How to Get Health Insurance
Getting health insurance is an important step in taking care of your health and financial well-being. Having health coverage can help you access preventive care, save you money on doctor’s visits and prescriptions, and protect you from unexpected medical bills. Here’s a comprehensive guide on how to get health insurance.
Understanding Health Insurance Basics
Before getting health insurance, it’s helpful to understand some key concepts about how health coverage works:
Types of Health Insurance Plans
There are several common types of health insurance plans:
HMO (Health Maintenance Organization) –Requires you to select a primary care doctor from their network. Referrals are needed for specialists. Out-of-network care is limited except for emergencies.
PPO (Preferred Provider Organization)- Gives you more flexibility to see doctors in and out of network. Out-of-network care will cost more.
POS (Point of Service)- Combines aspects of PPO and HMO plans. You select a primary doctor to oversee care and referrals aren’t required for in-network specialists. Out-of-network care is allowed but costs more.
Catastrophic- Basic, high-deductible coverage for those under 30 or with hardship exemptions. Useful alongside a Health Savings Account (HSA).
Essential Health Benefits
Under the Affordable Care Act, individual and small group plans must cover ten essential health benefits including preventive services, prescription drugs, and maternity care.
In addition to monthly premiums, most plans require members to pay deductibles, copays or coinsurance when receiving care until an annual out-of-pocket maximum is reached.
Finding Available Health Insurance Options
You can explore health insurance options through government exchanges, private insurers, Medicare and Medicaid, or through an employer.
Government-run insurance exchanges make it easier to compare plans side-by-side. [Healthcare.gov](https://www.healthcare.gov/) offers plans from private insurers that meet ACA standards. Those under 30 or with low incomes may qualify for subsidized coverage.
In addition to plans on the exchanges, private insurers like UnitedHealthcare, Cigna and Aetna, sell individual and family health insurance plans directly to consumers. Comparing quotes from multiple companies can help find the best rates.
Medicare and Medicaid
Americans over 65 or with certain disabilities qualify for Medicare. Low-income individuals can receive Medicaid. Requirements vary by state. Those who qualify for both are dual eligibles.
Many employers offer group health plans you can enroll in as an employee benefit. Your portion of premium costs are deducted from your paycheck, often pre-tax. COBRA coverage extends this option after leaving a job.
Selecting the Right Health Insurance Plan
With so many options, choosing the right health plan takes some legwork. Follow these steps to pick coverage that fits your needs and budget.
Step 1: Estimate Your Upcoming Health Care Costs
Think about doctor visits, prescriptions and any medical services you expect to need in the coming year. This gives you an idea of what kind of coverage to look for. Those with minimal predictable care needs may want a lower premium, high-deductible plan. Someone managing a chronic condition may prefer a higher premium with lower out-of-pocket costs per visit.
Step 2: Make Sure Your Doctors Are In-Network
Nothing is more frustrating than picking a plan only to find your providers don’t take it. To avoid surprises, search for your doctors on insurer websites and confirm they are in-network before selecting a plan.
Step 3: Understand Prescription Costs
Medications make up a large chunk of many people’s medical expenses. Before choosing insurance, check which pharmacies the plan contracts with. Also look at the plan’s drug formulary – the list of prescriptions they cover and at what tier – to learn what your medicine costs would be.
Step 4: Weigh Monthly Premiums Against Deductibles
Plans with higher monthly premiums tend to have lower yearly deductibles and copays, and vice versa. Generally, paying a higher premium makes sense if you expect substantial medical expenses. Paying a lower premium but higher deductible is smart if you just want protection from a medical catastrophe.
Step 5: Compare Network Options
Do you want access to out-of-state providers for college or frequent travel? Are there nearby out-of-network specialists you want to see? Understanding network tradeoffs helps pick the right plan.
Step 6: See If You Qualify for Cost-Sharing Reductions
Those with incomes up to 250% of the federal poverty level may qualify for extra subsidies to lower deductibles and copays on silver-tier exchange plans. This can make expensive care more affordable if you meet eligibility rules.
Step 7: Consider Adding Dental, Vision and Life Insurance
Many medical plans only cover basics. For more complete coverage, explore adding stand-alone vision, dental and life insurance plans that fit your needs and budget.
Purchasing Your Chosen Health Insurance Plan
Ready to buy health insurance you’ve selected? Here are some final steps for purchasing coverage and getting set up.
