Obtaining Insurance

Many residents are unsure about where to start when they need to purchase health insurance for the first time or select a plan after moving to a new state.

It can be especially confusing for those who are unfamiliar with the common terms used in the health insurance industry or do not know about the different plans and coverage options that are available.

A good first step is to begin researching the basics of health care and the plans that are available in a given state. Moreover, conducting research can help residents discover the features of plans that are most important to them and how they meet their needs. Gaining an understanding of the basic aspects of health insurance will be instrumental in making the right health care choice.

There are several ways that residents can obtain health insurance in their state. Many options are available online through the health insurance marketplace, but there are additional resources including insurance brokers third-party aggregators.

Moreover, employed residents can usually select a health insurance plan through their employers. Affordable Care Act (ACA) regulations require employers to offer a certain quality of medical care. However, employers who meet certain criteria are exempt from this.

In addition, certain residents can obtain COBRA insurance which provides coverage to recently unemployed residents who did have health insurance during their time of employment. Thus, prospective policyholders have several options for purchasing health insurance and carefully research these before making a final decision.    

How to Select a Plan

When learning about health insurance, residents will discover that there are many components and details to consider. Fortunately, it is not necessary to understand every concept to purchase the right health plan. Prospective enrollees should focus on the features that matter most to them and then compare different plans.

When beginning to compare different plans, residents should analyze how the most important features to them compare among the plans. Then, it can be helpful to examine which plans meet minimum requirements. Prospective members can look at each plan’s deductible, premium and copayment costs.

It may also be helpful to check the degree of accessibility that members have to different medical providers and facilities. Other factors that sway decisions include the process for claims, policies regarding prescriptions and whether members can visit a specialist without a referral.  

Finding Affordable Plans

Health care plans can be expensive, especially the ones found through the health insurance marketplace. All plans that are available in the marketplace or through an employer must follow ACA regulations, meaning that several must be considered affordable.

However, some “affordable” plans may still be out of reach for some prospective enrollees. In cases like that, residents can expand their search to private insurers. Local insurance agencies may able to assist residents in finding appropriate and affordable health insurance in the private insurance market.

In addition, residents shopping for health insurance can examine the health plans offered by their employer. These options are partially subsidized by employers, thus they are much cheaper than those found in the online marketplace. Moreover, residents can find a third-party aggregator online.

For others, government health care may be a good option. Many residents are eligible for programs like Medicare, Medicaid and CHIP. A final option is to hire an independent insurance broker. They can help prospective enrollees with complex needs and medical history find insurance.

Employer-Sponsored Health Insurance Plans

Many employers offer health insurance for employees. Both parties are required to meet certain requirements. For instance, employees must be working full-time at a medium to large-sized company. Smaller companies may also offer health insurance plans but are not required to.

However, residents who believe they and their company qualify should talk to their employer about different health care programs. Companies that qualify to provide healthcare can either provide employer-subsidized plans or opt for a reimbursement option. In both cases, employee medical costs are partially covered by their employer.

Plans offered by employers must meet ACA regulations and minimum coverage requirements. These requirements include affordability and value of medical coverage. In addition, employers are required to inform employees about health insurance changes.

According to ACA regulation, employees may forego employer-sponsored health care and opt for coverage through the online marketplace. However, employees may lose out on certain tax privileges. Additionally, employees switching from a private plan to an employer-subsidized one should pay attention to enrollment periods to avoid missing deadlines.

COBRA

The Consolidated Omnibus Budget Reconciliation Act, otherwise known as COBRA, helps to protect newly-unemployed residents’ health care. Under COBRA, workers are protected from losing their employer-subsidized health care if they lose their job with that employer. However, not all companies offer this kind protection for health care coverage.

Usually, it is companies with 20 or more workers that are able to support continued coverage. Workers whose companies offer COBRA, must lose their employment through no fault of their own and must have been enrolled in the employer’s health insurance plans. However, residents who lose their jobs will have to pay higher costs to continue receiving insurance because it will no longer be subsidized. Thus, members will have a higher out-of-pocket.

There is a process that must be completed in order for an employee to obtain continued coverage through COBRA. In many cases, the employer must report the employee’s new status to the insurance provider. Then, the insurance company will reach out to COBRA in order to determine which options the employee has regarding continued coverage.

Afterward, the insurance provider will give the employee a certain period of time to either accept the plan or to find a different option through the online health insurance marketplace. However, newly unemployed residents can be denied from this kind of coverage for a variety of reasons. For instance, those who commit fraud, such as when they fail to report other health care coverage, can be denied from continued coverage.