Need a health insurance plan? You’re certainly not alone. According to the 2020 U.S. Census, 28 million Americans did not have health insurance in 2020. But health insurance is important to have–you get to access the healthcare services you need at affordable rates, and the peace of mind in knowing you’re covered is an excellent way to reduce stress.
This page goes over the basics of getting health insurance, such as where you can get it from and what type of plan makes the most sense for you in particular. By the time you’re done reading, you’ll be able to take action on finding the perfectly-priced plan that meets all of your needs.
Regardless of where you source your health insurance from, be sure to pick a trustworthy health insurance company that puts the patient first. With a digital-first approach where the physical and mental wellbeing of the patient is emphasized above all else, you can spend minimal time managing your plan while making sure that you’re always covered for everything you might need.
- What Is the Affordable Care Act?
- When Should You Sign Up for Health Insurance?
- Different Ways to Acquire Health Coverage
- Coverage Options for People With Disabilities
- Types of Health Insurance Plans
- Health Insurance Marketplace
What Is the Affordable Care Act?
The Affordable Care Act (ACA) (also sometimes referred to as “Obamacare”) took effect in 2010. Its objective was to enable all Americans to get affordable health coverage that helps pay for all of the healthcare services they might need.
Before the ACA, the only option was private health insurance, which was more or less expensive depending on your specific lifestyle criteria. The ACA puts some restrictions on what companies may charge more for–for example, companies may not discriminate based on pre-existing conditions or gender like they once could.
Overall, the ACA has made healthcare significantly more affordable for many Americans, and many of the healthcare plans you can enroll in will follow the guidelines for Minimum Essential Coverage (MEC) outlined in the ACA.
When Should You Sign Up for Health Insurance?
The ACA puts some limitations on when you can sign up for a new healthcare plan or modify your existing one.
Open Enrollment Periods
The Open Enrollment Period is a span of time in which everyone can enroll in a new plan or modify their existing one. In most states, the 2021 Open Enrollment Period begins on November 1, 2021 and runs through January 15, 2022.
Special Enrollment Periods
Outside of the Open Enrollment Period, you can enroll in a new plan or modify your existing one if you qualify for a Special Enrollment Period. According to healthcare.gov, the following qualifying life events make you eligible for a Special Enrollment Period:
- If you lose your existing health coverage
- If you move
- If you get married
- If you have a baby
- If you adopt a child
Short-Term Medical Plans
If you don’t qualify for a Special Enrollment Period and the current date falls outside the Open Enrollment Period, you can still get health insurance via a short-term medical plan. Short-term medical plans are usually more expensive than traditional healthcare plans. To keep costs somewhat inline with traditional healthcare plans, short-term medical plans will usually cover just the essentials–such as hospital visits and other unexpected healthcare needs. If you have a short-term medical plan, it’s wise to switch to a more traditional plan as soon as the Open Enrollment Period begins.
Different Ways to Acquire Health Coverage
There are a variety of different ways you can get health coverage. Each has its ups and downs to consider, and the source that’s best for someone else won’t necessarily be right for you.
Coverage Through Your Employer
Due to the employer mandate in the ACA, employers with more than 50 full-time employees or full-time equivalents (FTEs) are required to offer health insurance options to their full-time employees and FTEs. Small businesses are not required to offer health benefits in the same way that larger employers are, but many choose to anyway to stay competitive with larger companies. Due to costs associated with premiums, small businesses will usually offer plans with lower monthly premiums, but higher deductibles and copays.
Employer-sponsored group health insurance plans are often the cheapest way to get health insurance for you and your family. Group health insurance plans are less expensive in general because the cost for the insurer is spread among many people. Your employer also usually pays for a portion of your monthly premium–on average, the employer contribution to monthly premiums is 83% for individuals and 73% for families.
Health Insurance Coverage Through Your Spouse
Although employers are not technically required to extend healthcare coverage options to spouses of full-time employees or FTEs, many still do so to increase employee satisfaction.
