Whether you're turning 26 and about to move off your parent's health insurance or getting job-based insurance for the first time, it's perfectly normal to feel overwhelmed by the complexity of health care and insurance systems. What are your options for coverage? When can you enroll? How do you choose a plan that meets your needs without breaking your budget?
Here's what you need to know.
If you're a full-time employee, you probably qualify for insurance through your job. Most employers pay at least part of your monthly premium; the rest comes out of your paycheck. Many job-based health plans also cover spouses and (in some cases) domestic partners, so you might be eligible for insurance through a partner's plan. However, employers generally pay less toward spousal coverage.
If you're an American citizen or lawfully present immigrant, you can also apply for coverage through the Health Insurance Marketplace. If you're not eligible for insurance through your job or spouse's job, and if no one else claims you as a tax dependent, you might qualify for an income-based government subsidy that covers part of the cost. The Marketplace will also determine your eligibility for Medicaid.
Open enrollment is the annual period when you can enroll in a health insurance plan. For the Health Insurance Marketplace, open enrollment for 2018 runs from November 1, 2017 to December 15, 2017. Job-based health plans have different open enrollment periods, but they usually take place in the fall and last a couple weeks. Check with your employer for specifics.
Outside the open enrollment period, you can join a new plan if you experience a life change that qualifies you for a special enrollment period — such as getting married, having a baby, losing coverage through your job, or aging off your parent's health insurance after age 26.
When you start a new job, it could take up to 90 days before your insurance kicks in, so make sure you're covered by another health plan in the meantime. You'll pay a penalty on your next tax return if you go more than 60 days without insurance.
You can apply anytime for Medicaid or the Children's Health Insurance Program (CHIP).
With job-based coverage, your company selects the insurer, but many employers offer several plans from which you can choose. The Health Insurance Marketplace offers a variety of plans from different insurers. Either way, you'll need to:
Before choosing a health plan, you need to understand what you will pay — to your insurance company and your medical providers. This depends on the plan's:
Premium: The amount you pay the insurance company each month.
Deductible: The amount you must spend out of pocket before insurance covers anything other than routine preventative services, such as annual wellness exams and visits to your primary care physician.
Co-pay/co-insurance: The amount of the medical bill you pay after you meet your annual deductible. (Co-pay is a set amount. Co-insurance is a percentage of the bill.)
Out-of-pocket maximum: The most you will be required to pay before insurance covers 100 percent.
Getting the best deal on your health care is a guessing game of sorts. Plans with lower monthly premiums usually come with higher annual deductibles. You pay less up front but risk paying more later if you need expensive tests or care. If you choose a plan with a lower deductible and higher premium, and then don't need much care throughout the year, you spend more money on insurance than you would have spent without it.
Try to estimate how much you will spend on care and prescription drugs throughout the year. If you need regular care, you probably want a lower deductible. If you rarely get sick and have no chronic conditions, you might fare better with the lower monthly premium.
Insurance companies have their own provider networks — doctors and hospitals with whom they have negotiated discount rates. When you see an out-of-network doctor, your insurance company might not cover as much (or any) of the bill.
If you want to keep your current primary care doctor or specialists, find out which insurance plans they take before enrolling. Most insurers publish provider networks online, but they aren't always up to date, so it's best to call your doctors and confirm.
Depending on the insurance options available to you, you might not have access to a plan your current doctors accept. In that case, find a new primary care provider as soon as you enroll and schedule your first appointment. You can get your annual wellness exam (free with most insurance plans) and start building a relationship with your new doctor.
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