But if you need to buy an individual plan, the process is far more complicated. You’ll most likely need to purchase a plan through your state’s health insurance exchange.
If you haven’t attempted to apply on an exchange up to this point, it can be an incredibly mysterious undertaking.
But in this guide, we’re going to attempt to pull back some of the mystery, and explain the process.
Where to Get Individual and Family Health Insurance
Our discussion in this guide is going to center on the Affordable Care Act (ACA), and health insurance plans provided by your state’s health insurance exchange. But before we dive into those, let’s first take a quick look at the primary alternatives.
We’re not going to cover Medicare or Medicare supplements in this guide, since that’s an entirely separate – and very extensive – topic.
Employer Sponsored Health Plans
If you have health insurance available through your employer, it will almost always be the most cost-effective coverage you can get. Though the overall monthly premium of an employer plan may be comparable to plans available on the health insurance exchanges, you’ll typically get the benefit of an employer subsidy.
For example, while the premium may be $2,000 per month, if your employer pays 70%, your portion will be just $600 per month.
In addition, employer plans often have lower deductibles and out-of-pocket maximums than what you’ll find with typical policies on the exchanges.
Christian Health Sharing Ministries
These plans are exactly what the name implies, which is to say they’re not traditional health insurance. However, at least superficially, they closely resemble traditional health insurance.
Members pool their money together through monthly contributions, to cover the health expenses of those in need.
They have features similar to health insurance plans, such as deductibles and copayments, but they’re called by different names. They’re fully ACA compliant, although they typically cost no more than a half the premiums paid for traditional health insurance.
Examples of health sharing ministries include Medi-Share, Liberty HealthShare and Christian Healthcare Ministries.
There are important factors to be aware of with these ministries. For example, you must be a Bible believing Christian, adhering to a lifestyle consistent with those beliefs. And much as was the case with health insurance prior to the ACA, you can be excluded for pre-existing health conditions, or charged higher premiums. Also, these ministries may cap total benefits at levels well below those of traditional insurance.
Medicaid is a federal health plan, administered by each individual state. It’s designed specifically for low income individuals, who can’t afford traditional health insurance. But in addition to income guidelines, there may be certain other requirements, such as pregnant women or families with dependent children, though specific eligibility varies somewhat from state to state.
In total, more than 72 million people participate in the plan. When you apply for coverage on your state health insurance exchange, you may be referred to Medicaid if you’re deemed qualified. Covered services include doctor visits, hospitalization (both inpatient and outpatient), prescriptions, preventative care, pre-natal and maternity care, and mental health services. Medicaid can also be a supplement to Medicare for low income seniors.
Eligibility is determined by the percentage of your income compared to the federal poverty level for your state of residence. Your income can exceed that level by a certain percentage, which is higher for those with children and for pregnant women, than it is for adults.
Buying Individual and Family Health Insurance Through Your State Health Insurance Exchange
When the ACA was rolled out in 2010, it effectively consolidated the health insurance market. The entire process now takes place on your state’s health insurance exchange. As a result, there are far fewer providers than there were previously, and the plans can be prohibitively expensive.
Let’s go through the process detail by detail.
The ACA has open enrollment from November 1 to December 15, offering eligibility for anyone to purchase health insurance for the following calendar year.
However, you can purchase a plan outside the open enrollment window based on certain qualifying life events. These include losing your employer health coverage, having a baby, marriage, moving to a different state, becoming a US citizen, release from prison, losing Medicaid or COBRA coverage, and several other events.
Once such an event takes place, you’ll be entitled to a 60-day special enrollment period, within which you’ll be eligible to purchase coverage.
Probably the most important benefit of the ACA was that it removed the ability of insurance companies to decline an individual for coverage. Under the Act, you can no longer be excluded from coverage due to pre-existing health conditions. What’s more, you cannot be charged higher premiums for those conditions. Those two provisions alone enabled millions to get health insurance who couldn’t under the previous system……….Read More>>