If you’re shopping for health insurance outside of a work-based plan, you’re in luck this fall. After years of cutting and, some say sabotaging, the Affordable Care Act during the Trump administration, the Biden administration is doing everything it can to help people find good health plans on healthcare.gov right now: the period Open enrollment begins this week. You’ll have more time to enroll, more free help choosing a plan, and a greater chance of being eligible for subsidies to help keep down the costs of a health plan you buy through the aca marketplace.
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Still, choosing health insurance can be hard work, even if you choose a plan through your employer. there are a lot of confusing terms and the process forces you to think a lot about your health and finances. plus, you have to navigate everything on a deadline, often with only a few weeks to explore your options and make decisions.
Whether you’re approaching the age of your parent’s plan and choosing one for the first time, or you’re on a plan that no longer works for you and you’re ready to change things, or you’re uninsured and want see if you have any viable options, there is good news. Asking yourself a few simple questions can help you zero in on the right plan out of all the ones on the market.
here are some tips on where to look and how to get reliable advice and help if you need it.
tip #1: know where to go
It’s not always obvious where to look for health insurance. “In this country it’s a really wacky patchwork quilt of options,” says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University.
If you’re 65 or older, you’re eligible for Medicare. is a program run by the federal government: the government pays for much of your health care. You may also be eligible if you have certain disabilities. For those already enrolled in Medicare or a Medicare Advantage plan, the open enrollment period to change your supplemental health and prescription drug plans for 2022 is extended through December 1. 7 this year.
For those under 65, Corlette says, “The vast majority of us get our coverage through our employer. The employer will typically cover 70% to 90% of your premium costs, which is pretty good”. Check with your supervisor or your company’s human resources department to find out what plans, if any, are available to you through your job.
Then there is Medicaid, the health insurance program for people with low incomes, which covers about 80 million people, nearly one in four Americans. it’s funded by both the federal and state governments, but it’s administered by each state, so whether you’re eligible depends on where you live.
For just about everyone else, the place to go is healthcare.gov, where they can buy insurance on marketplaces created by the Affordable Care Act, also known as obamacare.
This is where you look for health insurance if you don’t fit into any of the categories we mentioned earlier, Corlette says, if, for example, “Your employer doesn’t offer you any coverage; you’re not eligible for Medicare because you’re not old enough to enough and you’re not poor enough to get medicaid. You can go to the marketplaces, apply for financial help based on your income, and pick a plan there.”
tip #2: overwhelmed by options? To help you choose, think about what is predictable about your health
If you’re in basically good health and choose between one or two plan options through your job, the choice can be quite simple. you can ask your co-workers what they like, sign up through an online benefits portal, and be done for the day.
however, if you’re shopping in the affordable care law marketplaces, the number of options can seem overwhelming at first. In Austin, Texas, “we had 76 plans to review with clients,” says Aaron Delao, director of the foundation’s community health initiatives.
Even with dozens of options, you can narrow things down with a few basic questions, says delao. First, ask yourself: “Do you [just] want insurance for that catastrophic event that could happen, or do you know you have a health problem now that will need ongoing care?”
If you’re in good health, any of several plans might work. but if you or your spouse or dependent family member have particular ongoing health needs (such as an underlying medical condition, for example, or plan to undergo fertility treatment in 2022 or need to see a particular medical specialist), that information can be really helpful in helping you narrow down the field to your best health insurance option. “If there’s a plan that doesn’t have their provider or their drugs in-network, they can be removed,” she says.
Sometimes you can enter your medications or doctor names while searching for plans online to filter out plans that don’t cover them. You can also just call the insurance company and ask: Is my provider in-network for this plan I’m considering? Is my medication on the plan’s formulary (the list of medications that an insurance plan will cover)?
There are also two different types of main plans to consider. “You can choose between what’s called an HMO or a PPO,” says Corlette. A health maintenance organization tends to have a strict network of providers: if you see an out-of-network provider, all costs are your own. A preferred provider organization “will give you a much wider choice of providers — it may be a little more expensive to see than an out-of-network provider, but they’ll still cover some of that cost,” she explains.
