Published October 29, 2018|3 min read
Updated July 11, 2019. If you don't have health insurance through an employer, parent or spouse, you can purchase a plan through the marketplaces created by former President Barack Obama's health care law. Federal open enrollment — the time of year when anyone can sign up for or switch health insurance — began on Nov. 1, with new plans slated to go into effect Jan. 1, 2019.
Not sure how to assess your options? Here is step-by-step guide on how to sign up for a health care plan.
Healthcare.gov, the federal marketplace, is open as of Nov. 1 and closes Dec. 15, but some state exchanges have longer open enrollment windows. Learn the deadline for buying a 2019 health care plan in your state.
Note: If you miss the applicable open enrollment deadline and have a 2018 health care plan, your insurer might automatically re-up your coverage or enroll you in a comparable plan. Otherwise, you have to qualify for a special enrollment period to buy health insurance. Special enrollment periods are tied to big life events like marriage, the birth of a child or loss of health insurance.
Obamacare provides subsidies that lower how much eligible shoppers pay out of pocket for a marketplace plan. These subsidies include:
a tax credit to put toward your premium, which is the monthly cost of having the health care plan.
cost-sharing reductions to help pay for a plan's deductible (the amount of expenses you're expected to cover before insurance kicks in) and copays or coinsurance, the fixed dollar amount or percentage you pay for doctor visits, prescriptions and other services.
Many low- to middle-income families qualify for at least some aid. Visit Healthcare.gov to find out what type of assistance you can receive, based on your income and family size. The marketplace will apply the estimates to the price of plans when you shop, making it easier to spot affordable options.
Low-income shoppers might qualify for Medicaid, the joint state and federal health insurance program for needy Americans, instead of Obamacare subsidies. If so, you'll need to apply for coverage through your state's designated website. Check out our state-by-state guide to Medicaid for more details. Eligible Americans can apply for Medicaid at any time of the year.
Remember, Medicaid is different than Medicare, the federal health insurance program primarily for older Americans. With Medicare, you automatically qualify and, in most instances, get automatically enrolled once you turn 65. But existing beneficiaries can change their health care plans from Oct. 15 to Dec. 7.
Obamacare marketplace plans come in three main flavors: bronze, silver and gold (there are also platinum plans, but they're rarely offered). Each one offers the same level of care, but splits the costs between you and the insurer differently. Understanding how these metal tiers work is instrumental when it comes time to comparison-shop.
Bronze plans carry the lowest premiums, but highest deductibles, meaning you'll shoulder higher out-of-pocket costs for care, but pay less for the plan itself. Bronze plans are an option if you're in good health, don't qualify for cost-sharing reductions or can't afford silver or gold plan premiums in your state.
Silver plans have mid-tier premiums and deductibles. They set the price of the premium tax credit, though you don't need to buy a silver plan to take advantage of that subsidy. You do need to buy a silver plan to take advantage of any cost-sharing reductions you qualify for.
Gold plans carry higher premiums, but lower deductibles than bronze and silver plans. Consider them an option if you can afford the higher monthly payment as your insurer will shoulder 80% of your out-of-pocket health care costs.
Keep in mind, Obamacare caps out-of-pocket costs for all marketplace policyholders at $7,900 for individuals and $15,800 for families in 2019.
There are also different types of private health insurance plans. Your major choices include:
Preferred Provider Organization or PPOs let you choose between an in-network doctor, who can you see at a lower cost, or an out-of-network doctor at a higher cost. They let you skip referrals.
Exclusive Provider Organization or EPOs don't cover out-of-network physicians, but let you skip referrals for specialists.
Point of Service or POSs charge less if you use doctors within the network. They usually require referrals for specialists.
While the least restrictive plans are more expensive (and vice versa), what's important is that you can work within the parameters of a plan you're selecting. Check to see if your current go-to physicians are in-network or at least partially covered. Alternately, consider whether a plan's network meets your current health care needs.
If you opt for a high-deductible health care plan, be sure to open a health savings account. HSAs are tax-advantaged savings accounts specifically designed to help HDHP participants shoulder out-of-pocket health care costs. Learn how to open an HSA.
Plans sold on the federal and state marketplaces must cover 10 essential benefits, including hospitalization, mental health services and maternity care. They're also subject to other requirements, like coverage for pre-existing conditions.
Translation: They're usually much more robust than plans you'll find off-exchange. But, if you don't qualify for any Obamacare subsidies, you might find them prohibitively expensive.
If so, there are alternatives to explore in lieu of foregoing coverage. These include:
Off-exchange plans: To avoid some of the more stringent marketplace plan rules — notably, the stipulation that they offer gold and silver versions of each plan sold on a state exchange — private insurers also sell "off-exchange plans" during open enrollment directly or through third-party brokers. These plans abide by the major Obamacare rules. For instance, they cover the 10 essential benefits. But they're generally considered ineligible for subsidies. Still, if you don't qualify for subsidies, they're worth looking into. You might find plans at lower price points than what's available through your state exchange.
Short-term health plans: These plans are typically cheaper, but less robust than marketplace plans. For instance, they might forego coverage for pre-existing conditions or cap certain services, including doctor stays, at a certain amount. Following changes made by the Trump administration, short-term health plans can last for up to three years. But it's important to read the fine print of a policy carefully so you understand the scope (or limitations) of its coverage. Policygenius partner Agile can help you compare short-term health plans across companies.
Health care sharing ministries: A faith-based alternative to traditional health insurance, health care sharing ministry participants pay a monthly “sharing amount” similar to a premium. Those funds can go toward medical expenses, but HSMs aren't subject to Obamacare rules, so each one sets their own guidelines for members. These guidelines affect covered services and sometimes require certain behaviors from members, like abstaining from tobacco and drugs and attending group worship.
Learn more about these and other health insurance alternatives, including COBRA, limited benefit plans and prescription discount cards.
Disclosure: This post contains references to products or services from one or more of our advertisers or partners. These codes earn us a small fee at no additional cost to you.
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