It can be challenging to find a health insurance plan that stays within your budget.
Here are the ways to get health insurance so you make sure you and your family are properly protected.
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What Types of Coverage Exist?
Health insurance coverage comes in four major types: employer-sponsored health insurance, individual or private plans, Medicare and Medicaid.
More than half (56%) of private sector employees are covered by a work-based health insurance plan, according to the Kaiser Family Foundation.
Private health insurance that’s not through an employer has become more common since the Affordable Care Act (ACA) went into effect in 2014. The ACA created a health insurance marketplace that lets consumers compare health plans available in their area. The law also created premium tax credits and cost-saving subsidies to reduce health insurance costs for people who buy in the ACA marketplace at Healthcare.gov..
Insurance through an employer
Employer-sponsored group health insurance is a health plan chosen and primarily paid for by your employer. These plans are also offered to or can include your dependents (usually spouses and children). Your employer chooses which plan options are available to you and picks up the bulk of the cost of health insurance premiums. Employees also typically pay premiums, which are taken out of your check on a pre-tax basis, which lowers your taxable income.
Individual health insurance
Individual health insurance is a policy you buy either for yourself or your family. Individual health plans are available through the ACA marketplace or directly from a health insurance company. These plans allow you to find health insurance coverage that has the benefits you want and that covers your preferred doctors and hospitals. Since the health plan isn’t provided by your employer, you can change jobs at any time without risking the loss of your insurance coverage. You can renew or change your health insurance plans or options annually.
Medicare
Medicare is a federal program that provides health insurance for people over age 65 and for people under 65 with a disability, end-stage renal disease or amyotrophic lateral sclerosis (ALS).
Medicaid
Medicaid is a state and federally run program that provides health insurance to eligible low income Americans, pregnant women, children, people with disabilities and elderly adults.
You may be eligible for both Medicare and Medicaid. If you think you’re eligible for either of these programs, visit medicare.gov or medicaid.gov to learn more and apply.
5 Ways to Get Health Insurance
1. The ACA health insurance marketplace
The health insurance marketplace at Healthcare.gov provides insurance plans to individuals, families and small businesses. Through this online resource, you can learn more about health insurance, compare plans, enroll in a plan and figure out how much you can save through premium tax credits and subsidies.
You can purchase a health plan through the marketplace even if you’re offered insurance by your employer; however, you may not qualify for subsidies if you have access to employer-sponsored coverage.
To buy a policy through the marketplace, you must apply during open enrollment or special enrollment. Open enrollment for 2023 coverage begins Nov. 1, 2022, for the federal marketplace and runs until Jan. 15, 2023, in most states. To have your coverage start by Jan. 1, 2023, enroll in your plan by Dec. 15, 2022.
Some state exchanges may have slightly different open enrollment periods. If you miss open enrollment, you may qualify for a special enrollment period due to a major life change like moving, getting married, having a child or losing your existing health coverage.
To begin your search for insurance through the marketplace, head to Healthcare.gov during open enrollment or after you qualify for a special enrollment and enter your ZIP code. It will direct you to either your state’s exchange or to the federal marketplace where you can begin shopping.
2. A health insurance broker or agent
A health insurance broker or agent can help you navigate the wide range of insurance options and enroll in the best health insurance plan for you. You don’t pay any fees when working with agents or brokers, as they’re paid on commission by insurers.
To find a broker or agent, you can use the federal government’s Find Local Help tool to set up in-person, phone or email appointments. You can also enter your phone number or email address to be contacted by an agent or broker to talk about plan choices. Agents and brokers must be licensed in their states to sell health insurance.
3. Directly from a health insurance company
Some people can find plans that better fit their specific needs or budget by shopping directly with health insurance companies. These plans may meet ACA requirements or you may find a cheaper plan that doesn’t offer as comprehensive coverage that’s found on the ACA marketplace. Purchasing a health plan outside of the marketplace removes the opportunity for premium tax credits or other subsidies that are available through the marketplace.
