Health insurance is one of the most important purchases you’ll make all year.
Take heart, though. You have important consumer protections on your side, brought to you by the Affordable Care Act, also known as ObamaCare, which is still in effect for now. With a little know-how and research, you can find a health plan to cover you and your family.
What does Individual Health Insurance Cover?
Health insurance covers medical expenses for illnesses, injuries and conditions. But, unlike a plan through an employer, individual health insurance is something you select and pay for on your own. So, what’s health insurance for and why do you need it?
- Because accidents or health problems can happen at any time
- Medical expenses can be high—they’re the number one cause of bankruptcy
- To gain access to a network of doctors and hospitals that have negotiated lower rates with insurance companies
- To pay and keep track of medical payments quickly and easily
- To safeguard your way of life and your family’s physical and financial well-being
Understanding Health Insurance Terms
We know health insurance has its own language with different terms, like “deductibles,” “coinsurance” and “copayments.” Once you get a good grasp on some of these basic terms, you’ll see how simple health insurance can be. Let’s start by defining these terms:
Deductible: This is a set amount you have to pay toward your medical bills every year before your insurance company starts paying. It varies by plan and some plans have no deductible.
Premium: This is the amount you pay your health insurance company to keep your coverage active. Most people pay their premium monthly.
Coinsurance: This is the percentage of your medical bill you share with your insurance company after you’ve paid your deductible. Unless you have a policy with 100 percent coverage for everything, you have to pay a coinsurance amount. For example, if you have a $100 doctor’s bill and your plan covers 80 percent of it, your coinsurance amount due to the doctor’s office is 20 percent, or $20.
Copayment (or “Copay”): Your copayment, or copay, is the flat fee you pay every time you go to the doctor or fill a prescription. It’s usually a relatively small dollar amount. Copays do not count toward your deductible.
There are other insurance terms that may be confusing to you, but starting with these four is a good foundation. You can always check our glossary for more terms and definitions.
When to buy a health plan
You can purchase individual coverage only during the period known as open enrollment.
Open enrollment for 2019 health plans runs in most states from Nov. 1, 2018 to Dec. 15, 2018.
However, some states are extending the time that people have to buy health insurance. Currently, those states are:
- California – Oct. 15, 2018 to Jan. 15, 2019
- Colorado – Nov. 1, 2018 to Jan. 15, 2019
- D.C. – Nov. 1, 2018 to Jan. 31, 2019
- Massachusetts – Nov. 1, 2018 to Jan. 23, 2019
- Minnesota – Nov. 1, 2018 to Jan. 13, 2019
- New York – Nov. 1, 2018 to Jan. 31, 2019
- Rhode Island – Nov. 1, 2018 to Dec. 31, 2018
You can buy a health plan outside the open enrollment period if you have a “qualifying life event,” such as moving outside your insurer’s coverage area, getting married or having a baby. You can also buy coverage outside the open enrollment period if you had a special situation that prevented you from enrolling earlier.
The main qualifying life events that will give you a 60-day “special enrollment period” are:
- Getting married.
- Having a baby, adopting a child or placing a child for adoption or foster care.
- Becoming a U.S. citizen.
- Leaving incarceration.
- 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).
- For people with a marketplace plan already, having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions.
- Gaining status as a member of an Indian tribe.
You can sign up at any time of year for Medicaid or CHIP, which are federal and state insurance programs for low-income families.
Some health insurers sell short-term, or temporary, health insurance plans outside the open enrollment period. But these plans provide only limited benefits. Starting in 2019, any person can get a short-term plan, which lasts up to one year with the chance to extend the plan for two more years.
There is no longer an individual mandate penalty if you don’t have health insurance.
How to buy individual health insurance
Ready to shop? You have lots of choices: Compare websites, go directly to a health insurance company via its website or call center, contact a health insurance agent in your area or using your state’s health insurance marketplace (also called exchange).
Not all insurers sell plans through the government-run marketplaces, so you’ll find more options by shopping both in and outside the marketplaces.
If you qualify for subsidies, you can get them only by buying through your state’s health insurance marketplace. Healthcare.gov has links to state marketplaces.
You could be eligible for a premium discount in the form a tax break if your income falls below 400 percent of the federal poverty level (FPL). For 2019 health plans, the 400 percent threshold is $48,240 for a single person. Here are more examples:
- Household of 2 — income of less than $65,840
- Household of 3 — income of less than $83,120
- Household of 4 — income of less than $100,400
- Household of 5 — income of less than $117,680
You qualify for a plan with reduced out-of-pocket costs if your household income falls below 250 percent of the federal poverty level — $30,350 for a single person (the government uses FPL standards from the previous year to determine eligibility).
If you qualify for a tax break, you’ll see the premium savings as you shop and compare plans on the marketplace website. Keep in mind that catastrophic plans do not qualify for subsidies.
Let Uniamericainc.com help you find affordable health insurance now.