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Health Insurance Plans for both Individuals and Families
How to Get Health Insurance
According to the Commonwealth Fund, more than half of all Americans under age 65 get their insurance through their employer, The rest of the population get it through Medicaid or the individual insurance market and the rest remain uninsured. Those people aged 65 and older are automatically qualify for Medicare. The people who have lost their employee-sponsored insurance, or never got it, there are five options open to them, which depend on their income, which state they live in and whether they had coverage recently. You are requested to continue your employer's coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA.
What is COBRA
COBRA is the smoother but most expensive option for those who have lost employer coverage.
Employers basically pay about 75% of the premiums for their employees, for the rest the employee remain responsible. An employee paid $1,242 on average for single coverage in 2019. But in case of COBRA you have to pay the full cost on COBRA, which averaged $7,188 for that year. The contribution for family coverage was $6,015 on average in 2019, but the full cost of coverage averaged $20,576. At your state's marketplace or HealthCare.gov, you can find individual health insurance policies and pricing. If you lose your job and coverage, you may qualify for a special enrollment period where you have up to 60 days after you lose your employer's coverage to buy a policy.
It doesn't matter what state you live in, you can enroll in affordable, reliable health coverage as mandated by the Affordable Care Act. Links to your state’s marketplace can be found at Healthcare.gov. Residents of states who have no individual marketplace purchase their insurance directly through Healthcare.gov.
When Is Open Enrollment for Health Insurance?
In order to sign up for insurance through your state’s marketplace or Healhtcare.gov, you basically need to wait until the open enrollment period, which generally runs from Nov. 1 to Dec. 15 every year. That is also the time when you can make a change to your employer-sponsored coverage in case you wish. If you have a life event that qualifies you for a Special Enrollment Period, you also can enroll in or change your marketplace plan. You may be qualified for a Special Enrollment Period according to Healhtcare.gov if you or anyone in your household in the past 60 days:
Got married - You can pick a plan by the last day of the month and your coverage starts the first day of the next month.
Having a baby, adopted a child or placed a child for foster care - Your coverage can start on day of the event, no matter if you enroll in the plan up to 60 days afterward.
Divorced or legally separated and lost health insurance. Anybody divorced or got separation legally without losing coverage will not qualify you for a Special Enrollment Period.
Died - You will be eligible for a Special Enrollment Period in case someone on your Marketplace plan dies in consequence of which you are no longer eligible for your current health plan.
Changes in Residence - Household moves will qualify you for a Special Enrollment Period if-
1. Moving to a new residence in a new ZIP code or county.
2. Moving to the U.S.A from a foreign country or United States territory.
3. If you're a student and you move to or from the place you attend school.
4. Moving to or from transitional housing, a shelter.
5. If you're a seasonal worker and move to or from the place you both live and work.
How Does Health Insurance Work?
Health insurance is mainly a contract that requires that your health insurance company pays some or all of your health care costs in exchange for a monthly payment which is called a premium. Though each plan offers different types and amounts of coverage, all typically cover doctor visits for certain doctors within that plan, hospital stays, prescription drugs and some other services. More comprehensive plans may include mental health care, behavioral health care, vision care, dental care, physical and occupational therapy and more.
Most plans require you to pay other costs for your health care In addition to the premium. These may include:
A deductible. Before your insurance plan starts to pay, this is an amount you pay for covered health care services . For example with a $2,000 deductible, you pay the first $2,000 of covered services yourself.
Co-payments. After you've paid your deductible, this is a set fee that you pay for a covered health care service – typically $5 to $25 per service.
Co-insurance. After you've paid your deductible, this is a percentage of costs of a covered health care service you pay.
It’s very important to look closely at the details of each plan out of these variables in order to be sure it covers for the care and services you most likely require and it includes the doctors and hospitals you want treating you.
What Type of Health Insurance You Think Should I Get?
There are different types of health insurance plans which are designed in order to meet different needs of different people. Some types of Health insurance restrict that you may have free choices of doctors or requires you to use the plan’s set network of doctors, hospitals, pharmacies and other medical service providers, or needs you to pay more out-of-pocket for providers outside the plan’s network.
