Historic gains in health insurance coverage have made it easier than ever for low-income individuals to access medical care. Despite these changes in America’s healthcare system, however, more than 27 million individuals remain uninsured.

Essential healthcare needs like childhood immunizations and routine check-ups are the first thing to go. Some individuals will also forego certain prescription medications priced over a particular amount. All of this delay and avoidance comes right down to one thing: a fear of being unable to pay ever-increasing medical bills.

Even under the Affordable Care Act, many individuals say that the high cost of insurance is the main reason they opt out of coverage.

The cost of not having health insurance can be a steep price to pay though, with one’s own well-being on the line. The balancing act of prioritizing health and managing your personal finances should never become an opportunity cost. Instead, focus on how to choose health insurance.

Choosing the right plan that is both tailored to your needs, and that suits your budget, is a smarter and more effective long-term solution. In this post, we’ll discuss everything you need to know to help you acquire a health insurance plan.

What Is Health Insurance in the United States?

In the United States, health insurance coverage enables residents and citizens to access to medical facilities and primary healthcare providers. Those eligible for coverage in the United States purchase health insurance and then choose their Primary Care Provider (PCP) from a network of providers offered by the insurance company.

The Affordable Care Act significantly improved and reformed health care legislation. As a result, there are now more inclusions considered standard in insurance plan benefits. Add to this the fact that roughly half of uninsured individuals are eligible for health care under existing programs, and you have an opportunity to capture and provide more comprehensive healthcare for all.

How Do I Get Health Insurance?

To get started with finding and buying health insurance, you’ll need to consider which source of coverage is either already available for you or which suits your situation.

Health Sources

There are several sources of coverage you can turn to, including:

Your employer
Your employer

If your position qualifies for health insurance and your employer offers it, you won’t need to use government insurance exchanges or marketplaces. Your company will enroll you in their healthcare coverage plan. Keep in mind that you may still need to pay part of the premiums, but so does your employer. This lowers total premiums, on average.

Your state’s public marketplace
Your state’s public marketplace

If you’re an independent contractor or you work at a job that doesn’t provide healthcare coverage, you can use your state’s marketplace to choose and enroll in a state or federal health insurance plan. These marketplaces have an open enrollment period that eventually close down, so you have to select your plan during specific times of the year to ensure coverage. You can get started by heading online and applying at HealthCare.gov

Private exchange or insurer
Private exchange or insurer

An alternative route that may be attractive is to forgo your state’s marketplace and go directly to an external health insurance provider for individual health plans. While you can choose your plans specifically, the downside of these plans is the high premiums. You also won’t be eligible for premium tax credits or income-based discounts to offset your monthly premiums.

Government programs
Government programs

These are special programs that you must qualify for, including Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). To apply for these programs, however, you must qualify under age or health condition requirements. If you do qualify, the application is easy and available online.

Keep in mind that there are also special circumstances that may qualify you for particular kinds of healthcare coverage. If you’re military personnel, for example, you would qualify for coverage under the Veterans Administration or TRICARE. If you experience voluntary or involuntary job loss or a reduction in work hours, you may qualify for continuing coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Types of Health Insurance Plans

When it comes to buying health insurance, you have several sources open to you. Before you learn how to buy health insurance, however, you should compare the various types of health insurance plans open to you.

Health Maintenance Organization (HMO):

One of the most popular options when buying health insurance are HMO plans. The plans that fall under this category offer low co-payments and cover the costs of preventative care. However, you must choose from healthcare providers approved to be part of the plan.

Health Maintenance Organization
Preferred Provider Organization (PPO):

As the name suggests, PPO health plans give you flexibility in choosing your own provider, and they offer lower co-payments.

Health Maintenance Organization
Exclusive Provider Organization (EPO):

These plans allow you less freedom to choose providers, but the out-of-pocket costs remain low. With EPOs, you have to stay in-network to receive coverage.

Health Maintenance Organization
Point of Service Plan (POS):

Referrals are required if you’re going with a Point of Service plan. There are more provider options, but it’s your primary care doctor who will coordinate your care and choose your specialists.

Health Maintenance Organization

To correctly assess which type of healthcare works best for you, consider several different factors and go beyond a mere cost comparison. Try to consider what the plans cover, prescription coverage, whether you want to handle the paperwork behind referrals personally, and even where you live.

What Should Health Care Plans Cover?

Under the Affordable Care Act, benefits that once varied vastly from plan to plan are much more standard.

Services that weren’t historically offered by all plans must now provide multiple “essential health benefits,” which include:

  • Emergency services Emergency services
  • Hospitalization Hospitalization
  • Laboratory tests Laboratory tests
  • Maternity Maternity and newborn care
  • Mental health and substance-abuse treatment Mental health
  • Outpatient care Outpatient care
  • Pediatric services Pediatric services that include dental and vision care
  • Preventative services Preventative services like immunizations
  • Prescription drugs Prescription drugs
  • Rehab services Rehab services

With the variety of health insurance sources and plan categories, the best way to make the right decision is to look at the fine print of the plan. Coverage for specialists, medications, home care or nursing care, bill or service disputes, and even the right (or not) to go to any provider you choose are crucial in your decision. You must, of course, also compare factors such as out-of-pocket costs.

How to Add Family Members

Marketplace plans have open enrollment periods. For example, the application for 2020 opened on November 1st, 2019, and ends on December 15th, 2019. However, you may qualify to enroll after this date if you’ve experienced recent changes in your life.

Health Plan

You qualify for this Special Enrolment Period (SEP) if you suddenly lose health coverage (which may entitle you to a provision like COBRA), if you move states, get married, have a baby, or adopt a child. If you have to apply during the SEP timeframe, keep in mind that you have 60 days from the change event to apply.

If you need to add family members to your health insurance such as spouse and children, begin by preview prices and plans based on your income. After this, it’s a simple matter of contacting the Marketplace Call Center to enroll or creating an account to apply online.

Conclusion

The application process may be multi-step and lengthy, but it’s rarely confusing. Under the ACA, state and federal marketplace plans and insurers cannot deny you coverage based on your specific medical conditions or health history. However, the complications arise when you’re doing the research. When you shop for health insurance online, the trickiest aspect will be finding the right plan for you.

To help streamline the process, you can begin by considering all your options in a stepwise manner. Begin with the source – where will this insurance come from? Next, ask yourself about the type of plan. Finally, list out the specific coverages, beyond the essential benefits of the ACA mandate, you’d like to have.

This is a much more sane approach to previewing plans because you already know what you’re looking for, instead of being confronted with multiple options right away. Gaining clarity on your medical must-haves is really the first step when learning how to get health insurance.