If your spouse is covered under a workplace health insurance plan, check to see if you can add yourself to the plan. If you can do so, this option is often less expensive than a similar plan would be from an alternative source.
Coverage Through Your Parents’ Insurance Plan (If You Are Under Age 26)
Along with providing healthcare coverage to full-time employees, employers that meet the threshold for the employer mandate must also extend healthcare coverage options to dependents of full-time employees or FTEs who are under the age of 26. If you are under 26, you don’t have healthcare coverage, and one of your parents is covered through a workplace plan, adding yourself to that plan will often be the most pragmatic choice.
Individual Health Insurance
An Individual health insurance plan refers to a healthcare plan purchased from the Marketplace on healthcare.gov. The Marketplace is a health insurance platform run by the federal government that allows individuals to shop for and enroll in plans for themselves and their families.
The upside of Individual plans is that you can completely customize your plan based on exactly what you think you’ll need coverage for, such as certain prescription drugs. The downside is that they are often more expensive than employer-sponsored plans because the employer does not help out with monthly premium costs and you are not part of a group health insurance plan.
Certain membership organizations offer healthcare coverage options to their members. These types of group plans are often less expensive than Individual plans due to being group health insurance plans, but more expensive than employer-sponsored plans because the organization does not help pay for premium costs like an employer would.
Contact any membership organizations you are a part of to see if they offer healthcare coverage options for their members. One popular example of a membership organization that offers healthcare coverage options is AARP.
Medicare is a public health insurance program run by the federal government. Most recipients of Medicare are age 65 or older, though Medicare also covers some individuals under the age of 65 with certain conditions and diseases.
Thanks to federal subsidies, Medicare is a low-cost source of health insurance that is suitable for many individuals age 65 or older. However, some individuals with very specific or more expansive healthcare requirements may find the public offerings to be lacking. Go here to learn more about applying for Medicare.
Medicaid is similar to Medicare in that it is a source of low-cost health insurance thanks to financial help from the federal government. However, Medicaid eligibility is determined by income rather than by age. To see current Medicaid eligibility requirements, visit Medicaid.gov.
Like Medicare plans, Medicaid plans are often somewhat limiting in terms of which healthcare providers you can visit, how frequently you can visit them, and which services you are covered for. That being said, the low cost is often appealing enough to offset any potential restrictions involved with being on this type of plan.
Children’s Health Insurance Program (CHIP)
Children’s Health Insurance Program (CHIP) is run by the same agency as Medicaid, but Medicaid and CHIP are not exactly alike.
- Medicaid offers healthcare coverage to low-income families, whereas CHIP offers healthcare coverage to families that make too much to qualify for Medicaid, but too little to easily afford a traditional healthcare plan
- Medicare offers healthcare coverage to both adults and children, whereas CHIP offers healthcare coverage only to children (individuals under the age of 18) in a family
To see if your family qualifies for CHIP, visit Medicaid.gov.
Coverage Options for People With Disabilities
Individuals who have disabilities are in a unique situation when it comes to healthcare because their healthcare needs are often significantly more intensive than those of the average individual.
Coverage options vary for individuals with disabilities. Some choose to use Medicaid plans due to the cheaper cost, whereas others may qualify for a discount on private plans. To explore all of your options, visit the coverage options for disabilities page on healthcare.gov.
Types of Health Insurance Plans
Once you decide on where you want to source your health insurance from, the next step is deciding on the particular type of plan you wish to enroll in. Just like sources of health insurance, each particular type of health insurance plan comes with its ups and downs in regards to health care costs and covered health services.
