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 Health Insurance Options for Families: Here’s What to Consider

Choosing the right health insurance plan for your family is one of the most important decisions you can make. With so many options available, it can be overwhelming to determine which plan will best meet your family’s needs. Here are key factors to consider when selecting a health insurance plan, including coverage for children, maternity care, and more.

Shortcuts: Considerations For: Purchasing Coverage for Children | Expectant Families | Comprehensive Coverage | Cost Considerations | Network Considerations | Additional Benefits

Things to Consider When Purchasing Coverage for Children

Children’s health needs can vary widely, from regular check-ups and vaccinations to treatment for illnesses and injuries. When evaluating health insurance plans, pay attention to the following aspects:

1. Pediatric Care

Ensure the plan covers routine pediatric visits, immunizations, and screenings. These are essential for monitoring your child’s growth and development.

2. Specialist Care

Check if the plan includes access to pediatric specialists, such as allergists, endocrinologists, and behavioral health providers. This is crucial if your child has or develops specific health conditions.

3. Emergency Services

Accidents happen, and children are often the most frequent visitors to emergency rooms. Confirm that emergency services are covered, including ER visits and urgent care. Inside tip: hospitals are now required to disclose the cost of their services online, so familiarize yourself with the costs of local hospitals before you actually need them.

Considerations for Expectant Families: Maternity and Newborn Care

For families planning to have children or expecting a baby, maternity and newborn care coverage is vital. Here’s what to look for:

1. Prenatal Care

Prenatal visits are critical for monitoring the health of both the mother and the baby during pregnancy. Ensure the plan covers regular check-ups, ultrasounds, and any necessary prenatal tests.

2. Labor and Delivery

Review the coverage for labor and delivery, including hospital stays, birthing centers, and any potential complications. Some plans may also cover home births.

3. Postnatal Care

After the baby is born, postnatal care for both the mother and the newborn is essential. Check if the plan includes coverage for follow-up visits, lactation consultations, and newborn screenings.

Expecting to grow your family soon? Pay attention to pre- and post-natal care options.

Pay Attention to Comprehensive Family Coverage

Beyond children’s and maternity care, consider the overall family coverage offered by the plan:

1. Preventive Care

Preventive care helps detect and prevent health issues before they become serious. Look for plans that cover annual check-ups, vaccinations, and screenings for all family members

2. Chronic Condition Management

If anyone in your family has a chronic condition, such as asthma, diabetes, or hypertension, ensure the plan covers the necessary medications, specialist visits, and ongoing treatment.

3. Mental Health Services

Mental health is as important as physical health. Check for coverage of mental health services, including counseling, therapy sessions, and psychiatric care. Many mental health services are now mandated for coverage by ACA-compliant health plans.

Cost Considerations

Understanding the costs associated with health insurance is crucial for budgeting. Here are the primary cost factors to consider:

1. Premiums

Premiums are the monthly payments you make to maintain your health insurance coverage. Compare premiums across different plans to find one that fits your budget.

2. Deductibles

The deductible is the amount you pay out-of-pocket before your insurance begins to cover expenses. Higher deductibles usually mean lower premiums, but it’s essential to choose a deductible that your family can afford. Contrary to popular belief, there are ways to truly get your money’s worth out of high-deductible health plans, read about how here.

3. Copayments and Coinsurance

Copayments are fixed amounts you pay for specific services, while coinsurance is a percentage of the cost of care. Review these costs to understand your out-of-pocket expenses for doctor visits, prescriptions, and other services.

4. Out-of-Pocket Maximums

The out-of-pocket maximum is the most you’ll have to pay for covered services in a year. Once you reach this limit, your insurance covers 100% of the costs. This is an important factor for protecting your family from high medical expenses.

Pay Attention To These Network Considerations

Health insurance plans typically have a network of preferred providers. Here’s what to keep in mind:

1. In-Network vs. Out-of-Network

Using in-network providers usually costs less than out-of-network providers. Ensure your preferred doctors, hospitals, and specialists are in-network.

2. Provider Availability

Check the availability of in-network providers, especially specialists. Access to a wide range of providers ensures you can get the care you need without significant delays or travel.

…And Finally, Consider These Additional Benefits

Some health insurance plans offer additional benefits that can be valuable for families:

1. Telehealth Services

Telehealth services allow you to consult with healthcare providers remotely. This is especially convenient for busy families and can reduce the need for in-person visits.

