No one plans to get sick or hurt, but when it happens, it can be incredibly expensive to get care if you don’t have the right health insurance coverage. 

Though health insurance offers significant financial protection, how can you ensure you’re choosing the right plan? 

Whether you’re trying to find the right plan to choose through your employer-sponsored coverage, or you’re just beginning to look into your individual health insurance options, our team  at Insurance Bargains is dedicated to helping you navigate the confusing and complicated world of health insurance so you could stay healthy without breaking the bank. 

The Basics of Health Insurance 

Employer-Sponsored 

A health insurance policy selected and purchased by your employer and offered to eligible employees and their dependents. Your employer will typically share the cost of your premium with you. 

Individual Plans 

An individual health plan is one you purchase on your own, not through an employer. You can purchase these from a health insurance exchange, also referred to as the health insurance marketplace. 

Family Plans 

A family health insurance plan is essentially the same as an individual plan but with dependents added to the policy. 

Medicare 

A federal health insurance program that insures seniors aged sixty-five and older. Beneficiaries can choose their coverage through a private insurance company with a Medicare Advantage plan or through the government. 

Short-Term 

A short-term health insurance plan can help to bridge any gaps in coverage you may encounter. 

Dental & Vision

Generally speaking, most medical insurance plans don’t cover routine dental or vision care. You’ll need to enroll in separate plans to meet these needs. 

HMO vs. PPO

Health Maintenance Organizations (HMOs) is a plan that offers members care within a specific network of doctors, hospitals, and other medical providers, otherwise known as in-network providers. 

Preferred Provider Organizations (PPOs) offer more flexibility where you seek care. You can schedule appointments with out-of-network doctors and see specialists without getting a referral. 

Key Health Insurance Terms You Should Know

• Premium: The amount of money you pay to your health insurance company each month to keep your coverage. 

• Deductible: The amount of money you pay out-of-pocket before your health insurance pays for health care services. 

• Copay: Cost-sharing payments you may have to make out-of-pocket when you receive certain health care services or medications. 

• Coinsurance: Another type of cost-sharing payment you have to make out-of-pocket when receiving health care services or medications. 

• Out-of-Pocket Maximum: The cap on how much you’ll have to pay out-of-pocket for health care in one year. Once you’ve reached this amount, your insurer will pay for your covered care for the rest of the year. 

Open Enrollment Made Simple 

An open enrollment period is a window that occurs typically in the fall when you can sign up for health insurance, adjust your current coverage, or cancel your plan. 

Plan Type	Dates
Marketplace plans (Healthcare.gov and state exchanges) and individual plans	November 1st to January 15th
Employer-sponsored health insurance	Dates depend on your employer, but typically individuals enroll in the fall.
Medicare	October 15th to December 7th
Medicaid	No date restrictions- you can apply for coverage anytime.

 

Unless you experience a qualifying life event such as a loss of coverage through an employer, significant family changes, or loss of coverage through a covered employee, you will have to enroll for health insurance during the open enrollment period. 

You Lost Your Employer-Sponsored Insurance… Now What? 

If you’ve lost your employer-sponsored insurance due to job loss, your next steps might seem daunting. However, you may find that you have options due to a special enrollment period. 

The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires employers with more than twenty workers the opportunity to continue their health coverage for up to 18 months after their position has ended. This coverage includes you, your spouse, and other dependents on your plan. Generally speaking, you would have at least sixty days to enroll in COBRA coverage. 

Another option is to sign up for an Affordable Care Act plan (ACA). Though you typically sign up for health insurance during Open Enrollment, losing your job qualifies you to enter a Special Enrollment Period to choose a new plan. 

While short-term insurance is not the same as Marketplace coverage and is not required to cover minimum essential health benefits, it may be an optimal option for individuals who need a bridge of coverage and cannot wait for Open Enrollment or do not qualify for a Special Enrollment Period. 

If you have a limited income, Medicaid may be the perfect option for you. While you can apply at any time, there are set criteria for you to meet in order to qualify. 

Final Thoughts

Health insurance is a safety net meant to take care of your financial well-being when life continues to offer you unpredictability. Ensure you’ve done your research so that you could choose the right coverage for you and your family.