When it comes to getting health insurance, there’s no time like the present…and we mean that literally. After higher-than-expected enrollment in coverage plans earlier this year (and increased subsidies), the Biden Administration extended the Affordable Care Act (ACA) open enrollment period to August 15th, making U.S. health care cheaper and more accessible than ever before.
The why of health insurance (though achingly obvious) can be better appreciated when the what is also clear: What’s available, what forms you need to gather to get it, and what you should be looking for. This can be an intimidating topic, but we’re here to help break down the basics and get you one step closer to an #adulting level of self-care.
What is health insurance and why is it important?
Health insurance is a specific type of insurance that covers medical expenses. Since health care in American can be expensive, insurance helps manage risks like high costs. Simply put, it’s an agreement between you and an insurance provider to share in the cost of health and medical expenses incurred throughout the year. It’s a contract that you pay into, and can be augmented to include immediate family members and spouses.
From monthly prescriptions to sudden illness to accidents, medical services are essential, and they don’t come cheap; a routine physical, for example, can cost up to $200. Having insurance helps protect you (and your family) from overwhelming medical debt. Plus, thanks to the Affordable Care Act, preventive services like yearly check-ups, screenings, vaccinations, and some prescriptions like birth control are available to you at no additional cost.
Generally, private health coverage requires you to pay a set monthly bill, called a premium, to your insurance provider to maintain enrollment. Depending on your plan, you may also be responsible for other costs you have to pay at the doctor’s office or pharmacy. These “out-of-pocket costs” are known as cost-sharing and can take the form of a deductible, which is a fixed amount that you pay before your insurance kicks in. This can also be in the form of a copay or coinsurance, which is the amount that you pay when you receive certain services—like $10 for every visit. The total you can spend out-of-pocket every year is limited, and the maximum is listed in the plan information. Premiums and out-of-pocket expenses usually work opposite of each other, meaning the higher the premium, the lower the out-of-pocket expenses and vice versa.
Are there different types of plans?
While many people get health coverage through their employer, there are alternatives. Student health insurance is one option, as is remaining as a dependent on your parent’s insurance plan until the age of 26. Medicaid and CHIP are government options that provide free or discounted insurance to those eligible, including low-income adults, children, pregnant women, elderly adults, or those with disabilities. Medicare is reserved for people over 65, as well as younger people with disabilities. And, lastly, the ACA (or Obamacare, as it is sometimes called), serves as a marketplace that offers individual insurance options that you can buy if you don’t have coverage through an employer or alternative aid.
How do I find the right plan for me?
Individual health insurance plans can largely be found through HealthCare.gov, though a handful of states run their own marketplace sites, and alternative individual plans are also available. As noted above, you may not be able to get a plan through HealthCare.gov if you get insurance through your job, unless your employer’s options are deemed unaffordable. Conversely, should you qualify for Medicaid or CHIP, those options will be more affordable than plans available on the individual market.
If you don’t feel comfortable securing your own plan, an enrollment navigator, broker, or agent can help with the process. You can find out more about locating a navigator here.
What documents do I need in order to sign up?
First, you’ll need an estimate of your total household income before tax for the upcoming year; this information can be found on your tax return. Be sure to include income earned by all adults in your household, even if they aren’t applying for insurance with you. If you do want to secure coverage for your spouse, family, or kids, you’ll need their social security numbers and dates of birth (along with your own, of course!). You’ll also need everyone’s employer information, including business name, address, and phone number.
If applicable, immigration paperwork may be necessary. For naturalized citizens, this means the number from the certificate of citizenship / naturalization (located at the upper right hand corner) and your alien number (located just below, beginning with an “A”). For those with a visa, green card, or foreign passport, you’ll need the alien/USCIS number and I-94/visa/green card/passport number. If members of your household don’t need insurance, you won’t need to provide immigration paperwork.
What should I look for in a plan?
Selecting health insurance is kind of like a flowchart-style game, with you as the star. Take a deep breath and look at your current situation, past health, and current needs. Before you begin your search, take time to consider the following questions:
- Am I eligible for discounts on premiums (your monthly payment) or out-of-pocket costs (additional payments for certain visits and prescriptions) with this plan?
- Will this plan require me to fill out a medical questionnaire?
- Does this plan cover prescription drugs?
- Does this plan include annual or lifetime limits on coverage?
- Will my premium be based on any factors other than my age and where I live?
- Will my occupation make a difference?
- Are there providers near me that are covered by my plan?
Once you have a better idea of what you’re looking for, tools exist to make the game of getting health care a winnable one. If you’re looking for a place to get started, visit Healthcare.Gov or get free, expert help on the ins and outs from a local assister at GetCoveredAmerica.org.