2. Wellness Programs

Many plans include wellness programs that offer incentives for healthy behaviors, such as gym memberships, weight loss programs, and smoking cessation support.

3. Prescription Coverage

Ensure the plan covers a broad range of prescription medications and review the formulary to see if your family’s medications are included.

Telehealth services are an important component of modern health plans.

In Conclusion…

Choosing the right health insurance plan for your family involves careful consideration of various factors, including coverage for children, maternity care, overall family health needs, costs, and provider networks. By taking the time to evaluate these aspects, you can find a plan that offers the best protection and peace of mind for your loved ones.

For more detailed information about family health insurance options or to find the best plan for your family, call us at (855) 218-3447 or click here to get in touch. Our experts are here to help you navigate your healthcare needs!

Family Photo by cottonbro studio: https://www.pexels.com/photo/family-having-meal-at-the-table-3171200/

Expectant Mother Photo by MART PRODUCTION: https://www.pexels.com/photo/close-up-photo-of-pregnant-woman-7088487/

Credit Cards Photo by Pixabay: https://www.pexels.com/photo/close-up-photography-two-brown-cards-259200/

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Should People Under 30 Buy Health Insurance?

Should people under 30 get Health Insurance? After all, people under 30 don’t always have a lot of money and are also in good health. Is it worth the chance?

Certainly, there are multiple reasons why it is highly advisable for young adults to purchase health insurance. Here are a few:

Random, Expensive Things Can Happen

Choosing to go without health insurance may appear as though it’s a way to save money in the immediate future, especially when you are in good health and don’t often visit a doctor. Nevertheless, unexpected injuries and illnesses do occur, and they can be far more costly to cover when you don’t have insurance. Just a few days in the hospital can cost as much as $30,000 if you don’t have insurance.

Health plans that help you avoid out of pocket expenses for healthcare are often less than you think, and are even more affordable now than ever before. Four out of five people are eligible for plans that can cost $20 or less each month. But don’t simply take our word for it – get in touch with our team to find out how little you can pay for health insurance.

Another upside to purchasing health insurance is that it offers a ceiling on the amount you are likely to spend on health care over a given year. One of the advantages of ACA-approved plans is that they must provide hospitalization coverage, so that even if you don’t need to use it regularly, it safeguards you from financial ruin in the event of an unexpected medical situation.

You Have a Good Chance of Obtaining Low Prices are Great

Depending on your annual earnings, you may be eligible for a subsidy from the government which can be used to cover your monthly premiums. Many people living in the US may qualify and it could make health insurance very affordable. In some cases, it even brings the cost of plans to $0. This post provides more info about subsidies.

Your eligibility for a subsidy is determined by your income, and you will not have to spend more than 8.5% of your earnings on a health plan. Too much of a hassle to calculate this yourself? Not to worry. Our pros can help you figure out your cost and what type of plan you should get.

All Plans Include Complimentary Amenities That Promote Your Well-Being

Are you healthy? Let’s make sure it remains that way! There are some health services, such as regular check-ups, immunizations, and cancer screenings, which can assist in detecting medical conditions before they become more serious, thus helping you to remain healthy as you age. This is most commonly known as preventive care.

If you have any health plan, you will be able to reap the benefits of free preventive care. You don’t need to pay anything extra for copays. Even the least expensive plans offer the same preventive services as the pricier plans, so it’s possible to buy the least expensive health insurance and still get access to:

  • Immunizations
  • Annually scheduled check-ups
  • Getting a yearly physical with a pap smear
  • Measuring blood pressure levels and cholesterol levels
  • Click here to learn more about preventative care and other “essential” healthcare benefits

Inexpensive Plan Alternatives Are Available

When shopping for health insurance, it’s possible to see that there are various plans separated into metal tiers: bronze, silver, gold, and platinum. These metal tiers generally go up in cost and the level of coverage they provide.

The most costly option is Platinum, but it does cover the biggest percentage of medical costs. If you don’t regularly require health care, a more economical bronze plan is a better choice. These plans have higher deductibles, so if you do need health care, you will have to pay a larger sum out-of-pocket. However, the annual medical expenses are limited, safeguarding you in a medical crisis without having to pay expensive monthly premiums. Additionally, bronze plans will fully cover preventative care, thus enabling you to get a yearly checkup (and more) at no cost.