Understanding the Health Maintenance Organizations (HMOs)
An HMO plan usually covers care only from doctors working for or contract with the HMO. It usually would not cover out-of-network care except in emergency case. Some HMOs want you live or work in its service area in order to be eligible for coverage. HMOs often prefer integrated health care focusing on prevention and wellness.
Understanding the Exclusive Provider Organizations (EPOs)
An EPO is a managed care plan only covering services which are rendered by the specialists, doctors or hospitals in the plan’s network. There is only one exception and that is the case of an emergency.
Understanding the Point-of-Service (POS) Plans
POS plans have lower out-of-pocket fees only when you use doctors, hospitals and other health care providers belonging to the plan’s network. POS plans also wants that you procure a referral from your primary care doctor before you can see a specialist.
Understanding the Preferred Provider Organizations (PPOs)
To create a network of participating providers, PPO plans contract with medical providers, such as hospitals and doctors, You pay less when you use providers belonging to the PPO network. You are free to use hospitals, doctors and providers outside of the network, but you pay an extra cost.
What’s the Difference Between Government Insurance Companies and Private Insurance Companies?
Health care coverage is offered by both public and private companies. Through two national health care systems, Medicare and Medicaid, the government provides public health care . Private health insurance is provided through for-profit insurance companies. Rules and regulations are placed on for-profit companies who sell their products through marketplace exchanges overseen by each state. Anyone whose age is 65 automatically is qualified for Medicare, which becomes their primary source of health insurance. Secondary insurance which is obtained through an employer, spouse or through the marketplace, can cover such costs not paid for by Medicare. This is known as Medigap insurance.
Medicaid is primarily for those who are low-income and disabled individuals, and it is based on income. The Children’s Health Insurance Program (CHIP) which is a subset of Medicaid, offers subsidized low- or no-cost health insurance for children.
How Much cost Is Health Insurance?
It is shown that in 2020, the average cost for health insurance nationally was $456 for an individual and $1,152 for a family per month as to the report of eHealth, . However, costs may differ mainly among the large selection of health plans and according to state regulations. You may qualify for a subsidy under the ACA, to help pay your premiums which depends on the number of people in your family and your income for the year. These subsidies are substantially lower monthly premiumsThere is another option and it is to sign up for personalized medical services, popularity known as concierge medicine or direct primary care. You pay a monthly or annual fee in order to access care directly from your physician. These arrangements have average costs ranging from $77 to $183 a month according to the American Academy of Family Physicians.
Affordable Health Insurance
The Affordable Care Act, a comprehensive health care, reforms law enacted in March 2010. It is ACA, PPACA or “Obamacare" sometimes known as. According to the Centers for Medicare and Medicaid Services, the law has three primary goals.
1. Make affordable health insurance open to more people. In the form of premium tax credits, the law provides consumers with subsidies, and lower costs for households with incomes between 100% and 400% of the federal poverty level. That can trigger up to about $50,000 a year for individuals and more than $100,000 a year for a family of four.
2. To cover all adults with income below 138% of the federal poverty level it expands the Medicaid program. Many states are unwilling to expand their Medicaid programs.
3. Support innovative medical care delivery methods that is designed to lower the costs of health care generally.
Open enrollment for ACA programs generally starts from November 1 to December 15. You can enroll in a plan or change your existing plan if you have a life event that qualifies you for a Special Enrollment Period. There are also cheaper health insurance plans, popularly known as short-term plans. These plans are not required to comply with ACA regulations and they offer far less comprehensive coverage. Most insurance experts recommend to avoid short-term plans if at all possible, the main reason of it is that the money you save in premiums will be shortened by the costs of care you are responsible in case you need it.
Comparison - Individual Health Insurance Plans Vs. Family Plans
For a group of individuals, like the employees of a company or members of an association, a group health insurance plan provides coverage. Costs comes generally lower for group plans as the risk is spread among more policyholders. Health coverage, regardless of who covered you, whether offered by your employer or through the health insurance marketplace, is available as an individual or family plan.
Health Insurance Plans for Individuals:
Under the ACA, it is worth remembering that Individual health insurance policies are open for people who don’t have job-based coverage or have lost job-based coverage. Individual health insurance policies are applied under state law.
Health Insurance Plans for Families: These plans cover for two or more people, including dependent children. According to the ACA, it is regulated that dependent children may remain on their family plan until age 26. This rule is applied to both employer plans and individual market plans.