Navigating the complex ecosystem of health care can seem overwhelming at first. Whatever your age, health circumstances or location, it's important to make time to study the best health insurance options available to you on an annual basis. It's a good idea to review your current benefits before Open Enrollment so you can make smarter selections for the coming year.
Since the Affordable Care Act (ACA) was signed into law, there are more insurance plans to choose from than ever before. You'll want to understand what your options are in order to make the decision that is best for you. If you don't have employer-provided benefits, then you'll choose between either public health care insurance or private health care insurance.
There are two forms of health care: public and private plans, which each feature different types of coverage and costs. Visit www.healthcare.gov to search for the insurance plan options that best fit your needs.
- Public exchange insurance plans vary in degree of coverage and are designated from highest to lowest monthly premium cost – Platinum, Gold, Silver and Bronze. Plans that offer more coverage have higher monthly premiums. Platinum or Gold plans that offer more coverage tend to be cost-effective for those who use health care services frequently, such as families or someone with a chronic condition.
- Health Maintenance Organization (HMO) – A type of U.S. health care coverage in which subscribers are required to receive all of their health care from a provider within a given network.
- Preferred Provider Organization (PPO) – A type of health care plan where a group of doctors and hospitals agrees to render particular services to a group of people for a reduced cost. This type of insurance is generally more expensive than HMOs but offers subscribers more freedom to select physicians.
- Point of Service (POS) – A type of health care plan where you pay less if you use doctors, hospitals, or health care providers in the plan's network.
- Exclusive Provider Organization (EPO) – A type of health care plan in which only services provided by doctors and hospitals in the plan's network are covered (except in cases of emergency).
- Private exchange insurance plans offer the same options, but are created by private sector companies, such as a health insurance company or a brokerage (which are not a part of the ACA), or are offered directly on an insurer's website. However, only public exchange insurance plans allow you to qualify for premium subsidies that lower your monthly costs if you meet income requirements. Determine whether you or your family qualifies for tax subsidies by estimating your total income for the upcoming year. If you make more money than you estimated, you'll have to pay back some of the assistance you received. If you make less, you may get an extra subsidy.
Unless you have insurance through your employer, you'll be selecting a health plan during the national Open Enrollment period. The Open Enrollment for 2020 began on November 1, 2019, and ended on December 15, 2019. The next open enrollment period will run from October 15, 2020 to December 7, 2020, for coverage effective in 2021.
If you can afford health insurance but choose not to buy it, you must pay a fee —– the Individual Shared Responsibility Payment – for any month you, your spouse or your tax dependents don't have health insurance. You can enroll in a health insurance plan during the rest of the year, but only if you qualify for a Special Enrollment Period.
In some cases, insurance companies sell private health plans outside of Open Enrollment that count as minimum essential coverage, which means they meet all the requirements of the ACA. If you purchase a private health plan, then you won't have to pay the fee that people without coverage must pay, but you also won't be eligible for receiving advance premium tax credits on your monthly payments or other savings based on your income.
Alternative Health Care Options
- COBRA – The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives some individuals who lose their health benefits the ability to continue receiving benefits for a limited period of time. You can become eligible due to job loss, reduced hours at work, death, divorce and other events.
- Medical Financial Aid – The U.S. Department of Health and Human Services (HHS) helps fund community health centers serving tens of millions of uninsured and underinsured Americans. Patients pay based on what they can afford for services such as routine checkups, maternity care, immunizations, prescription drugs and dental, mental health and substance abuse care. To learn more about this program and find the closest HHS-supported center, visit the U.S. Department of Health and Human Services Health Resources & Services Administration.
- Discounted Care – Many university teaching hospitals and dental schools operate clinics on a sliding payment scale, so it is often worthwhile to check with the institutions near you about discounted services.
- Patient Assistance Programs – Many pharmaceutical companies offer patient assistance programs (PAPs), through which uninsured patients with limited incomes can access drugs they couldn't otherwise afford. Ask your doctor, pharmacist or clinic how to proceed, or visit Partnership for Prescription Assistance.
- TRICARE – TRICARE is a health care program for uniformed service members including active duty and retired members of the U.S. Army, U.S. Air Force, U.S. Navy, U.S. Marine Corps, U.S. Coast Guard, the Commissioned Corps of the U.S. Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Association, as well as their family members.
- Veterans Affairs Coverage (VA) – The U.S. Department of Veterans Affairs operates the nation's largest integrated health care system, with more than 1,700 hospitals, clinics, community living centers, domiciliary centers, readjustment counseling centers and other facilities. If you served in the active military, naval or air service and are separated under any condition other than dishonorable, you may qualify for VA health care benefits.