For those under the age of 30 who do not anticipate needing much health care, a catastrophic plan could be a viable option. Despite the name, these plans are simply more cost-effective for younger individuals. The reduced monthly premiums come with high deductibles, meaning that the primary function of catastrophic plans is to protect you from large, unexpected medical bills. An interesting feature of this type of insurance is that preventive care is covered, as well as three primary care visits per year.

We’ll Do The Shopping For You

Shopping for a plan requires quite a bit of research and careful consideration. To ensure you get the best deal that meets your needs, you’ll want to compare several options and do some research into the various plan features. Our team is actually trained to do this for you! We’ll take some time to talk to you and understand your unique needs, and we’ll help you find the coverage that works best for you.

Call us at 855-218-3447, our experts are standing by! Or click the button below and we’ll get in touch with you.

Find my health insurance options

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Photo by Fauxels and Mike via Pexels

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I’m Pregnant, Does That Affect My Health Insurance?

Congratulations! Pregnancy is a big life event! However, it can be expensive.

Here’s what you need to know about pregnancy and health insurance:

Wait! I Don’t Have Insurance!

If you don’t have insurance and are pregnant, you may qualify for one of a variety of health insurance programs. Our team can help you explore your options, as we proudly cover thousands of people in 47 of the 50 states and the District of Colombia. Call our hotline at 855-218-3447 and we’ll assist you with further information.

If you DO have insurance, here are the steps you should take.

What Will My Insurance Cover?

It’s worth looking into all of your health insurance options to make sure you’re getting the best coverage possible.

Pregnancy is considered a pre-existing condition, which means that your health insurance company can’t refuse to cover you simply because you’re pregnant.

However, some surprising services may not be covered by your health insurance during pregnancy, such as prenatal care, delivery, and post-natal care.

Most health insurance plans cover much of the delivery and aftercare costs, but you may need to pay part of the bill.

Find out what services are covered by your plan and what your costs are likely to be by looking at your summary of benefits or by calling your insurance company.

Here are some things you might want to look for to confirm whether your plan covers these services (here is a list of other non-pregnancy related health plan features most people aren’t aware of), and if so, how much of the bill you’ll be expected to pay:

  • Prenatal Care, including screenings
  • Labor and delivery in your chosen setting, including home births, hospitals, birthing centers or alternative birthing options, such as water births
  • Midwife services
  • Enhanced coverage for high-risk pregnancies or pregnancy complications
  • Medically prescribed C-sections, including recovery
  • Neonatal care
  • Lactation Consultations

Let Your Insurance Provider Know

Contact your health insurance provider as soon as you know you are pregnant.

You should contact your health insurance company to let them know that you are pregnant. They may have special coverage options for pregnancy that you don’t know about.

This could include things like:

  • Maternity clothes
  • Home health services
  • Breast pumps
  • Prescription drugs

Some states even have laws that require insurance companies to provide coverage for pregnancy. You can usually find this information on your state’s Department of Insurance website.

Choose a Pregnancy Care Provider

Your Choice of Doctor Can Change Your Entire Pregnancy Experience

This could be an OBGYN, a family doctor, or a midwife.

If you already have an OBGYN you are comfortable with who is covered by your insurance, you are good to go. If not, you will need to choose another provider to be with you throughout this process.

Once you have chosen someone, you will need to contact your insurance company again to find out if they cover care from this specific provider.

If they don’t, you may need to look into other options.

Get Screened

During pregnancy, you will need to get screened for a variety of conditions and diseases and have additional healthcare options. These include:

  • Testing and counseling for STDS (sexually transmitted diseases)
  • Testing for blood conditions
  • Prenatal tests including anemia screening and screening for urinary tract infections, etc
  • Testing for gestational diabetes
  • You will also be prescribed prenatal vitamins during this time to help the development of the fetus and can help protect your baby from certain birth defects

Where Will I Deliver My Baby?

After choosing your OBGYN or midwife, you’ll want to find out at which birthing facilities they have admitting privileges. Unfortunately, not all OBGYNS have admitting privileges at every hospital and without those, a hospital can reject an obstetrician’s request to treat you there.

To be sure that this won’t happen to you, be sure to check your OBGYN’s website or speak to them to find out about hospital affiliations. Then visit your health insurer’s website to see whether those hospitals are in your plan’s network.

