans and more traditional health insurance plans. When you purchase gap health coverage, your monthly premium goes up, but your obligation towards your deductible goes down.
As such, it’s a popular option for individuals who work for small businesses but want more traditional health coverage billing.
#6: Some Membership Organizations Offer Health Insurance Coverage
If you’re part of a membership organization (such as AARP), you sometimes have the option of acquiring health insurance through that organization.
Membership organization group health insurance plans are an attractive option due to their lower costs. Group health insurance plans generally cost less than individual ones do.
However, membership organization plans are generally not quite as good of a value as employer plans are, seeing as the membership organization usually does not help out with monthly premiums.
#7: Some States Still Have Individual Mandates
When the ACA first came into effect, an individual mandate existed nationwide. This mandate required you to purchase health insurance or else you would receive a financial penalty.
The individual mandate is no longer enforced nationwide, but certain states still enforce it on a state level. If you live in one of these states and you do not purchase health insurance coverage, you may be in for an unwanted financial surprise later this year when you receive your state tax return.
#8: You Have Options If You Lose Coverage Suddenly
If life comes at you fast and you find yourself without health insurance coverage for one reason or another, you have plenty of options to choose from.
- COBRA allows you to maintain your employer-sponsored health insurance plan, usually for up to 18 months after you leave your job, regardless of whether you quit voluntarily or were fired, except in the case of gross negligence.
- Short-term health insurance plans allow you to purchase basic health insurance coverage during any time of the year, albeit at a usually higher price.
- Sometimes, you can get health insurance immediately from the Marketplace on healthcare.gov, a health insurance shopping and enrollment service managed by the federal government. More information on Marketplace plans is included in the section below.
#9: You Can’t Always Buy Health Insurance When You Want To
If you don’t get health insurance through your employer or a membership organization, a popular third choice is purchasing an Individual or Family plan through the Marketplace on healthcare.gov.
Marketplace plans cannot always be purchased at any time, though. There are two periods during which you can purchase a health insurance plan through the Marketplace:
- Open Enrollment Period. During this period of time, anyone can purchase a new plan or modify their existing one. Click here to see the Open Enrollment Period for this year.
- Special Enrollment Period. If you have a qualifying life event, you will have the option to purchase a new plan or modify your existing one outside of the Open Enrollment Period.
#10: Some Individuals Can Get Free or Heavily Discounted Health Insurance Coverage
If you’re having trouble affording a traditional health insurance plan from your employer, a membership organization, or the Marketplace, you may qualify for one of the following programs to receive free or heavily discounted health insurance coverage.
- Medicare is a federal program intended primarily for individuals age 65 or older.
- Medicaid is a federal program intended primarily for individuals with low annual incomes.
- CHIP is a federal program for individuals who make too much to qualify for Medicaid, but too little to be able to easily purchase traditional health insurance plans. Children in families that qualify for CHIP are eligible for free or heavily discounted health insurance.
The upside to the above plans is that they are almost always less expensive than traditional health insurance plans are. However, they are also usually less robust in terms of which healthcare services you’re covered for. They also usually provide less flexibility regarding how frequently you can see healthcare providers, as well as which healthcare providers you have access to.
Finding health insurance coverage isn’t the most simple thing in the world—you have many options to choose from, and it’s important for you to pick the right options for you in particular so that you have the most coverage at the lowest price.
Keep the above guidelines in mind as you shop around for health insurance coverage and you’ll give yourself the best chances of picking the perfect plan.
As a final guideline, be sure to work with a health insurance company that puts the physical and mental wellbeing of the patient first. By working with a company that has a digital-first and convenient approach to managing billing and how you access healthcare services, you can stay healthy throughout the year without having to deal with unnecessary stress.