Health Insurance for Individuals: Options and Alternatives You May Not Know About
Finding good health insurance for individuals isn't nearly as difficult as you might think. If you no longer have access to group insurance provided by employers, there are still many options for you to choose from. Whether you're younger and starting your own business, retiring before 65 and unsure what to do next, or have a chronic medical condition for which you need coverage, you'll find options that could be a good fit for your situation.
Medicare Options Before and After 65
Once you turn 65, you're eligible for Medicare as long as you either qualify for social security benefits or are a U.S. citizen or permanent resident. But there are ways to collect Medicare if you don't meet the age requirement.
- Social Security Disability Insurance: When you're receiving Social Security Disability Insurance (SSDI), no matter your age, you also qualify for Medicare. Typically, you must receive SSDI checks for more than 24 months before Medicare kicks in. If, however, you're getting SSDI because you have amyotrophic lateral sclerosis, then the waiting period is waived. There are many requirements that you must meet to qualify for SSDI, so check with your local Social Security Administration office for the exact rules in your region.
- Kidney Disease Exception: Someone with kidney failure (end-stage renal disease) may qualify for Medicare coverage when they're younger than 65. There are a few specific requirements. First, you must have had a kidney transplant or be receiving dialysis. You must also be applying for Medicare and either be eligible for SSDI or railroad retirement benefits, or have a spouse or parent who paid Medicare taxes for a sufficient period of time.
Here's another important detail to keep in mind: If you or someone you're caring for qualifies for Medicare, you might also want to look into the PACE program. PACE stands for Programs of All-Inclusive Care for the Elderly, and provides extra health care services so recipients don't have to move into a nursing home or care facility. It's available to Medicare and/or Medicaid recipients who are 55 or older, live in a PACE service area, and are certified by their state as needing the level of care a nursing home provides.
If You're Disabled or Have a Lower Income
The Supplemental Security Income program provides health insurance for individuals who are 65 or older with a limited income, or disabled or blind children and adults under 65 who have a lower income. You must meet the income threshold as well as some residency requirements.
Even if you're under the age of 65 and not disabled, you may still be able to get help if you can't afford a regular health plan. Medicaid is a joint federal and state program that helps cover some medical costs for people with a lower income. The program may also provide additional benefits, like nursing home care and personal health services. The exact income requirements vary from state to state, so contact your regional Medicaid office for details.
Health Insurance Through the Affordable Care Act
Because of the Affordable Care Act (ACA), insurance companies can't deny someone due to pre-existing conditions. Depending on your health care costs, paying a monthly premium may be a worthwhile investment until Medicare kicks in. Make sure that you read through the plans carefully. HMOs and bronze level PPOs, for example, have more limited options for doctors. Check with your physicians to ensure they accept the plan you're considering before you sign up. Typically, you can only sign up during the open enrollment period unless you qualify for special enrollment.
Health Insurance Outside the Affordable Care Act
If you want health insurance outside of a more traditional plan, some locations offer direct primary care plans where doctors charge a low monthly fee that covers most (but not all) primary care services. People with more funds at their disposal may consider concierge plans, in which you pay a higher annual or monthly fee for unlimited appointments and other extras, such as telehealth, longer visits, and more personalized care.
If you no longer have access to group health insurance, you still have a lot of choices. If you're unsure if you qualify for Medicare, the federal government has an online eligibility calculator. The website will also calculate your monthly premiums. But don't worry if you don't qualify. There are many other options you can consider in the meantime.
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*This information is for educational purposes only and does not constitute health care advice. You should always seek the advice of your doctor or physician before making health care decisions.