How to Get Health Insurance if you are self-employed or unemployed

No one plans to get sick or injured, but when it does, it’s important to be prepared. Health insurance is an important tool for everyone to protect against unexpected medical costs and provide valuable benefits to help maintain and improve health and well-being. If you don’t have health insurance through your job, choosing a health plan can feel overwhelming – but with the right information, it can be easy to find a cheap, good one.

Read on for tips and information that can help when shopping for health insurance if you’re self-employed or unemployed — including retirees who are too young for Medicare.

Where to shop for Health Insurance

You can shop for health plans in the Affordable Care Act (ACA) Health Insurance Marketplace at HealthCare.gov or directly through an insurance like Cigna. The ACA Marketplace is run by the federal government, although some state governments choose to run their own exchanges.

When to Buy Health Insurance

Of the Opening Period when individuals and families can purchase a new health plan or make changes to their current health plan ACA Marketing. Open enrollment begins on November 1 each year with a December 15 deadline for purchasing plans that begin on January 1, and a January 15 deadline for plans effective on February 1.

Special Period of Engagement it is possible to get insurance or change plans at other times of the year. To qualify, you must have experienced a life change within the past 60 days such as losing your health insurance, getting married, or having a baby. In addition, individuals whose income falls below 150% of the Federal Poverty Line (FPL), which is approximately $19,000 for an individual and $40,000 for a family of four, may be able to enroll or change their plans throughout the year.

What to Look for When Shopping for Health Insurance

When shopping for a personal or family plan, the first thing you want to look at is the premium, which is the price you’ll pay. for your health plan – usually monthly or bi-monthly. Think of it like a subscription fee you pay for a streaming service. You pay your insurance to get that protection, even if you don’t go to the doctor that month, just like you pay for streaming even if you don’t watch a movie.

When you buy insurance in the ACA marketplace, the cost of the benefits you choose, your age, where you live, and the insurance company will vary.

Depending on your income, you may be able to qualify for subsidies, including tax credits you can lower your monthly health care costs by adjusting your bill. Because of the changes made throughout the pandemic, and extended to 2025 up to Inflation Reduction Act, more people than any other good position for help on the market, be sure to check if you qualify. Many people qualify for subsidies to reduce their payments to $0 per month.

Expenses are a starting point for determining which health plan is the best fit for your budget and needs, but not the whole picture. Factors such as deductibles, co-pays, co-pays, out-of-pocket limits, and your unique health needs should also be considered. determine the full potential of a plan.

Health Tips to Help You Shop for a Plan

In order to make an informed decision when purchasing a health plan, it is important to understand some key information and factors that can significantly affect total costs. Most of the information that comes out during open enrollment for these plans can affect the total amount you pay for health care.

Subtraction: Your deductible is the amount of money you need to pay for medical care before your health plan starts sharing the costs. For example, if your deductible is $1,500 for the year, you’ll pay out-of-pocket for all care (except preventive care, like annual checks) until you spend $1,500.

Choose a health plan with a deductible you can afford, since it comes out of your own pocket if you have health care expenses. Also, be sure to check if a plan you are considering has a separate deductible for health services and for hospitals – you are responsible for it.

Communication: A network is a group of health care providers, such as doctors, pharmacies, and specialists, who contract to serve people. buy into some health plans. You want to make sure the doctors and pharmacies you and your family need are covered by the plan you’re choosing. Otherwise, you will accumulate unnecessary costs for out-of-network services.

Copay: A copay is a special fee you pay when you visit a doctor or get a prescription from a pharmacy. If the plan includes copays, they will pay your share of the cost of a doctor’s visit or medication. If you choose a health plan with copays, the amount will be listed on your ID card.

Insurance: Instead of copays, plans can include coinsurance – you pay a percentage of the costs for covered services, and your health plan pays the rest. Depending on your plan, your coinsurance usually starts after you meet your deductible.

Out of pocket height: The maximum amount you can pay for expenses per year. This amount includes the money you spend on deductibles and copays or coinsurance. If you reach your maximum annual amount, your health plan will cover all of your costs for the rest of the year.

Facing Different Types of Health Plans

Connections and costs can vary widely between the three types of health plan: health care organization (HMOs), special delivery organization (PPOs), and institutional providers (EPOs).

An HMO health plan provides you with a local network of doctors, hospitals, and other health care providers and facilities that choose from. These types of health insurance plans require you to choose a primary care provider (PCP) from within the network. Your PCP is at the center of your medical care, welcoming you, helping coordinate all of your care, and providing referrals. special people in the network. The costs for an HMO plan – copays and coinsurance – are usually lower than other types of health plans, if you stay in network.

A PPO health plan offers a wide network, so you have more doctors, hospitals, and other health care facilities to choose from. Your out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan. If you are willing to pay a higher monthly premium to have more flexibility in choosing your doctor and your health care, a PPO health plan may be right for you.

An EPO health plan offers a local network of doctors and hospitals for you to choose from. EPO usually has lower out-of-pocket costs than PPO plans. However, if you choose to receive care outside of your plan’s network, it may not be covered (except in an emergency). If you’re looking for lower monthly expenses and are willing to pay a higher deductible when you receive care, an EPO plan may be right for you.

Health Planning for Minors

If you’re in good health and don’t visit a doctor often, health plans with higher deductibles often have lower premiums and can help save money. All plans available in the ACA Marketplace include free preventive services. This includes annual physical exams, appointments, and vaccinations.

Your health needs are unique, and will change over time. Instead of just thinking about your age when choosing a plan, think about what you might need in the coming year.

Family and Child Health Planning

If you have children, it may be difficult to estimate your health care expenses. A crash on the playground, a fight of virus that affects the stomach (RSV) or the flu, or other illnesses or injuries can quickly increase costs. A plan with a low deductible and high premiums that pays for a larger percentage of your medical costs may be better for your family.

Take the Time to Understand Mental Health Planning

To better understand mental health insurance as a health insurance plan, you generally need to look at the Summary of Benefits. This is a document that shows the services included in the plan and what you will pay for the services included. Usually there will be a line that describes coverage for mental health, behavioral health, or substance abuse. Depending on your mental health needs, this may be one of the deciding factors in how you choose your plan.

It can be helpful to look at plan brochures to see if there are any additional plan options that affect access to mental health care. For example, Cigna individual medical plans offer additional access to behavioral health services through MDLIVE – a leading healthcare and telehealth provider with over 2,500 certified physicians and nurses.

Even if you have not been diagnosed with a mental illness, a plan with behavioral health can ensure that you get specialized care when you need it. A recent study Evernorth published in the Journal of the American Medical Association indicates that if necessary, total health care costs – including medical and pharmacy costs – can be significantly reduced.

How to Explore Your Choice Plan

To see which plans are available in your area, visit HealthCare.gov and enter your ZIP code or visit The Cigna website. If you have specific questions about certain plans or providers, most insurers have sales representatives who can answer questions about in their plans. For more guidance, you can get local help through HealthCare.gov/find-assistance from a broker who specializes in ACA plans to help determine what’s best for you, or an assistant who can walk you through your options and specific needs.

Leave a Comment