After The Birth

Having a baby allows you to qualify for a special open health insurance enrollment period in many cases.

Contact your insurance company, employer or state insurance marketplace to add your child to your health plan shortly after giving birth.

If you have insurance through the state, having a baby qualifies you for a special open enrollment period in your state’s marketplace which allows you 2 months to choose a plan for your baby or make changes to your existing plan.

If you have insurance through your employer, many of them require you to add your baby to your policy within 30 days.

Family Planning Made Easy

Reach out to the team at HealthPlanOptionsToday to help you get the best care for your future family. Click the button below and we’ll contact you, or call our hotline at 855-218-3447 for instant help.

Find my health insurance options

You May Also Be Interested In:

New Law Brings Online Shopping To Hospital Visits
This FREE Guide Answers the Tough Questions About COBRA.
How The “Coverage Bill of Rights” Has Changed Health Insurance
The true cost of not having health insurance is much more than most realize.
The True Cost of Not Having Health Insurance: (It’s more than you think)
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Getting Your Money’s Worth From High-Deductible Health Plans

Think high-deductible plans aren’t worth it? Think again.

What’s A High Deductible Health Plan?

Officially speaking, High Deductible Health Plans are health insurance plans that carry deductibles greater than $2800 for families and greater than $1400 for a single person. On average, most high deductible plans have even higher deductibles- over $4000 per individual and over $8000 per family.

In addition, these plans also have yearly out-of-pocket maximums. An out-of-pocket maximum is the highest amount you will pay for healthcare on your own. By law, the maximum can’t be over $7000 for an individual and $14k for a family (note: these are 2021 legal limits; the amounts will increase slightly in 2022).

The advantage of these plans is that they typically have a lower premium (the monthly payment for health insurance) than other health insurance coverage- their premiums are sometimes half or even less than half of the cost of other plans.

Who Should Buy A High Deductible Health Plan?

If you’re someone who visits the doctor or pharmacy often, you should probably steer clear of high-deductible plans, as the costs that you’ll accrue will probably outweigh the savings on the premium.

If you don’t use health care often, then a high deductible plan is probably worth your consideration. When it comes to choosing whether or not to purchase health insurance, it’s best to err on the side of caution- and an HDHP is the least cautious way to go. Many people who purchase these plans are just looking for a safety net in case of a serious unexpected emergency.

Also, if you don’t have any major chronic health conditions and don’t visit specialists, these plans are a good fit for you. Lastly, if you don’t have any small children, then high deductible plans are a good way to go- small children tend to need more healthcare than others.

How Can I Get My Money’s Worth From A High-Deductible Plan?

The first way to get your money’s worth from a high deductible plan? To quote a classic Motown song: you better shop around. Know which services can be accessed via urgent care- urgent care is usually much less expensive than ER care. Also, if you inform healthcare providers up front that you intend to pay cash for services, then you may be able to obtain a discount. Also, if you know in advance that you’ll need to visit a hospital for a certain reason, hospitals are legally required to post their prices online.

The second way to get the best out of a HDHP? Get a health savings account – more commonly and more simply called an HSA. A health savings account is a special savings account that can only be used for medical expenses. They’re special because they’re tax-free and may even help with saving for retirement. Only certain plans are eligible for HSAs, so let your HealthPlanOptionsToday team member know that you’re interested in this option.

Picking the Health Plan That’s Right For You

Choosing the proper healthcare plan can feel complex, but it isn’t rocket science. The team at HealthPlanOptionsToday is here to help. We’ll take the time and care to understand your individual needs and budget, and will curate a personalized health plan selection just for you. Call us at 855-218-34479 or click the button below, and we’ll be happy to get in touch with you.

Find my health insurance options

You May Also Be Interested In:

New Law Brings Online Shopping To Hospital Visits
This FREE Guide Answers the Tough Questions About COBRA.
How The “Coverage Bill of Rights” Has Changed Health Insurance
The true cost of not having health insurance is much more than most realize.
The True Cost of Not Having Health Insurance: (It’s more than you think)

Cover photo by Kampus Production from Pexels

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Health Insurance for College Graduates

Recent college graduates have more health care options than ever before.

