What Forms of Health Insurance Are Available to Me?

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Health insurance is not ‘one-size-fits-all.’ Your needs can change with your stage of life, your employment status, and your income. Families can have different needs than individuals. And retirees have different needs from students and working adults. Take a look at health insurance plans you may need depending on your situation.

If You’re a College Student

College is expensive, so it’s tempting to cut out costs when you can. But health insurance shouldn’t be one of the things you sacrifice. While most students are generally healthy, illnesses and accidents can and do happen. Getting stuck with a big bill will only add to the expense—and the stress. Fortunately, college students have some affordable options:

  • If you are already on your parent’s insurance plan, you can likely remain on it until age 26.

  • If you are working while in school, you may have options available through employer-sponsored health insurance.

  • Most colleges and universities offer student health insurance for enrolled students. It usually covers care from the school’s medical services. (Check to see if coverage continues when classes are not in session or when you are at home for a visit.)

  • You can buy a plan through the Health Insurance Marketplace. You can probably find reasonably priced plans that cover basic services—and you may qualify for cost reduction through federal subsidies. Applying through the Marketplace is the only way to get federal subsidies. Open enrollment starts November 1st each year. But students can enroll any time through Special Enrollment if they move to attend college or lose other coverage.

  • Apply to Medicaid in the state where you attend school. Medicaid provides free or low-cost coverage, but eligibility varies from state to state. If the state where you go to school has ‘expanded’ Medicaid, you can qualify as a childless adult based on your income alone. When you submit an application through the Marketplace, it will automatically tell you if you are eligible for Medicaid. You can also apply directly with the state’s Medicaid agency.

  • Find private health insurance directly from an insurance company or through a broker. Many insurance companies offer college student plans or short-term insurance. These plans are often cheaper than staying on family insurance. The insured population is healthier and the coverage is for a limited time—during college enrollment. This lowers the risk for the insurance company, so they can offer lower rates.

If Your Employer Doesn’t Offer Insurance or You Don’t Qualify

Employers’ responsibilities for offering healthcare varies under the ACA (Affordable Care Act). Businesses with 50 or more FTE (full-time equivalent) employees must offer health insurance or face penalties. Smaller employers do not have to provide insurance. No employer has to offer insurance to part-time workers—generally those working less than 30 hours per week on average. If you can’t get employer-sponsored health insurance, here are your options for affordable coverage:

  • Apply for insurance through the Health Insurance Marketplace. You can choose the level of coverage that’s right for you and your family from the metal plans—bronze, silver, gold and platinum. The more precious the metal, the more coverage you get. The cost also goes up with the metal. However, the Marketplace will tell you if you qualify for a cost reduction through federal subsidies. Open enrollment starts November 1st each year. You may be able to enroll any time through Special Enrollment if you have a qualifying life change.

  • Get free or low-cost coverage through Medicaid. When you apply through the Marketplace, you will automatically find out if you qualify for Medicaid. If you do, your state will contact you about enrollment. You can also apply through your state’s Medicaid agency.

If You’re Self-Employed

When you’re self-employed, you are responsible for your own health insurance. You are self-employed if you run a business with no other employees. Examples include freelancers, consultants, and independent contractors. You have three basic options to obtain self-employed health insurance:

  • Purchase individual health insurance through the Health Insurance Marketplace. You can choose from plans with four different coverage levels. These metal plans are bronze, silver, gold and platinum. Platinum plans offer the most coverage, but they also cost the most. The Marketplace will tell you if you qualify for cost reduction through federal subsidies. (Open enrollment starts November 1st each year.) You may be able to enroll any time through Special Enrollment if you have a qualifying life change.

  • Purchase insurance directly from an insurance company. Most large insurance companies offer individual plans. You can contact them for a quote or work with a broker. However, you won’t qualify for federal subsidies applying outside the Marketplace. If you wouldn’t qualify for subsidies anyway, this may not matter for you. Talk with your tax advisor to see how to maximize any healthcare tax benefits.

  • Purchase group insurance. Group insurance can have better benefits and more flexibility than individual insurance. Self-employed people can access group insurance through professional, trade, industry or membership organizations. In some states, a small group can consist of one person in order to buy insurance.

If You’re Retired

Your health insurance options during retirement depend on your age. If you are 65 or older, you are eligible for Medicare coverage. Depending on your work record, you may or may not have to pay a premium for Part A (hospital coverage). But most people can qualify for Part B (doctor visits and outpatient care), regardless of work record. Medicare is not part of the Health Insurance Marketplace and the ACA did not change how you enroll for Medicare. Also, you still have the choice between traditional Medicare and Medicare Advantage. 

People 65 and older may also qualify for their state Medicaid program. This is dual eligibility. The two programs together can cover most of your healthcare costs. Check with your state’s Medicaid agency to see if you qualify for dual eligibility.

If you retire before age 65, you can’t enroll in Medicare yet, but here are some other options:

  • You can use the retiree coverage through your employer if it’s available.

  • You can enroll on your spouse’s plan if the employer allows that option.

  • You can use COBRA coverage. However, you will likely be responsible for the full cost of coverage.

  • You can buy insurance through the Health Insurance Marketplace. Losing employer-based insurance due to retirement qualifies you for Special Enrollment. You can apply any time. However, if you voluntarily give up retiree coverage, you do not qualify for Special Enrollment. Applying through the Marketplace will tell you if you qualify for cost reductions with federal subsidies.

  • You can buy private insurance or find group coverage through a professional, trade, industry or membership organization.

If You’re 65 or Older and Still Work

Your options if you are 65 or older and still working depend on your employer’s size. If your employer has 20 or more employees, you can choose either of the following:

  • Enroll in an employer plan and delay Medicare. However, most people do not pay a premium for Part A (hospital coverage). So, you may want to go ahead and enroll in Part A. It can serve as your secondary insurance and pay for costs your employer plan does not cover.

  • Enroll in Medicare and decline employer coverage. This may be a more affordable option if your employer does not cover much of your insurance premium. It may also be the better choice if your employer coverage is poor.

If your employer has fewer than 20 employees, it is their choice whether to require you to enroll in Medicare. If they do, Medicare pays first and any employer coverage is secondary insurance.
In either scenario, you will qualify for Medicare special enrollment period if you stop working or lose your insurance. 

If You Have a Pre-existing Condition

Before passage of the ACA in 2010, insurance companies could deny coverage or charge you more for a pre-existing condition. A pre-existing condition is any medical problem you had before coverage starts on a new plan. Examples include asthma, high blood pressure, and cancer. The ACA made this practice illegal. No insurance company can deny you or charge you more for a pre-existing condition. They also can’t raise your rates solely because you develop a condition during coverage. This includes Medicaid and CHIP (Children’s Health Insurance Program).

Your health insurance options with a pre-existing condition are the same as anyone else’s. If you have a pre-existing condition, consider how often you will use healthcare services. A higher premium may be worth it for you if it lowers your out-of-pocket costs.

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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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