4. Membership organizations and association health plans
People who don’t have employer-provided health insurance, are self-employed, are unemployed or own small start-ups may still be eligible for a group health insurance plan. These health plans require membership to a professional, trade or membership organization. You can check to see if your organizations offer association health insurance. Association health plans let freelancers, small businesses and self-employed people band together to buy group health insurance at discounted rates.
Be wary of plans provided through some membership organizations that are “health services discount” plans rather than actual health insurance. These plans may save you money on prescriptions but they don’t have broad coverage.
Consumers shopping outside the marketplace should also be cautious of health care-sharing ministries, where individuals of a shared faith contribute money to a health care cost pool distributed by a ministry to pay for certain health-related expenses. This is not health insurance and doesn’t cover pre-existing conditions or guarantee reimbursements.
When Should You Sign Up for Health Insurance?
The best time to sign up for health insurance is before you need it. Open enrollment for private health insurance through the federal marketplace (and many state marketplaces) begins on Nov. 1 every year and runs until Jan. 15.
Special enrollment periods
You may qualify to enroll in health insurance during what’s called a special enrollment period if you have a qualifying life event. Qualifying events for special enrollment include:
- Losing your health coverage
- Getting married or divorced
- Having or adopting a child
- Moving to a new state
- Aging out of a parent’s health insurance plan
Special enrollment periods typically last 60 days after your qualifying event, so begin applying for special enrollment as soon as possible to avoid missing the window.
Short-term health insurance plans
If you don’t qualify for a special enrollment period or need to purchase health insurance outside of the open enrollment period, a short-term health insurance plan may be available to you. These plans often don’t meet the ACA’s minimum essential coverage requirements or cover pre-existing conditions. These plans are regulated to last up to 364 days with the opportunity to renew a policy twice and are not available in every state.
How Much Does Health Insurance Cost?
A Forbes Advisor analysis of unsubsidized ACA marketplace premiums found that the average monthly cost of health insurance on the ACA marketplace is:
- $365 for individual coverage for a 21-year-old person
- $386 for a 27-year-old
- $412 for a 30-year-old
- $469 for a 40-year-old
- $655 for a 50-year-old
- $994 for a 60-year-old
The exact cost for an ACA plan varies by age, type of benefit design, metal tier and how many people are covered on the plan. Health insurance companies can’t use your health status or pre-existing conditions when setting rates for health insurance.
Common Health Insurance Scams
Common health insurance scams include robocalls and phishing emails that push “comprehensive” health plans that meet the requirements of “Obamacare.” Some emails feature the logos of well-known insurers or organizations like AARP.
During open enrollment, callers impersonate representatives of the insurance marketplace, offering special rates or encouraging you to join an association or union to get covered. Government representatives will never call to try and sell you insurance, nor will they push you with high-pressure sales pitches.
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How to Get Health Insurance FAQs
How do I get health insurance if I am retired?
People who are age 65 or over are eligible for Medicare, a federal health insurance program that offers comprehensive coverage.
You can sign up for Original Medicare from the government or get Medicare Advantage, which is offered by private health insurance companies that contract with the government. If you have Original Medicare, you can get prescription drug benefits through Medicare Part D.
How do I get health insurance if I have a disability?
If you have a disability, you may be able to get coverage through Medicare or Medicaid. These government programs offer comprehensive health coverage.
You can also get coverage through the ACA marketplace. Depending on your household income, you may get a subsidized ACA plan that may provide premium tax credits and cost-sharing subsidies that reduce out-of-pocket costs.
How do I get health insurance if I am self-employed?
If you don’t have access to a spouse’s or parent’s health insurance plan, self-employed people can get coverage through multiple avenues.
Self-employed health insurance is available through the Affordable Care Act marketplace or directly from a health insurance company. You can also get coverage through Medicare or Medicaid, if you’re eligible.
Looking for Health Insurance?
Via Healthcare Marketplace's Website