Hello, graduate! Congratulations on completing your 4 year journey (or 5 or 6 year journey; no judgement here). The “real world” that you’ve heard about all your life- that world of bills, responsibilities, and student loan payments- awaits. Many colleges mandate that students have health insurance; some of these colleges even include this insurance as part of the enrollment cost. If you attended one of those colleges, or even if you didn’t, you may be wondering whether it’s worthwhile to continue with your health insurance- especially with all those bills looming.

While we are admittedly biased, we strongly recommend you always have health insurance; it’s the best way to keep from immense debt and even financial ruin in case something bad happens to you. Aside from all that, it’s nice to just have access to physical and mental health services, and even preventative care if you’re not feeling well.

Health Insurance Options For College Grads

There is more than one way to get covered by health insurance, even if you’re working at a job that doesn’t provide health insurance… or if you’re freelancing or not working at all. If you’re not sure which route to go, we encourage you to call us and our licensed agents can help you understand all of your options. Here are some of the most popular options:

Use Your Parents’ Health Insurance: Simply put, if you’re under 26 years old, you can still enroll in your parents’ health insurance plan, once their plan allows dependents to enroll.

Obamacare/Health Insurance Marketplace: There are low-cost options available through the health insurance marketplace for every level of need. If you call our health insurance hotline, one of our experts can help you explore your options and enroll. Some college graduates are eligible for a special enrollment period after they graduate, depending on whether or not they had student health insurance during school.

Private Insurance/Short-Term Insurance: If you’re not able to qualify for marketplace insurance because you’re outside of the enrollment period, or if you’re in between jobs, or if you work as a freelancer or within the gig economy, private health insurance is historically one of the more popular options. Short-term health insurance is also an option; it allows you to get health insurance coverage just long enough to make it to the next enrollment period.

Medicaid Coverage: Medicaid is government-supported healthcare for people who need a little extra help. If you apply for Obamacare, then you’ll find out whether or not your income level makes you eligible for Medicaid.

If you’re still confused as to which direction to go, one of our agents can help you. They’ll take time to understand your unique situation and income level, and will then help you find a plan that’s right for you. Call an agent at 855-218-3447, or click below to get started on the journey.

Find my health insurance options

You May Also Be Interested In:

New Law Brings Online Shopping To Hospital Visits
This FREE Guide Answers the Tough Questions About COBRA.
How The “Coverage Bill of Rights” Has Changed Health Insurance
The true cost of not having health insurance is much more than most realize.
The True Cost of Not Having Health Insurance: (It’s more than you think)

Photo by Stanley Morales from Pexels

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Here’s When You Should Change Your Health Insurance Plan

Starting a family soon? Paying for insurance but still can’t afford to get sick? These are just 2 of the reasons that may cause you to consider changing your health plan.

For many people, health insurance is one of those things that they don’t think about… until they need it. And let’s admit it- more than a few of us have picked plans semi-blindly, not having a true picture of the benefits or exactly what we’re getting into. While it’s not the best way to shop for health insurance; that approach nothing to be ashamed of; after all, insurance terminology can be complex to those who are unfamiliar with the business, and for those who are young and healthy, sometimes it’s easy to think “why would I need this if I rarely get sick?”

Time has a way of making sure we pay more attention to these things, which leaves some people unsure of whether their frustrations with health insurance plans are part of the status quo or are issues that should be fixed. This often leads people to wonder “how can I change my health insurance plan mid-enrollment?” While that’s another question for another day, here are a few ways to know when you should change your health insurance.

When You’re Paying for Preventative Care

By law, all ACA-compliant health plans- in other words, health insurance plans that meet the minimum standard of “Obamacare“- MUST include free access to preventative care services such as flu shots and blood pressure screenings (read more about the covered preventative services here). In addition, they must provide some level of coverage for mental health care, which we’ve covered in this article here.

If your health plan does not include coverage for these services, it’s time to consider a change.

When Your Healthcare Needs Have Changed

Have you just made it through “the other side” of a serious health condition? Have you made a major lifestyle change, such as losing a major amount of weight? Have you moved on from a job that involved a major amount of physical strain? These are all examples of major health changes that may cause some to consider dialing back their health insurance coverage.

When Your Family Needs Have Changed

Are you one of the 1.4% of Americans that have had a baby in the last year? Are you planning to have a new addition to your family soon? Will your partner be eligible for medicare within the next year? Then it may be time for you to evaluate changing health insurance plans to better suit your family’s needs.

