How to Get Health Insurance
You want health insurance. Common sense suggests that you need health insurance. But you may wonder how to get health insurance. HealthMarkets explains your options for individual health insurance plans and provides you with an easy way to find the right coverage today.
5 Ways to Get Individual Health Insurance.
- An online shopping site such as HealthMarkets
- A licensed agent in person or over the phone, also available from HealthMarkets
- A government-run insurance exchange
- Directly from an insurance company
- State-funded programs for low-income residents
It’s important to learn about all of your options on how to get health insurance—as well as the details of what different types of plans can offer. If you’re trying to learn about how to get Medicare, check out our information on Medicare Eligibility.
When You Can Get Individual Health Insurance
Each fall features the Affordable Care Act’s (ACA) Open Enrollment Period, where U.S. citizens can enroll in new health plans.1
Special Enrollment Periods are also available throughout the year for people who experience “qualifying life events” and find themselves in need of health insurance outside of the Open Enrollment Period. These qualifying life events include:2
- Getting married or divorced
- Having a baby or adopting a child
- Losing health coverage
- Becoming a U.S. citizen
Federal and state administrations can also issue Special Enrollment Periods that waive the qualifying life event requirement. For example, a Special Enrollment Period was declared in 2021 for anyone without insurance from February 15 to May 15 for people who use the federal ACA exchange.3 Following that announcement, California’s state exchange issued a similar Special Enrollment Period from February 1 to May 15, 2021.4
For information on when states offer enrollment, check out HealthMarkets’ guide to Open Enrollment dates.
Types of ACA Plans
There are four main levels of ACA plans available: platinum, gold, silver and bronze. These plan levels vary based on the percentage of out-of-pocket costs you are responsible for after you’ve met your deductible. In general, the higher your share of the costs, the lower your monthly premiums. 5
Bronze plans have the lowest premium costs and the highest out-of-pocket share, while platinum plans have the highest premiums and lowest out-of-pocket expense. What plan is best for you depends on your medical needs and budget. 5
Need help deciding on a plan? HealthMarkets FitScore® takes your preferences, scans available plans in your area, and ranks your options to help you more easily find the insurance coverage that’s the right fit for you.
Lowering Insurance Costs With ACA Subsidies
Since costs are often a major factor in choosing a plan, keep in mind that there is financial help available. You may not know that in 2020, 86% of Americans qualified for premium tax credits that reduced their monthly premiums and 50% were eligible for cost-sharing that reduced out-of-pocket expenses.6
Premium tax credits
Prices for ACA health plans vary depending on your age, location, tobacco use, plan category, and whether the plan covers dependents.7The average monthly premium for an ACA plan without a tax subsidy in 2019 was $612. For those receiving premium tax credits, the average was $87.8
Families earning between 100% and 400% of the federal poverty level can use the tax credit to lower or cover the cost of the monthly premiums or claim it later in their annual tax returns. In 2021, eligible income is from $12,760 to $51,040 for an individual and from $26,200 to $104,800 for a family of four.9
Premium tax credits may be applied toward any metal level ACA plan.9
Ready to see how to get health insurance at a lower cost? Visit the HealthMarkets shopping experience and we’ll help you calculate.
Families earning between 100% and 250% of the federal poverty level can have the health insurance provider lower or cover more out-of-pocket costs when health services are received. In 2021, that means families earning between $12,760 to $31,900 per year.9
Cost sharing reductions are available only to qualified people who purchase silver ACA plans.9
How to Get Health Insurance for Low-Income Individuals
Medicaid is government-funded healthcare for people with lower incomes, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered and operated by states, so eligibility and benefits vary depending on where you live. Contact your state’s Medicaid program for information.10
Short-Term Health Insurance
Short-term insurance is a temporary way to fill a gap in insurance coverage. The maximum duration of your short-term health insurance policy varies by state, with many states allowing coverage for up to 36 months.14
The benefits of short term plans are that you can apply anytime during the year, you could have coverage as soon as 24 hours after applying, and you can cancel your plan at any time.14
However, short-term plans are not ACA compliant, so they do not have to include the law’s ten essential benefits such as prescription drugs, maternity care, and no-cost preventive services. These plans also do not have the pre-existing condition protections of ACA plans.14
Interested in how to get short-term health insurance? HealthMarkets can help you shop and apply for a short-term plan now.
Types of Health Insurance Plans
Not all insurance plans are alike, and the best kind of plan for one person may not be the best type of plan for another. Here are the most common types of health insurance plans.