Health Maintenance Organizations (HMOs)
Health Maintenance Organizations (HMOs) are a popular and affordable type of health insurance plan. HMOs are defined by three things:
- Their low costs in relation to other types of health insurance plans
- The requirement for you to get healthcare services from providers in the medical provider network. If you go outside of the medical provider network, you are usually not covered
- The requirement for you to visit your primary care physician (PCP) before seeing a specialist
Overall, HMOs are the most restrictive type of healthcare plan, but the low cost often makes up for the lack of flexibility, especially if your preferred healthcare providers are in the medical provider network.
Preferred Provider Organizations (PPOs)
Preferred Provider Organizations (PPOs) are another type of affordable healthcare plan. PPOs are similar to HMOs in that they are affordable and they make use of a medical provider network. The two key differences between HMOs are PPOs are:
- PPOs usually offer at least some coverage when you get healthcare services from outside of the medical provider network
- PPOs do not require you to visit your PCP before seeing a specialist
Overall, PPOs offer more flexibility in healthcare providers than HMOs do, and the lack of needing to see your PCP before seeing a specialist means you can often get healthcare services from specialists faster under PPOs than you would under HMOs.
Exclusive Provider Organizations (EPOs)
Like HMOs, EPOs require you to source healthcare services from within the medical provider network. However, unlike HMOs, EPOs do not always require you to see your PCP or get a referral before seeing an in-network specialist of your choosing.
An EPO is essentially a plan that is more limiting than a PPO, but less restrictive than an HMO.
Point-Of-Service (POS) Plans
Point-of-service (POS) plans are similar to HMOs in that you are not covered if you venture outside of the medical provider network. The exception to this rule is if your PCP makes a referral to a specialist outside of the medical provider network. In this case, a POS plan will help out with costs, whereas an HMO will not.
Health Insurance Marketplace
Once you’ve decided where you want to source your health insurance from and what your ideal type of plan is, it’s time to enroll in your plan. Some sources, such as employers and membership organizations, will handle enrollment internally. In some cases, you will have the option to choose between the various options listed below.
The Government Health Insurance Marketplace
If you’d like, it’s possible to find and enroll in a healthcare plan by yourself. Head over to the Marketplace on healthcare.gov, input your lifestyle details and contact information, and see the types of Marketplace plans that are available for you based on your criteria.
You will usually have four tiers of plans to choose from—Bronze, Silver, Gold, and Platinum, with Platinum offering the most coverage benefits and Bronze offering the fewest. Individuals under the age of 30 may also qualify for Catastrophic healthcare plans, which are very limited plans ideal for individuals who do not plan to make frequent use of healthcare services.
A Health Insurance Broker or Agent
Health insurance brokers and agents can help you find the right health insurance plan at the best price. You may be eligible for tax credits and/or other savings if you use an approved health insurance broker or agent and your broker or agent signs you up to a plan through the Marketplace. To learn more about health insurance brokers and agents, visit healthcare.gov.
Direct From Insurer
If you have a high individual or family income, you may not be eligible for lower costs on a healthcare plan that is purchased through the Marketplace. If you meet this income criteria, it may make sense from a financial standpoint to get private insurance directly from an insurance company rather than going through the Marketplace. Click here to learn more about if your income is too high for Marketplace tax credits.
If you need to get health insurance, the overall process is easy to understand:
- Figure out where you can source your health insurance from, including
- Employer-sponsored plans from
- Your workplace, Your spouse’s workplace, and your parent’s workplace.
- Individual and Family plans from the Marketplace.
- Plans from
- A membership organization.
- Public Medicaid, Medicare.
- CHIP plans.
- Employer-sponsored plans from
- Consider the type of health insurance plan you want, depending on how much you want to pay for health insurance and how much restriction you can tolerate
- Figure out which available health insurance source is the cheapest considering your ideal criteria
It’s also important to consider the health insurance company that you are enrolled under. The right health insurance company will always put the needs of the patient first and offer a convenient, member-centric, and digital-first approach to managing your plan. With the right company, when you need to access healthcare services, you’ll know for certain that you can get what you need, when you need it, and that the entire process will be smooth and hassle-free from start to finish.