Tip #3: Learn what some of those wonky health insurance terms mean
How much can you pay for health insurance each month? To compare the true overall cost of health plans and determine which might work best for your budget, you need to become familiar with several important insurance terms, words like premium, cost-sharing, deductible, and copay.
Fortunately, we’ve created a handy health insurance glossary just for you.
Insurance companies use these different types of charges (the premium versus the deductible, for example) as dials to keep their own costs manageable. a basic plan they sell can lower the monthly premium for a particular plan, making it seem cheap. but that same plan could have a “flagged” high deductible of, say, $6,000, which means you’ll have to spend $6,000 out of pocket on health services each year before your insurance starts paying its share of the cost. If you choose that plan, I’d bet you won’t have to use many health services, and therefore only have to worry about your hopefully affordable premiums and the costs of a few appointments.
If you have a chronic medical condition or are just more risk averse, you can choose a plan that has increased the premium amount. You’ll pay a little more each month than the other plan, but your costs will be more predictable—you’ll likely have a lower deductible and a lower coinsurance rate. that way, you can go to many appointments and pick up many prescriptions and still have manageable monthly costs.
The plans available and affordable to you will vary greatly depending on where you live, your income, who lives in your household, and your insurance policy. With the pandemic, Congress approved temporary new funds to cover more out-of-pocket expenses for people. Depending on your income, you may qualify for plans with premiums of $10 or less per month at healthcare.gov or your state’s insurance exchange.
tip #4: get trusted professional help, for free
still feeling overwhelmed with all the options here? you’re lucky. Free, unbiased professional help is available to help you choose and enroll in a plan. simply enter your ZIP code at healthcare.gov/localhelp and look for a “helper,” a person also referred to as a health care navigator on some state websites.”
aaron delao is one of those navigators, noting that he and his fellow guides don’t work on commission, they’re paid by the government. “We’re not contracted with insurance agencies,” he says. “We do it completely autonomously, impartially. It’s about what’s best for the consumer.”
In 2021, the Biden administration quadrupled the number of browsers before open enrollment. (The Trump administration had severely cut funding for the program.)
Insurance brokers can also be helpful, Corlette says. “Brokers get commissions, but in my experience, good brokers want repeat customers, and that means happy customers,” she says. To find a good broker, she advises, “visit healthcare.gov or your local state insurance department to find someone who is licensed and in good standing.”
tip #5: beware of too-good-to-be-true plans being sold online
The internet can be a scary place. Corlette says she warns people: Don’t put your contact information on health insurance interest forms on random websites or click on online insurance ads!
The plans that tend to come up when you google “I need health insurance” may seem appealing because they’re often so cheap, but they can also be “short-term” plans that don’t cover basic things like prescription drugs. or annual reviews. many experts warn that this type of plan is not very good.
“Unfortunately, there are a lot of scammers who take advantage of the fact that people recognize that health insurance is something they have to get,” Corlette says. She tells people, “Just go directly to healthcare.gov. It doesn’t matter what state you live in, you can go to that portal.” any plan you find there will cover the 10 essential benefits of ACA, like free preventive care and hospital coverage.
tip #6: know your deadlines
You usually only have a few weeks in the fall to sign up. This year, the enrollment period for healthcare.gov Marketplace plans that will take effect in January 2022 begins on November 1. from January 1, 2021 and will run through January 15, 2022. If you enroll in an employer-sponsored plan or Medicare, the deadlines will be different, but likely in the fall as well. For Medicaid, you can sign up at any time of the year.
delao, the health navigator, says that even if you’re already enrolled in a plan that seems fine and it’s tempting to let it auto-renew, it’s always a good idea to check annually to see what else is available.
“are you entitled to additional subsidies to reduce the cost of your monthly premium?” he says. “Is there a plan that, with those increased subsidies, can now get a silver plan instead of a bronze plan, which lowers your deductible [and] your copays?”
Discovering the right plan for you doesn’t have to require a huge time commitment, he says. his team aims to get people in and out, signed up for a plan, within an hour and a half. And those appointments don’t have to be in person—customers can get help over the phone and can often do everything they need to check in virtually.
Although signing up for health insurance can be confusing at first, it’s also very important, for your wallet and your health. hang in there, and I know there are people out there eager to help make sure you’re covered.