Most health insurance subscribers get coverage through their employer. As a result, they don’t need to use governmental insurance exchanges or marketplaces unless they want an alternate plan. But if your employer doesn’t cover your health insurance, you’ll need to explore your own options. In this post, we outline the process and answer potential challenges for buying personal health insurance.
CHOOSE YOUR MARKETPLACE
While most people start by going to HealthCare.gov, it’s important to remember there are several ways to purchase health insurance. When you shop at Healthcare.gov, you only see “on-exchange” plans. But insurance companies only make a fraction of their plans available “on exchange.” You can also purchase health insurance either directly from an insurer or through a private exchange. Just remember that you won’t be eligible for tax credits if you choose these options, which are income-based discounts on your monthly premiums.
NOTE: Open enrollment for 2021 ACA-compliant individual/family health plans has ended for 2021, but consumers in the 36 states that use HealthCare.gov have access to a special COVID-related enrollment period that continues until August 15, 2021. For state-run exchanges (states that don’t use HealthCare.gov), the COVID-related special enrollment period will vary. Check with the marketplace in your state to see if a COVID-related special enrollment period is available and the eligibility requirements.
CHOOSING COVERAGE — OPTION #1: SHORT-TERM COVERAGE
For many people, buying a short-term health insurance plan is the fastest way to ensure they have some level of coverage in place. While these plans are not ACA-compliant, they can be purchased at any time of year and offer some level of protection against unforeseen medical expenses. As the name suggests, the coverage is only temporary. But 2018 federal regulations allow short-term plans to have initial terms of up to 364 days and a total duration of up to three years.
CHOOSING COVERAGE — OPTION #2: ACA-COMPLIANT COVERAGE
Those who prefer to buy health plans that are compliant with the Affordable Care Act generally do so because the plans are comprehensive and — thanks to various subsidies — more affordable. Suppose you’re looking for a plan outside of the annual open enrollment period (or outside the special COVID-related enrollment period). In that case, you can still enroll, provided you have a qualifying life event.
A few such qualifying events include:
- Getting married
- Having a baby, adopting a child, or placing a child for adoption or foster care
- Moving
- Becoming a U.S. citizen
- Losing other health coverage due to job loss, divorce, COBRA expiration, or aging off a parent’s plan
- Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
- Change in income or household status that affects eligibility for premium tax credits or cost-sharing subsidies
PLAN OPTIONS
When shopping for health insurance, it’s easy to become overwhelmed by a sea of acronyms. But the most common types of policies fall within four groups: HMOs, PPOs, EPOs or POS plans. The type of policy you choose determines everything from your out-of-pocket costs to which doctors you can see. So, it’s important to take all factors into account.
HMO: HEALTH MAINTENANCE ORGANIZATION
These plans feature lower out-of-pocket costs and a primary doctor who coordinates your care, but they offer less freedom to choose providers.
PPO: PREFERRED PROVIDER ORGANIZATION
These plans offer more provider options and no required referrals but come with higher out-of-pocket costs.
EPO: EXCLUSIVE PROVIDER ORGANIZATION
These plans feature lower out-of-pocket costs and don’t require referrals, but they offer less freedom to choose providers.
POS: POINT OF SERVICE PLAN
These plans offer more provider options and a primary doctor who coordinates your care, but also require referrals.
COMPARING PLANS
When comparing different plans, take a close look at the amount and type of treatment you’ve received in the past. While it’s impossible to predict every medical expense, recognizing trends can help you make better decisions.
Also, look for a summary of benefits. For example, if you choose an HMO or POS plan, you typically must see a primary care physician before scheduling a procedure or visiting a specialist. These plans may be better if you don’t mind your primary doctor choosing specialists for you. If you’d rather choose your own specialists, a PPO or EPO provides that option. A PPO might also be better if you live in a remote area with limited access to doctors since there’s a greater likelihood you’ll need to go out of the network..
REMEMBER — YOU SHOULD SHOP INSURANCE OPTIONS EVERY YEAR
While you might want to stay with one plan simply out of convenience, plans, doctor networks, prescription coverage, and your family’s health needs change every year. The market also continues to change — what might be a perfect fit for your family one year may be terrible the next. It’s important to do your due diligence.
CHOOSING THE RIGHT PLAN FOR YOU
Whether you need help narrowing your options or determining which plan could be a good fit, that’s where Health & Benefits Partners can help. Contact us today as our experienced and knowledgeable team will not only answer your questions, they’ll make sure you feel confident about your health care plan decisions.