If you’re looking for affordable health insurance, there are a variety of options to consider. Some are subsidized through employer-sponsored coverage, marketplace plans, or Medicaid.
Rates vary by age, location, and other factors. Some plans are less expensive for people who don’t smoke or who have a chronic medical condition.
Health insurance through your employer
Health insurance through your employer can offer you an inexpensive way to get coverage. You may be able to get a subsidy from the federal government to help pay for your premiums.
Depending on your employer, you may be able to save money with a flexible spending account (FSA) or health reimbursement arrangement (HRA). These are options that let you contribute pretax funds to cover qualified medical expenses.
Employer-sponsored plans, also known as group health plans, are the most common way that Americans get health coverage. But employers have to follow certain laws and regulations.
Health insurance through the ACA Marketplace
The ACA Marketplace (also called the health insurance exchange) is a place where you can shop for and compare a variety of health plans. These plans must meet certain requirements, including covering essential health benefits like doctor visits, preventive care, and prescription drugs, among other features.
The Marketplace also helps you receive financial assistance through premium tax credits, cost-sharing reductions, and other programs. You can apply for coverage during an annual open enrollment period or during a special enrollment period that’s triggered by a qualifying life event.
The Marketplace was designed to help people make smart decisions about their healthcare by offering a simple, impartial place to shop for health insurance and applying for financial assistance. However, a growing number of consumers are using websites other than the marketplaces to enroll in Marketplace plans and receive financial assistance.
Medicaid
If you are low-income and have a health problem or are pregnant, Medicaid may be a good option for you. Unlike private insurance, it covers a wide range of services and does not have copays or deductibles.
States can offer more services than the federal requirements, such as extra help with doctor visits, hospital stays and long-term care (custodial care) that would be unaffordable for individuals without private insurance. In return, state governments receive federal matching funds that help pay for these additional services.
Income is taken into consideration to determine eligibility, with modified adjusted gross income (MAGI) — taxable income plus Social Security benefits, tax-exempt interest and other sources — the main factor. Eligibility is capped at 138 percent of the federal poverty level (FPL). For children, the limit is higher.
Medicare
Medicare is a federal health insurance program for people 65 and older, certain people with disabilities or end-stage renal disease, and some children under the age of 65. It covers doctor visits, hospital stays and medically necessary care.
Part A: Medicare covers hospital stays and skilled nursing (only after a formal admission to a hospital for three days or more and not for custodial care). It also covers doctors’ visits, some emergency care, most lab tests, diagnostic testing, preventive services, some medical supplies and some prescription drugs that must be administered at a doctor’s office or facility or by a nurse or other healthcare provider.
Part B: Medicare covers outpatient services, such as most provider office visits even if the doctor’s office is “in a hospital,” durable medical equipment and most professionally administered prescription drugs. It usually has a deductible and coinsurance.
Short-term health insurance
There are a number of reasons you may need to purchase short-term health insurance. You may have lost your employer-sponsored coverage, or are temporarily between jobs. You may need a temporary alternative to COBRA, or you may be waiting for ACA coverage to begin at your new job.
Many people buy short-term plans to reduce their monthly premiums. But they are not regulated by the ACA and do not provide the same level of coverage as an ACA-compliant plan.
They usually exclude or severely limit coverage for maternity care, prescription drugs, preventive care and other benefits, and they have high deductibles. Moreover, they often refuse to reimburse providers for their services. Additionally, they can deny claims on preexisting conditions. So it is important to compare a variety of plans before buying one.
