It shouldn’t have to be said, but having health insurance is important, both for you and your family. The benefits and peace of mind of purchasing a private health insurance plan far outweigh the costs. Below are some personal stories from individuals who finally decided to get the coverage they needed. One of them may sound just like your current health needs.
Leah: “I’m 60, and have been without health insurance since going into private practice. Once I get covered, I’ll be able to get medical care for the normal issues that come up as you get older. My mother had breast and cervical cancer, and I’ve been scared to get a mammogram or gynecological exam, because I didn’t know how I could get treatment if they found anything! Looking forward to getting all those check-ups…”
Cara: “I have health insurance but it does not cover maternity. Adding a maternity rider would double my health insurance monthly cost a month. I am 33 and married, waiting to be able to afford to be able to start a family. With maternity care offered in the new plans, 2014 just might be my year to get covered—and get pregnant!”
Beth: “Get covered means that I can quit a job I hate but offers health insurance, to take a job that I love with a nonprofit company and be able to purchase affordable insurance for myself.”
Danielle: “In 2008 and 2009, I had pretty big and very unexpected emergency surgeries. If I hadn’t had health insurance, I probably wouldn’t have been able to go to grad school and my parents would have probably had to mortgage the house. Having health insurance matters!”
Private Health Insurance accounts for over half of the coverage for all Americans. Over 58 percent of us have to buy our own insurance. This includes the elderly and low-income families who receive health care through public programs like Medicare, Medicaid, SCHIP, TRICARE, and Veterans programs, but seek additional coverage.
Affordable Care Act
Until this year, almost 46 million Americans chose to go without any health care coverage at all. Even more had inadequate insurance. According to the U.S. Census Bureau, that percentage of the total population has remained relatively unchanged for over 20 years.
Since the rollout of the Affordable Care Act in 2014, the private health insurance market has changed. Now, the majority of Americans must have some form of health insurance- either through their employer, public programs, or purchasing it on their own. If they don’t then they face potential fines tied to their taxes. Of course, there are more specific details to what the Affordable Care Act entails. Those won’t be discussed here. Instead you can read a more complete article here: Affordable Care Act.
There are multiple means for purchasing private health insurance. You can purchase through an insurance company of your choice, an agent, an online insurance seller, or the Health Insurance Marketplace which is sponsored by the federal government.
- Insurance Company: Using a simple internet search, you may find many health insurance companies in your state or region which offer a wide range of health plan options. Often, these websites will provide comparison charts between plans or other companies.
- Agent: Speaking with an individual insurance agent will provide you with the personal help and attention that you need. They will be able to help you compare health plans, based on features and price. They will also be able to help you complete the necessary paperwork to begin coverage as soon as possible.
- Online Insurance Seller: Various companies sell insurance online. They often sell health care plans from a variety of insurance companies, so they would be able to provide you with comparisons between places and help you to enroll.
- Health Insurance Marketplace: Set up by the federal government, this online enrollment option through HealthCare.gov allows you to choose between a variety of different plans, even if you do not qualify for low-income support. To apply for individual or family coverage, you need to create an online account, complete the application, select a plan, and then enroll. You would then need to contact the insurance company in your geographic area who is the underwriter on the plan in order to pay your first premium by the due date. You may also call by phone at 1-800-318-2596 or find a local representative to help you in person.
Some Americans may qualify for private health insurance at a lower cost, based on income and household size. Based on estimates for 2014, your income needs to be below $45,960 per year for an individual and $94,200 per year for a family of four.
Below is a full chart detailing qualification levels based on household size and income.
If you are looking to purchase health insurance on your own, there are options available to you. As stated previously, costs depend upon your age, number of dependents, whether or not you smoke, and where you live. In a 2010 study by the Kaiser Family Foundation, the average per person monthly premiums in the individual (private) market was studied. Vermont and Massachusetts had the highest rates, at $401 and $437 respectively. Alabama and California were two of the cheapest, at $136 and $157 per month. In 2009, on average, the annual premium was $2,985 for an individual and $6,328 for a family.
Keep in mind that the individual cost statistics are averages across both adults and children. Of course, once more recent data on the post-Affordable Care Act switch becomes available, these numbers may change.
When you begin your research into the costs of different health care plans, don’t just look at the monthly premium quotes. You should also factor in doctor visit co-payment amounts, the annual out-of-pocket maximum, coinsurance, and the deductible amount. This will help you to determine whether or not you can afford the plan.
