Here’s a fact: health policies will not always cover 100% of your medical costs. What you must understand is that it is meant to share the total amount with you, but only up to a certain number. This is what’s referred to as the out-of-pocket limit, and once you hit that, that’s when they begin covering 100% of the cost.
The different ways these companies share costs with their policyholder is through deductibles, co-insurance, and co-payment, as well as your out-of-pocket limit.
One of the things you must remember is that ALL health insurance policies are required to cover 10 essential benefits. Aside from these 10, they must also meet affordability standards and other rules, which can vary from one state to another. This is so they can be considered part of the government-run health insurance exchange a.k.a. the Marketplace.
What about the providers that are not included in the exchange? These off-exchange plans also have to meet these requirements in order to be qualifying health coverage. Nonetheless, it always pays to be well informed—especially since these things do cost a considerable amount of money in the long run.
Note that if you’re able to purchase insurance, but choose not to, then you will have to pay a penalty on your federal tax return. This was outlined in the ACA and is referred to as the individual mandate.
I.WHO SHOULD PURCHASE A HEALTH PLAN
Ideally, every individual should purchase a health plan for themselves given the fact that medical expenses can be significantly expensive to pay for out-of-pocket. Did you know that medical bills can often lead a person to bankruptcy? This makes it one of the leading causes of financial troubles as well—something that can be easily avoided.
When choosing, consider your situation and look into the following:
-If you’re purchasing for a family. Note that family deductibles along with individual deductibles for every member of the plan, individual deductibles will be lower.
-If you’re a student. You can remain on your parent’s plan up until you’re 26 years old so it is highly recommended that you take advantage of this. Look into your university for any available plans—these tend to be more affordable as well.
-If you’re self-employed. If you recently left a full-time job, take advantage of COBRA until you’re able to secure a new insurance plan for yourself. Remember that if it isn’t open enrollment, you qualify for a special enrollment period whilst you shop on the Marketplace.
-If you have a tight budget. These policies can be a pretty hefty expense, especially if you’re already having a hard time with money management. For this, take advantage of Medicaid, which is a plan specifically meant for low-income households. You qualify for it if your income falls between 100% and 400% of the federal poverty line.
-If you’re a veteran. Look into getting health care through the U.S. Department of Veterans Affairs. If you already have coverage through a private-sector employer, note that you can use both plans at the same time.
-If you’re expecting a child. Maternity and childbirth are listed among the 10 essential benefits that are required by the ACA from any qualifying health policies—so these are already covered even if you were already pregnant prior to the start of your coverage. Needless to say, it’s a great investment to keep in mind, even if you’re still in the planning stages of starting a family.
-If you’re a senior citizen. Individuals over the age of 65 qualify for Medicare. This is a federal program that will assist with healthcare-related costs into the person’s old age. Note that you can also purchase supplemental policies called MEDIGAP, which should help with paying of co-insurance, co-payments, and deductibles. Now, these plans can be difficult to grasp so make sure you understand it properly before buying one. Consider speaking to someone knowledgeable, such as a family member or family lawyer.
-If you’re in the military. If you’re actively serving, your personal health care, as well as your family’s, would be covered by TRICARE. Note that there’s no need to purchase additional plans in order to meet ACA’s requirements.
-If you’re married but have no children. You don’t have to purchase a policy as a family. This gives you the option to buy individual plans—if this is something that, financial-wise, makes sense for you and your spouse. You can also become dependent on your partner’s employer-provided plan if this is available.
II.WHAT KIND OF INSURANCE SHOULD YOU PURCHASE
Remember, there are two types:
-Public health plans, which include CHIP, MEDICARE, and MEDICAID.
-Private health plans.
Most people would have some type of private plan, which was either purchased from the marketplace or provided by an employer. Note that both state and federal exchange will offer you both types.
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