When You Don’t Go to the Doctor… Because You Can’t Afford It

The whole point of having health insurance is to help reduce the cost of caring for one’s health. This is why one of the great ironies of our time is that thousands and thousands of people who have health insurance skip doctor’s visits when they’re sick or neglect refilling prescriptions… because it’s too expensive!

If this is the case, it’s definitely time to consider switching health plans. Even if you don’t switch health plans, then you may want to consider an HSA- a Health Savings Account- if it’s available through your health insurance provider.

Another Way to Find Out If You Should Change Your Health Insurance

There are many other situations that may cause people to consider changing their health insurance. Our team of experts can help you understand whether or not the time is right for you, and can help you find a plan that will suit your needs if you’re ready to change. Call the Health Plan Options Today team hotline at 855-218-3447 to speak with the team directly, or click the link below and we’ll get in touch with you.

Find my health insurance options

You May Also Be Interested In:

New Law Brings Online Shopping To Hospital Visits
This FREE Guide Answers the Tough Questions About COBRA.
How The “Coverage Bill of Rights” Has Changed Health Insurance
The true cost of not having health insurance is much more than most realize.
The True Cost of Not Having Health Insurance: (It’s more than you think)

Photo by Anastasiya Gepp from Pexels

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COBRA Premium Reimbursements and How to Qualify

Patient and Doctor Awaiting An MRI
Get ready for more Doctor's visits. The America Rescue Plan has extended COBRA coverage.

President Biden’s America Rescue Plan has already affected millions of Americans through tax subsidies and stimulus checks. Here’s how it may affect your health insurance this year, especially if you’ve lost your job due to COVID-19.

On March 11th, 2021, President Biden signed the America Rescue Plan into law. A major part of the rescue plan is that it will help qualified people receive assistance with health insurance costs through government subsidies and reimbursement.

Those who are laid off, retired, have experienced reduced hours, or have experienced any other qualifying reason for job loss are eligible for COBRA (the Consolidated Omnibus Budget Reconciliation Act), which is a law that helps people keep their insurance after losing their job. Biden’s plan subsidizes COBRA for those who have lost their job through pandemic-related issues.

Although an employee can qualify for COBRA for a variety of reasons, not all will qualify for an insurance reimbursement.  The federal government is willing to reimburse people for the cost of COBRA if they’ve lost their job due to COVID-19 However, if someone voluntarily left their workplace during the pandemic, they will not qualify for this government assistance.

What President Biden’s New COBRA Program Means

In regular times, COBRA mandates that continuing insurance options for individuals and their families are generally available for up to 18 months (depending on state requirements). Now, the federal government will be subsidizing premium expenses for those who qualify between April 1st to September 30th. This subsidy will cover the insurance premiums, but copays and deductibles would still be left for the former workers to cover. Those that would like retroactive coverage for previous months of coverage will be responsible for the premiums for those months. If retroactive coverage is not desired, the applicant would only be responsible for the premiums moving forward. Because most COBRA options are available from 18 to 36 months, when an employee’s eligibility finishes, the assistance from the federal government also no longer applies.

What Should I Consider Before Using Biden’s Plan?

One factor that will likely disqualify a large group of people from President Biden’s plan is outside enrollment. If someone who lost their job enrolls in insurance outside of COBRA, they would no longer be eligible to transition back into their former workplace’s insurance. Those who become new employees at a workplace that provide health insurance by September 30th are also no longer eligible. There are other restrictions that may hamper applicants in the long run as well- they can all be found here (or you can simply get in touch with one of our experts to discuss your options).

For those who qualify for COBRA, there are some other things to consider. If your insurance coverage comes to term shortly after April, you will want to make sure you have insurance coverage moving forward. Although you will have assistance for those eligible months, you might have a lapse in coverage if your next step is not planned ahead of time. (As a reminder, open enrollment for Affordable Care Act options is now available until May 15th). For those who are enrolled in family plans, any dependents who have turned 26 years old will be responsible for finding their own insurance policy. Another factor to consider is that former spouses of the primary insurance holder are still eligible for the COBRA plan but are responsible for the cost.

What If I Want Other Healthcare Options or Miss the Healthcare Enrollment Period?

For more information about COBRA and how President Biden’s plan affects you, or if you have any other questions or would like to enroll in health insurance, just fill out the short form below or give us a call at 855-218-3447 and we’ll help you get insurance at a rate you can afford.

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Is There a Health Insurance Penalty in 2021?

