Health Insurance Basics
Younger generations may cringe at the thought of health insurance, or some may be completely confused! It is common to be confused or overwhelmed. The amount of health insurance information available out there is enough to make your brain explode. However, I have compiled some short but detailed health insurance basics for all the youngsters out there who may need a little push during open enrollment season! Whether you are looking for health insurance for the first time, switching plans, or are curious about the health insurance world, this article is here to help you.
Public Health Insurance
Public health insurance is a program that is run by the federal, state, or local governments of which individuals who qualify may have some or all healthcare costs covered by the government. Qualifying criteria for public health insurance depend on your age and income. Medicare and Medicaid are the two main types of public health insurance.
Medicare: Seniors ages 65 or older are eligible for Medicare. Medicare is a federally run program where the government pays for your health care. Some under the age of 65 may be eligible for coverage if they have certain disabilities or conditions. Beneficiaries can choose to get their coverage through a private insurance company, like Empower Brokerage, with a Medicare Advantage plan, also called Medicare Part C. By sticking with Original Medicare, extra coverage may be available with a Medicare Supplement Insurance plan and prescription drug coverage through Medicare Part C.
Medicaid: Medicaid is only offered in certain states. Only those with low incomes can apply. Medicaid is funded by the federal and state governments but run by the state, and is available depending on the state you live in. Over 80 million Americans are covered by Medicaid.
Children’s Health Insurance Program (CHIP): Provides kids from low-income families with affordable healthcare. CHIP may be part of the Medicaid program in some states, but may also be a standalone program in other states that may not offer Medicaid. Children may be eligible for CHIP even if their parents do not qualify for Medicaid. Routine doctor and dental checkups are free under CHIP, and you can apply for coverage for your child at any time of the year.
Options for Private Health Insurance
Private health insurance refers to any health insurance that is offered by a private entity rather than a state or federal government.
Employer-Based Coverage: Almost half of Americans under the age of 65 get health insurance as a benefit through their employer. These are private group health insurance plans, usually offering different plans from a variety of providers. Your employer usually pays between 70-90% of your premium costs, making healthcare cheaper for you. Your HR department should navigate you through picking the best option for you.
Individual and Family Coverage: You enroll for this coverage by yourself. You can buy individual or family plans through your state or federal marketplace, health insurance companies, or brokers like Empower Brokerage.
Affordable Care Act Marketplaces: Also known as Obamacare, getting insurance through the Affordable Care Act is usually looked at as a last resort if your employer does not offer any coverage, you’re not old enough to qualify for Medicare, or your income is too high to qualify for Medicaid.
Other Options: Veterans can get health insurance through the Veterans Health Administration. Tribal members may have options through the Indian Health Service. College students can choose from a limited list of student health plans, or you can stay on your parents’ plan if you are under the age of 26.
COBRA: If you have lost a job and no longer get health insurance coverage from your employer, you may be able to keep your old plan through COBRA. However, since your employer will no longer be paying a portion of your premium, you will be paying a much higher amount than before.
Coverage Types for Private Plans
Basic or Catastrophic Coverage: If you are under 30 years old and healthy, have no chronic medical conditions, or don’t need to take prescription drugs, a basic plan might be all you need. This plan provides financial protection if you get a serious diagnosis or get into an accident, and you’ll otherwise only need to worry about — hopefully affordable — premiums. These are considered bronze plans.
Medium Coverage: If you have medical specialists you know you need to see or other ongoing health issues, you’ll want to look at plans that have higher premiums but offer more coverage. These plans can sometimes come with extra discounts. If you are getting a plan through your work and you can’t easily filter plan options, you can always call the insurance company or brokerage and ask: “Is my doctor (or preferred hospital or other health care provider) in-network for this plan?” “Is my medicine on the plan’s formulary (the list of medications an insurance plan will cover)?” This will make it easier to see which plans may work best for you. These are considered silver plans.
Comprehensive Coverage: Say you have a bigger budget for monthly premiums, and you want to pay more every month to have access to more flexibility and lower copays — a comprehensive plan might be your best bet in this case. You can use the same tips as above to make sure the plans will cover what you need — filter for your regular doctors or prescriptions, or, when in doubt, call the insurance company and make sure the plan you’re considering will be there when you need it. These are considered gold or platinum plans.
Types of Private Plans
Health Maintenance Organization (HMO) plans: An HMO plan is one of the most popular types of health insurance that you can purchase. These plans usually have a strict network of doctors and other health care providers within their network. They typically will not show you providers that are out of their network unless you would like to pay for coverage 100% out of your own pocket. HMOs are usually best suited for individuals and families that plan to see their primary care physician (PCP) on a regular basis throughout the year for check-ups and other health concerns.
Preferred Provider Organization (PPO) plans: PPOs have a broader, more flexible list of insurance providers within the network with available coverage. Out-of-network providers may be shown on the list but will be a little more expensive than in-network providers, with some of the costs usually covered by your insurance provider. Individuals who visit a specialist regularly generally prefer this type of health insurance plan.
Short-term or “Limited Duration” plans: Short-term plans are plans that are used to help bridge any gaps in coverage that you may have for short periods of time (usually anywhere from a few months to 3 years in some states). These plans are typically only used in situations where someone is in-between jobs. Short-term plans offer more limited benefits but can help safeguard your finances in the case of a covered illness or accident. It is non-renewable and does not include coverage for preventative care like physicals, vaccines, dental, or vision.
Have Health Insurance Questions?
We hope that this information on health insurance is helpful for you.
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Empower Brokerage wants to help you find the insurance coverage you need and how to save money getting it. Stay on top of your health and give us a call at (844) 410-1320.
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