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Health insurance is one of the most critical tools for protecting your financial and physical well-being. Whether you’re an individual or part of a family, having the right health coverage ensures you can access necessary medical care without facing overwhelming costs. But,
Health coverage isn’t just a safety net; it’s a safeguard– your well-being and your wallet. Let’s break down the various types of health insurance available to people under 65 in plain, no-nonsense terms and discuss how to choose the best option for your situation.
Major Types of Health Coverage for People Under 65
1. Employer-Sponsored Health Insurance
Employer-sponsored health insurance is one of the most common types of coverage. In fact, Employer-sponsored health insurance (ESI) is the largest source of health coverage for non-elderly U.S. residents. With employer-sponsored plans, your employer often helps cover the cost of premiums, making this option both affordable and convenient. Often, employers provide this perk as part of their benefits package.
- How it works: Your employer deducts your share of the premium from your paycheck.
- Pros: Typically more affordable than individual plans, with access to group rates
- Cons: Limited to the plans your employer offers, and coverage ends if you leave your job
- Who it’s best for: Employees who have access to employer-sponsored plans and want cost-effective coverage.
2. Individual and Family Plans (Marketplace Plans)
If you’re self-employed, a freelancer, or don’t have access to employer-sponsored insurance, you can purchase individual or family plans through the Affordable Care Act (ACA) marketplace or private insurers. The ACA marketplace offers a variety of plan options that are tailored to the different needs of individuals.
- How It Works: The ACA marketplace offers standardized plans categorized into metal tiers (Bronze, Silver, Gold, Platinum), each with different cost-sharing structures. To learn more about the different metal tiers, click here to watch a video.
- Types of Plans:
- HMO (Health Maintenance Organization): Requires you to stick to in-network providers
- PPO (Preferred Provider Organization): Offers flexibility to see providers outside the network (often at a higher cost).
- EPO (Exclusive Provider Organization): A blend of HMO and PPO features with some network restrictions.
- POS (Point of Service): Combines aspects of HMOs and PPOs, usually with a referral system.
- Pros: Access to subsidies based on income, comprehensive coverage, and no denial for pre-existing conditions
- Cons: Costs can add up if you don’t qualify for subsidies, and available plans vary by state.
- Best For: Self-employed individuals, freelancers, or those without employer-sponsored insurance.
To get a free health insurance quote, click here.
3. Government-Sponsored Health Insurance
Government programs such as Medicaid and CHIP are designed to provide comprehensive, affordable care for those on a tighter budget. Click here to learn more about Medicaid insurance.
- Medicaid:
- Eligibility: Based on income and household size– eligibility varies by state.
- Pros: Low or no-cost coverage, comprehensive benefits.
- Cons: Limited provider networks in some areas
- Who it’s best for: Low-income individuals and families.
- CHIP (Children’s Health Insurance Program):
- Eligibility: Targets children in families that earn too much for Medicaid but can’t afford private insurance.
- Pros: Low-cost coverage for children, including dental and vision care.
- Cons: Income limits apply, and benefits vary by state.
- Who it’s best for: Families with children who need affordable coverage.
4. Short-Term Health Insurance
Short-term health insurance provides temporary coverage for gaps in insurance, such as between jobs.
- How it works: Plans typically last up to 12 months and can sometimes be renewed.
- Pros: Lower premiums and quick enrollment
- Cons: Limited benefits, no protections for pre-existing conditions, and often missing many benefits that come standard on ACA plans.
- Who it’s best for: Individuals in transition who need temporary coverage (For example, someone who just lost their job and employer-sponsored coverage but is starting a new job in a month and needs something to fill the coverage gap.)
5. Catastrophic Health Insurance
Catastrophic plans are for the young and healthy—people who rarely need routine care but want to guard against major financial setbacks from severe illness or injury.
- How it works: These plans have low premiums but high deductibles and only cover essential health benefits after the deductible is met.
- Pros: Affordable premiums and protection against major medical expenses
- Cons: High out-of-pocket costs for routine care
- Who it’s best for: People under 30 or those who qualify for a hardship exemption
Final Thoughts
Finding the right health coverage is like choosing the perfect pair of shoes—it needs to be a good fit for your lifestyle and needs. Whether you’re considering employer-sponsored insurance, an ACA marketplace plan, or a government program like Medicaid, each option has its pros and cons. It can feel overwhelming to navigate all the choices on your own, but you don’t have to! At Empower Brokerage, we’re here to help you every step of the way. Whether you have questions, need guidance, or just want someone to walk you through your options, we’ve got your back. Let’s find the plan that fits you perfectly—because your health and peace of mind matter. Reach out to us today, and let’s make this journey easier together!
Have Health Insurance Questions?
We hope that this information on types of health coverage is helpful for you.
Insurance is oftentimes overwhelming, and we want to shed light on the industry by answering your questions. Comment below and your question may be the topic of our next post!
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Empower Brokerage wants to help you find the insurance coverage you need and help you save money getting it. Stay on top of your health and give us a call at (844) 410-1320.
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