Enroll During Open Enrollment or Special Enrollment Periods
For individual plans, you can only purchase coverage during yearly open enrollment periods or special enrollment periods triggered by qualifying life events like losing employer coverage or moving.
Pay Your First Month’s Premium
To activate coverage, you must pay your first month’s premium upfront. This can be paid online, by mail or over the phone depending on what options your insurer provides. Make sure to note monthly deadlines for paying subsequent premiums to avoid lapses in coverage.
Submit Proof of Prior Coverage
Your new insurer may require documents showing your prior insurance coverage periods without major gaps. This helps determine waiting periods before pre-existing conditions are covered.
Add Dependents or Family Members
Spouses, children under 26 or domestic partners may be eligible for inclusion on your health plan. Follow your insurer’s process for adding dependents and paying any additional premiums.
Select a Primary Care Physician
If your plan requires you to have a PCP to coordinate care, choose an in-network doctor for yourself and each covered family member. Inform your insurer of your selections.
Get New Insurance Cards
You should receive new medical cards that can be presented when you receive care. If cards don’t arrive before your coverage begins, contact your insurer to get replacements issued promptly.
Once enrolled, be diligent about upholding your end of the coverage agreement to avoid issues.
- Pay monthly premium bills on time and in full to avoid lapses in coverage. Set payment reminders and automate payments if possible.
- Inform your insurer if you need to change your address, phone number or other contact information to ensure you receive important coverage updates.
- During open enrollment periods each year, re-evaluate your medical needs and shop around to determine if another plan better fits your situation and budget.
- Report any life changes like marriages, divorces, new family members, or employment status changes to your insurer in case they impact your eligibility or dependent coverage.
Getting and keeping health insurance provides important financial and medical protections. Hopefully this guide gave you what you need to know to choose, purchase and maintain coverage that works for your situation. Let me know if you have any other questions!
Frequently Asked Questions
How can I find affordable health insurance?
Here are some tips for finding affordable health coverage:
- Shop on the health insurance exchanges which let you compare plan costs and benefits side-by-side.
- See if you qualify for premium tax credits or subsidies to lower monthly costs.
- Consider a higher deductible plan to pay less in premiums.
- Look for an employer, school, or association group plan that spreads risk for potential discounts.
- Work with an independent insurance agent who can help find you the best deal.
What do I need to sign up for health insurance?
To enroll in a health plan, you’ll typically need:
- Your personal information like legal name, birthdate, address, social security number
- Documentation of any prior health insurance policy information Income verification which may include pay stubs, tax returns, or W-2 forms
- Employer details if enrolling in an employer group plan
- Bank account & routing details to set up automatic premium payments
How do I avoid a lapse in health coverage?
To avoid going without insurance, be proactive about these steps:
- Pay monthly premiums in full and before deadlines to keep policies active.
- Renew plans during open enrollment periods before current policy expires.
- Report qualifying life events right away that let you enroll outside open enrollment.
- If switching plans, confirm the exact start and end dates for old and new policies to ensure no gaps.
Can I get an individual health insurance plan any time of year?
Outside of open enrollment, you generally need a qualifying life event to get a special enrollment period. Common qualifying events include losing your job and insurance, getting married or divorced, moving to a new coverage area, or having a baby.
What do I do if I missed open enrollment and have no special enrollment period?
If you aren’t eligible to sign up for an individual plan outside of open enrollment, some options include:
- Seeing if you can qualify for Medicaid or CHIP coverage for low-income individuals.
- Looking into short-term or temporary insurance plans.
- Checking for options with professional associations, alumni groups, or other organizations you may be part of.
- Exploring coverage options like Christian Healthcare Ministries and other health sharing ministries.
What are the penalties for not having health insurance?
As of 2019, Congress eliminated the federal individual mandate penalty for not having health insurance. However, a few states including Massachusetts, New Jersey, California and Rhode Island still penalize uninsured residents at tax time. The penalties vary by state but are designed to motivate maintaining coverage.
Getting health insurance is a big decision with many factors to weigh. Doing thorough research on the options available and understanding what coverage best fits your needs and budget is key to picking the right plan. Use this guide as a starting point, take your time exploring all the choices and don’t hesitate to ask for help from experts along the way. With the proper coverage, you can gain financial protection and peace of mind knowing your healthcare needs are taken care of.