- HMO. With a Health Maintenance Organization plan, you select a Primary Care Physician (PCP) who will make any necessary referrals to specialists within your plan’s network and service area.11
- PPO. With a Preferred Provider Organization plan, you are not required to have a Primary Care Physician and will have more freedom to see specialists outside of your plan’s network at an additional cost.12
- POS. A Point Of Service plan combines some of the features of an HMO and a PPO. Like an HMO,a POSplan usually includes a Primary Care Physician along with a selected network. But like a PPO, a POS plan allows for greater flexibility outside of your plan’s network.13
Some Health Insurance Terms Defined
Before you get health insurance, there are some terms you should know to help find the right plan for you.
Deductible: A deductible is the amount you pay each year before your insurance begins paying its share of your medical bills. For example, if you have a $2,000 deductible on your policy, you pay $2,000 toward any medical costs before your plan contributes. Your plan may cover some services and devices before your deductible is met.15
Copayment: A copayment (or copay) is a set fee you pay for services. For example, if you have a $25 copay for a doctor’s visit, you pay $25 to see your doctor and your insurance provider pays the rest. The amount you pay can vary depending on the service.16
Coinsurance: Coinsurance is the a percentage of your bill that you are responsible for after you’ve paid your deductible. So if your doctor appointment costs $150, you might be asked to pay 20% of that as your coinsurance, which would be $30.17
Out-of-pocket maximum: Your out-of-pocket maximum is the most you’ll pay for covered services in a calendar year. Costs such as deductibles and coinsurance could be considered out-of-pocket expenses. Once you reach this limit, your insurance provider will pay for the rest of your covered expenses.18
Tips for Buying Health Insurance
Keep these things in mind when shopping for a health insurance plan:
- How do you use health insurance? Are you one of those people who never goes to the doctor? Or, do you find yourself getting sick a few times every year? Are you active in taking preventive care measures? What does your family health history look like? Planning on having a baby? When shopping for health insurance, assess how much you expect to be relying on it.
- What is your budget? This does not only include how much of a monthly premium you can afford but also extends to out-of-pocket expenses such as deductibles, copayments, and coinsurance.
- What kind of plan do you want? Would you prefer the flexibility of a PPO? Would you like more directed care from an HMO? Personal preference plays a pivotal role in choosing a health insurance plan.
- Compare quotes. Health plan quotes come free and under no obligation. Compare costs of similar plans that you’re interested in to see where you can save money.
How to Get Health Insurance Using HealthMarkets
If you’re wondering how to purchase a health insurance plan, or are just curious about what’s available, HealthMarkets makes one-stop-shopping easy. We can help you find a plan that works with your needs, compare available coverage, and help you apply. Shop and compare plans now.
1. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/open-enrollment-period/. Accessed February 1, 2021. | 2. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/qualifying-life-event/. Accessed February 1, 2021. | 3. U.S. Department of Health &Human Services. January 28, 2021. Retrieved from https://www.hhs.gov/about/news/2021/01/28/hhs-announces-marketplace-special-enrollment-period-for-covid-19-public-health-emergency.html. | 4. Covered California. January 28, 2021. Retrieved from https://www.coveredca.com/newsroom/news-releases/2021/01/28/california-joins-president-biden-in-responding-to-covid-19-pandemic-by-announcing-special-enrollment-to-help-people-get-insurance/. | 5. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/choose-a-plan/plans-categories/. Accessed February 1, 2021. | 6.Kaiser Family Foundation. 2021. https://www.kff.org/other/state-indicator/effectuated-marketplace-enrollment-and-financial-assistance/ | 7. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/how-plans-set-your-premiums/. Accessed February 1, 2021. | 8. Kaiser Family Foundation. 2021. Retrieved from https://www.kff.org/health-reform/state-indicator/marketplace-average-premiums-and-average-advanced-premium-tax-credit-aptc/. | 9. Kaiser Family Foundation. October 30, 2020. Retrieved from https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health-insurance-subsidies/. | 10. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/. Accessed February 2, 2021. | 11. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/health-maintenance-organization-hmo/. Accessed February 2, 2021. | 12. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/preferred-provider-organization-ppo/. Accessed February 2, 2021. | 13. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/point-of-service-plan-pos-plan/. Accessed February 2, 2021. | 14. UnitedHealthcare. 2021. Retrieved from https://www.uhone.com/health-insurance/short-term-health-insurance. | 15. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/deductible/. Accessed February 2, 2021. | 16. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/co-payment/. Accessed February 2, 2021. | 17. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/co-insurance/. Accessed February 2, 2021. | 18. U.S. Centers for Medicare and Medicaid. Retrieved from https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/. Accessed February 2, 2021.
HealthMarkets’ FitScore intends to identify plans that fit your needs. You should carefully review official plan materials.