You’re not alone if you need to purchase health insurance. The number of uninsured people in the United States climbed for the fourth year in a row, reaching roughly 30 million in 2020. 1 We’ll go over each option for purchasing your own health insurance so you can figure out which one is right for you.
KEY TAKEAWAYS
- During the annual open enrollment period, you have the best opportunity of finding affordable, comprehensive health insurance.
- Instead of purchasing directly from an insurer, you should apply for subsidies through Healthcare.gov or your state exchange.
- You can also purchase health insurance through an agent or broker. You will not be charged a fee if you work with a broker.
- You may not be shown all of the plans that fit your needs if you buy health insurance through an online health insurance brokerage, sometimes known as a private exchange.
- You may be able to get a group deal on health insurance if you buy through an association or membership organisation.
Option 1: Purchase health insurance through the government’s Health Insurance Marketplace.
The Health Insurance Marketplace is sometimes known as the “exchange” for health insurance. When you buy health insurance through the marketplace, you may be eligible for subsidies (also known as premium tax credits) based on your income and other health insurance coverage qualifications.
Even if you are eligible for insurance through your workplace, you can get marketplace coverage, and it doesn’t hurt to shop around to see if you can find a better deal. If you have job-based coverage, however, you are unlikely to be eligible for subsidies.
On Nov. 1, 2021, open enrollment for 2022 coverage began. For coverage to begin on January 1, 2022, you must enroll by December 15th. 2 The open enrollment period was extended from February 15 to May 15 in 2021, due to the ongoing COVID-19 pandemic.3
Enrollment dates for state exchanges may differ slightly. You won’t be able to buy a policy for the rest of the year unless you experience a qualifying life event, like moving, getting married, or having a kid, so it’s critical to acquire one during this yearly enrollment time.
You can submit an application online, over the phone, or in person. If you need assistance with your application, you can work with a marketplace navigator, a certified application counselor, or in-person assistance workers in some states.
To purchase a marketplace plan, you must be a U.S. citizen or lawfully present in the country.
Healthcare.gov is a good location to start looking for a marketplace policy. If you enter your zip code, you’ll be sent to the federal marketplace to purchase a policy. You’ll be led to your state’s website if your state has its own marketplace. Direct links to state exchanges can also be found on Healthcare.gov’s The Marketplace in Your State page.
If you’re not sure if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), go to your state’s Medicaid website or fill out an application on Healthcare.gov.
Option 2: Collaborate with a real estate agent or broker
Because they have experience analyzing health insurance plans, an agent or broker can assist you in finding decent coverage for you. The federal government’s Find Local Assist service can help you find a private insurance broker who has been trained in the marketplace. You might wish to work with a broker who provides both marketplace and non-marketplace plans if you want to learn about the most possibilities and get the least biased advice.
Brokers are compensated by health insurance companies when they sell plans. Brokers do not charge fees, and consumers do not pay higher rates to interact with them. “Agent” usually refers to someone who solely sells insurance policies from one firm, whereas “broker” refers to someone who sells policies from many providers.
Private insurance brokers may also provide you options from insurance companies and web brokers on private enrollment sites. However, if you want to be considered for subsidies, you must apply through Healthcare.gov or your state exchange.
Only marketplace plans offered through Healthcare.gov will be shown by the government’s health insurance navigators. All of these plans are subsidy-eligible, and a navigator’s assistance is free.
Option 3: Purchase a policy directly from an insurer.
The Health Insurance Marketplace does not include all health insurance options. Some folks may be able to locate a plan outside of the marketplace that better suits their coverage needs or their budget. When you shop for a policy on a single insurer’s website, you’ll only see alternatives from that particular insurer. If you wish to buy straight, you’ll need to visit various insurers’ websites to view all of your alternatives.
Outside of the federal and state exchanges, ACA-compliant plans must meet the Affordable Care Act’s (ACA) minimum essential coverage standards, such as covering preexisting conditions, providing essential benefits, and providing preventative care at no cost before you reach your deductible.
Outside of the exchanges, you can purchase non-ACA-compliant short-term plans (up to 12 months) that may have more exclusions and fewer benefits. People who are deciding between insurance companies may believe that having some coverage is preferable to having none at all. Short-term health insurance programs promote its perceived coverage as a good alternative to ACA-compliant insurance with reduced premiums.
However, lesser expenses do not necessarily imply equivalent coverage for the consumer. Most short-term plans reject coverage to those with pre-existing diseases and severely reduce the essential health benefits provided by the Affordable Care Act (prescription drugs, mental health services, prescription drugs, and maternal care). Many people are left with an unpaid balance.
The true reasons for this apparent affordability are the purposeful policy constraints on applicants and the coverage plan. Short-term health insurance should be approached with prudence because the financial risk may outweigh the financial savings. 6
In summary, whether you apply through a private exchange or contemplate any so-called alternative to existing health coverage, pay great attention to what you’re signing up for. Keep in mind that if you don’t apply through the federal marketplace, you won’t be eligible for subsidies. If your state manages its own health insurance marketplace, you should purchase your health insurance plan through it to ensure that it is subsidy-eligible.
You may not be concerned if your income is too high to qualify for assistance. However, if you earn less than planned in the coming year, you may qualify for subsidies unexpectedly, so you should keep your options open. Subsidies are calculated based on how much money you make in the year you’re purchasing coverage. You’ll only get an estimate of your subsidies based on your expected income when you enroll.
Option 4: Purchase health insurance through an online broker.
Online health insurance brokerage, often known as private enrollment websites or private exchanges, provides assistance in comparing health insurance policies or finding the best available plan based on the information you provide.
Comparison shopping is a good idea, but customers should be aware that these websites will not show them every plan available that matches their needs.
Instead, these private exchanges will display a list of plans for which they will receive a commission if the client enrolls. They may make the plans that earn the brokerage a greater commission stand out more or provide more information about them.
These marketing gimmicks don’t always imply that the plans on these sites aren’t worthwhile. It simply means that consumers should be aware that when they visit one of these sites, they may not be getting a clear picture of their alternatives.
Private enrollment websites may request personal information that is not required by the federal or state markets. They may inquire about your height, weight, and preexisting conditions, all of which can affect your eligibility for non-ACA-compliant coverage. Your personal information may also be used to promote additional items to you by the company behind the website to which you provide it, as well as their business partners.
You cannot get premium tax credits (subsidies) if you buy your health insurance policy through a private exchange, just as you cannot get them if you buy them straight from a health insurance company.
Option 5: Become a member of a membership organization.
You may be able to get health insurance at group rates if you belong to a union, alumni association, professional organization, or another large group. Health insurance is available through Freelancers Union’s subsidiary, Freelancers Insurance Agency, as well as one of its partners, HealthPlanServices.
If you’re looking for health insurance through an association or membership organization, make sure you’re getting insurance and not just a discount plan for health services. Discount plans may help you save money on medications and spectacles, but they will not aid you if you have cancer. Also keep in mind that, even though the association is a non-profit, it may be affiliated with or even founded by a for-profit insurance agency that sells policies to association members.
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