Is health insurance required in the United States? The short answer: yes and no.

When the Affordable Care Act (ACA), or “Obamacare”, was launched in 2010, one of the biggest debates surrounding the law was not the idea of “healthcare for all” or what types of health incidents the ACA covers or doesn’t cover, but the idea that the act made health insurance mandatory for all Americans. While the law did not say anything like “you must have health insurance or you’ll go to jail”, it did create a tax penalty- popularly known as “the health insurance penalty”- for anyone without health insurance. One side of the political aisle said that this idea-  which simply became known as “the mandate”-  infringed on the freedom of Americans, while the other side felt that it was everyone’s right to have affordable health insurance, and a mandated public option would help keep costs down for everyone.

The Affordable Care act was launched nearly 10 years ago, and still never fails to be a major lightning rod in Washington, D.C. and in state government offices, especially during election season. While the individual mandate was lifted on the federal level in 2019, portions of the mandate still remain in the actual Obamacare law and in some states; these portions still create plenty of discussion everywhere in the United States.

What Is The Penalty For Not Having Health Insurance?

The national health insurance mandate was not as one-sided as we may have implied. While the mandate established a tax penalty for those without insurance, it also created a special premium tax credit for people with insurance, which served to help lessen the cost of health insurance. It also created provisions to expand Medicare for lower-income families. Congress voted to remove the federally mandated penalty for not having health insurance in 2017 via a law that became effective on January 1, 2019.

Some states, however, have their own insurance marketplaces, and have created their own mandated insurance, using a state tax penalty/tax credit system that is similar to the original federal system. As of early 2021, these states are as follows:

  • Massachusetts
  • Rhode Island
  • Vermont
  • California
  • New Jersey

In addition, the District of Colombia also has its own mandate. New Mexico, Kentucky, Maine, and Virginia are all expected to open their own marketplaces within the next two years, and Maryland, Hawaii, Connecticut, and Pennsylvania have made progress on creating mandatory healthcare law for their residents as well.

Pros and Cons Upsides and Downsides To Revoking The Health Insurance Penalty

In the words of the great Sir Isaac Newton, “with every action, there is an equal and opposite reaction”. In the case of the removal of the health insurance mandate, people quit their health insurance when it was no longer required in order to save money. Experts estimate that as many as 4 million people quit their health insurance solely based upon the removal of the health insurance mandate.

The biggest benefit of removing the mandate, especially for healthy young people, is that without having to pay for health insurance, a little more money can stay in one’s pocket. Stories have appeared of people who have used the mandate removal to their advantage, and have gotten rid of their insurance, then actually negotiated major health costs on their own and come out ahead of the system.

The downside, of course, is what Obamacare was originally created to avoid- not having health insurance is a major risk. Due to the extreme costs of healthcare in the US, most people without insurance or major savings are only one major medical crisis away from financial ruin or bankruptcy. Consider this- the average cost of an emergency room visit in 2018 was roughly $2000, which is nothing to laugh at, considering that in the pandemic era, surveys show that 25% of Americans have no emergency savings at all.

How To Compare Health Insurance

While the healthcare marketplace is one way to shop for insurance, there are other ways to shop that include other types of health insurance, such as private insurance and short-term coverage. The team at healthplanoptionstoday.com can help walk you through your options and get coverage in 3 easy steps, just click the button below to get started.

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COBRA Continuation Coverage, Explained.

COBRA is often thought of as the expensive health insurance alternative. That’s not always the case.

How COBRA Health Insurance Works

COBRA, which stands for Consolidated OmniBus Reconciliation Act, allows for a continuation in coverage in relation to an employee’s employer-sponsored health insurance plan even after the employee leaves their job. The health plan is guaranteed regardless of whether the employee left the job voluntarily or not, or if the employee was forced to leave by life certain life experiences.

However, COBRA should not be misinterpreted as a health insurance plan. It is more of a law that converts a group insurance plan into an individual one. Thanks to COBRA regulations, most employers with an excess of 20 employees offer coverage, with the exemption of churches and the federal government. 

What you need to know is that getting the COBRA plan is a little different from getting a plan through your employer since while using the former; you have to cover the full cost of the plan.

How do I Know That I Qualify for the COBRA Plan?

