Having good health insurance coverage is essential to keeping you and your family safe and healthy. But if your employer doesn’t pay for health insurance, or if you’re not currently employed, you may have questions as you navigate the process of obtaining insurance yourself. The following are some answers to many of the questions people in your situation often have.
Is Health Insurance Mandatory?
As of January 2019, health insurance is not mandatory at the federal level. The 2010 Affordable Care Act (ACA) required that all Americans have health insurance and imposed tax penalties on those who did not. In January 2019, however, the tax penalty portion of the ACA was repealed, meaning that at the federal level, Americans are no longer required to carry health insurance. A few states, however, do still impose health insurance requirements. If you live in California, Massachusetts, New Jersey, Vermont, or the District of Columbia, you must still carry health insurance. You can find more information on our resources page.
Where Can I Find Health Insurance Plans?
Many people shop for their health insurance plan through local insurance agencies or by shopping around using online search tools such as ehealthinsurance.com, healthplans.com, and nerdwallet.com, which allow you to compare quotes from multiple companies. As part of the ACA, the federal government collaborated with the health insurance industry to create a special Health Insurance Marketplace of federally subsidized health insurance plans. The government also operates a searchable database of health insurance plans outside of the Health Insurance Marketplace.
How Do I Pick a Plan?
Looking at the price tag of a plan is a quick way to determine whether it fits your budget, but there’s a lot more to consider when trying to find the right plan.
First, make sure you’re looking at plans that provide coverage for the right number of people. Some are for individuals, some for individuals and spouses, and some for families with children or dependents. Next, read the fine print to determine whether the plan provides the coverage you need or may need in the future. If you have a doctor, pharmacy, or other specialists already, make sure they’re in-network. Look at whether it includes services such as dental, eye care, pregnancy, mental health, physical therapy, and so forth. Make sure it meets your needs for prescriptions and medications. The next step is to make sure you’re aware of all of the plan’s costs. This includes not only the monthly premium but also the deductibles, copayments, and any coinsurance. Check to see if there is a maximum out-of-pocket amount.
Finally, familiarize yourself with the plan’s policies and procedures. Review how it handles claims and customer service. Look for reviews and ratings of the plan and the provider. Understand how the company handles disputes about bills or services. Once you have this information, carefully compare at least five or six plans that fit your needs and budget. Be sure that you compare information that is equivalent across the plans and weigh costs and benefits. For example, one plan might have a higher monthly premium. Still, it provides a lower deductible or out-of-pocket maximum.
Now let’s take a look at how Medicare works. One of the most popular choices for health insurance for people whose employers don’t provide it or who otherwise don’t have access to health insurance is Medicare. Created by law in 1966, Medicare is the national health insurance program for the United States. It provides coverage for anyone 65 or older, certain people under 65 with disabilities, and anyone with permanent kidney failure. The primary part of Medicare is called “Original Medicare,” and it covers the most typical primary care needs and certain medical specialists, as long as they are enrolled in Medicare. There is no premium, though there are deductibles and copayments or coinsurance, depending on the service and provider.
Most people who have Medicare also purchase Medicare Part A, Part B, Part D, or some combination of those. Part A provides coverage for inpatient hospital stays, nursing facilities, hospice, and some home health services. Part B provides coverage for outpatient care, some specialized and preventative services, and medical supplies. Part D provides coverage for prescriptions and medications. These plans do come with monthly premiums, differing deductibles, and additional copayment or coinsurance amounts.