For example, “Mr. Jones has a family health plan with a $500 annual deductible and 20% coinsurance. In February, his wife and two children got checkups. Mr. Jones paid the physician for these services, which cost $510. In March, one of the children got sick and the cost of the office visit was $50. Since the annual deductible was met, the health plan paid the doctor $40 (80%) and Mr. Jones paid the doctor $10 (20%).”
Important! Be sure to read the fine print of the plan you are selecting. There may be limitations to the number of days you can spend in the hospital, before paying out of pocket. There may also be benefit limits, like “mini-med” policies that cap payouts, leaving you to pay thousands of dollars for an unexpected illness or surgery.
With the new requirements of the Affordable Care Act, there are now changes to private health care plans, which may directly benefit you. For example, health care companies can no longer limit or deny benefits to a child under the age of 19 if they have a pre-existing condition. You can also remain on your parents’ health insurance if you are under the age of 26- great news for post-graduate college students who are still searching for employment. You now also have greater rights when dealing with your insurance company. Insurers can no longer cancel your coverage if you made an honest mistake. You can also ask your insurer to reconsider a medical payment if it is initially denied. Other benefits include:
- Lifetime limits on most benefits are now banned.
- Health insurance companies must make public justifications for all rate increases.
- Insurance companies must take the amount you pay in premiums and spend it on health care, not unlimited administrative costs.
- If you need to visit the emergency room, but are out of your health care provider network, you can still seek care.
- You can choose the primary care doctor you want in your insurance network instead of being assigned to one.
- Preventative care may be available at no additional cost.
There are a wide variety of benefits to choose from when selecting a plan. Unlike the broader benefits defined by the Affordable Care Act, you can choose which benefits you may need, depending upon the amount that you want to spend and the quality of your health. These benefits may include, but are not limited to, the following:
- Outpatient care
- Emergency room visits
- Prenatal care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitation due to an injury, disability, or chronic condition
- Lab tests
- Preventative services like counseling and vaccinations
- Dental and vision care
Of course, the benefits you want to have included in your private health care plan can increase or decrease your month premiums. The more extravagant benefits, like concierge services, the more you will have to pay.
Questions to Consider
MedicalNewsToday stated it succinctly when they noted that, “If you are not covered through your employer, or part of a COOP, and are not eligible to state funded programs, you will probably have to buy health insurance as an individual. When selecting the right insurance option, the purchaser needs to be aware of various factors.”
Ask yourself the following questions to help you decide on a health care plan:
- Do I want a plan that includes prescription coverage or not? If you choose a plan without this coverage option, your monthly premiums will probably be lower.
- Am I a female of childbearing age? If so, then I should consider a plan that covers pre-natal visits.
- Am I between the ages of 19 and 26? If so, then I can be added to my parents’ insurance plan.
- Do I have a spouse or children? Sometimes, the costs and benefits of different insurance plans persuade you to purchase individual plans instead.
- Will my current doctor be in network if I chose this plan? Check the insurance company’s list of network professionals. You may have to choose a different insurance company or plan, depending upon your desire to keep the same doctor.
- Does the plan include benefit options that I need? Sometimes choosing a different plan means saving money in the long run. For example, if you are a male, or a female over the age of 45, you probably don’t need maternity coverage.
- If my health care plan includes coverage for prescriptions, does that include the medications that I take. Sometimes, prescription plans don’t cover newer or more expensive drugs.
- Am I in good health and have a limited income? If so, you may want to select a low premium, high deductible plan. In the future, if your health needs change, you can choose a plan with a higher monthly premium, but lower deductible.
Other Enhanced Insurance articles related to Special Healthcare:
Enhanced Insurance is not written by attorneys. If you’re looking for legal advice, you need to contact a lawyer. Further, insurance practices and forms change constantly and are varied from state to state. For definitive answers in your area, contact a local agent.
While the majority of people want an agent involved in their purchase of insurance, many people want to see if they can save money by buying direct from the insurance company. Others want to try a direct quote to make sure the premium they’re now paying through their local agent is fair. If you want a quote for your coverage, click on the competitive quote button on the right side of this page.
Kaiser Family Foundation subsidy calculator: this factors where you live, family size, ages, and tobacco use.