To establish whether your group insurance plan is eligible for COBRA coverage, start by checking at the group’s plan Summary Plan Description. This document is available approximately 90 days after you join the plan. To get cobra insurance, you need to have qualifying events that lead to the loss of your health insurance. The main qualifying event for COBRA coverage is leaving or quitting your job provided that the reasons for leaving are not as a result of gross misconduct. The list below outlines the common cobra qualifying events for COBRA coverage.

  • When you leave or quit your job
  • Termination of your job posting for reasons other than gross misconduct
  • A reduction of your working hours
  • When you lose coverage as a result of being entitled to receive Medicare
  • Divorce or separation from your legal spouse

In the event that your spouse or dependent children lose their coverage from your plan as a result of a legal separation or your death, they are still entitled to COBRA coverage. The same happens for children who are on their parents’ insurance but lose their coverage once they turn 26. Such a child is still a cobra qualified beneficiary.

How Much Does COBRA Cost?

The cost of COBRA coverage is such that you have to pay the full amount of your health insurance plan as well as a 2% administrative cost. This means that COBRA coverage may be more expensive and the expense can even go higher should you consider the plan as a short-term option. In most cases, employers tend to subsidize health insurance cost for their employees. If you find that your health insurance is affordable, it may be that your employer is helping you cover part of the cost (although our agents can help you find affordable options otherwise). This means that before subscribing to cobra health insurance, ensure that you know how much the full cost of your health insurance plan is.

Some employees are eligible for getting assistance to meet their COBRA cost. Those who do qualify for health coverage tax credit. Such employees include those whose employment is terminated as a result of global trade. There are also workers who are entitled to benefits under the Trade Adjustment Assistance (TAA), and some employees who are entitled to pension payments under the Pension Benefit Guaranty Corporation (PBGC).

Is Cobra a Good Alternative?

While COBRA is a good option to retain your employer-sponsored health insurance in the event that you lose your job, make sure that you explore all alternatives before choosing the plan. Our experts can help you find more affordable plans that can suit both individual and family needs. We’d be happy to work with you, just fill out the form below and we’ll get in touch.

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Photo by Tima Miroshnichenko from Pexels

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Biden Reopens Obamacare Enrollment

Biden Signs Executive Order for ACA
President Biden, seen here with President Obama, signed an executive order that changed the ACA enrollment period. Here's what that means for you.

Don’t Have Insurance? Here’s How Biden’s Executive Order Helps You

On January 28, with just a few quick strokes of his pen, President Joe Biden signed an executive order that changed the way many Americans access their health insurance temporarily, and may permanently change the way federal agencies- and by extension, healthcare companies everywhere- approach insurance.

President Biden’s executive order will reopen Affordable Care Act (ACA) healthcare enrollment for a special enrollment period between February 15th and May 15th- and not just for those who are eligible for COBRA or other special coverages. The order also demands that federal agencies review their policies to make sure that healthcare truly is affordable, and to ensure their policies do not block insurance access for those with preexisting conditions, including COVID-19. Biden’s order also urged these same agencies to make other changes that will “protect and strengthen” access to healthcare in the future.

Biden made a statement after the order’s signing, saying “As we continue to battle Covid-19, it’s even more critical that Americans have meaningful access to health care”.

This executive order follows former president Trump’s changes to the Affordable Care Act. In 2018, Trump shortened the ACA’s enrollment period from 92 days to 15, which caused new healthcare enrollment to drop drastically. Also notably, the Trump administration and several states attempted to kill the ACA in a case that’s still pending before the Supreme Court.

What Does Biden’s Executive Order Mean For You?

If you’re worried because you or your family don’t have health insurance during the Coronavirus pandemic, you have another chance to secure insurance through the ACA marketplace- even if you have lost your job, stopped paying your private health insurance, or both. This will come as especially good news to those who missed because last year’s enrollment period was so short.

What If I Want Other Healthcare Options or Miss the Healthcare Enrollment Period?

If you miss the new Health Care Enrollment period or if you would like other healthcare options beside the ACA marketplace, there are still other options available for you, such as private insurance. The team at Health Plan Options Today can help you examine options such as these.

If you have any other questions, need help picking the best health insurance plan for your needs or would like to enroll in health insurance, just fill out the short form below or give us a call at 1-855-218-3447 and we’ll help you get insurance at a rate you can afford.

Need Health Insurance?

Fill out this form and our experts will contact you to help you get the right insurance for your needs.

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