Health Insurance USA

You're not alone if you need to purchase health insurance. For the fourth year in a row, the number of uninsured people in the United States increased to around 30 million in 2020. We'll go over each option for purchasing your own health insurance so you can decide which is best for you.

Option 1: Use the government's health insurance exchange.

The Health Insurance Marketplace is also known as the "exchange" for health insurance. Subsidies, also known as premium tax credits, may be available if you purchase health insurance through the marketplace based on your income and eligibility for other health insurance coverage.

Even if you are eligible for insurance through your employer, you can purchase a policy through the marketplace, and it doesn't hurt to see if you can find a better plan for your situation. However, if you have access to job-based coverage, you are unlikely to be eligible for subsidies.

The open enrollment period for 2022 coverage began on November 1, 2021. You had until December 15 to enroll for coverage that began on January 1, 2022. In 2021, the open enrollment period was extended from February 15 to May 15 due to the ongoing COVID-19 pandemic.

Enrollment dates for state exchanges may differ slightly. It's critical to purchase a policy during this annual enrollment period because you won't be able to do so for the rest of the year unless you have a qualifying life event, such as relocating, getting married, or having a child.

You have the option of applying online, by phone, or in person. In some states, you can work with a marketplace navigator, a certified application counselor, or in-person assistance personnel if you need assistance applying. To purchase a marketplace plan, you must be a U.S. citizen or lawfully present in the country.

Visit HealthCare.gov to begin your search for a marketplace policy. Enter your zip code and you'll be directed to the federal marketplace to purchase a policy. If your state has its own marketplace, you'll be taken to its website. Direct links to state exchanges can also be found on Healthcare.gov The Marketplace in Your State page.

If you are unsure whether you are eligible for Medicaid or the Children's Health Insurance Program (CHIP), you can find out by visiting your state's Medicaid website or by completing an application at HealthCare.gov.

Option 2: Hire an Agent or Broker

Because they have experience evaluating health insurance plans, an agent or broker can assist you in finding the best policy for you. You can find a marketplace-trained private insurance broker using the federal government's Find Local Help tool. You may want to work with a broker who sells both marketplace and non-marketplace plans to learn about the most options and get the least biased advice.

Brokers are compensated by health insurance companies when they sell policies. Consumers do not pay brokers a fee or pay higher premiums to work with them. An "agent" is someone who only sells policies from one insurance company, whereas a "broker" sells policies from multiple insurance companies.

Private insurance brokers may also show you options on insurance company and web broker private enrollment sites. If you want to be eligible for subsidies, you must apply through Healthcare.gov or your state exchange.

The government's health insurance navigators will only show you plans available through Healthcare.gov's marketplace. All of these plans are eligible for subsidies, and the assistance of a navigator is free.

Option 3: Purchase Directly from an Insurance Company

The Health Insurance Marketplace does not include every available health insurance plan. Outside of the marketplace, some people may be able to find a plan that better meets their coverage needs or their budget. When you shop for a policy on the website of a single insurer, you will, of course, only see options from that insurer. If you want to buy direct, you'll need to visit the websites of several insurers to see all of your options.

Plans sold outside of federal and state exchanges that are ACA-compliant must meet the ACA's minimum essential coverage standards, such as covering pre-existing conditions, providing essential benefits, and providing preventive care at no cost before you meet your deductible.

Outside of the exchanges, you can also purchase non-ACA-compliant short-term plans (up to 12 months) with more exclusions and fewer benefits. People who are switching insurance companies may believe that having some insurance is preferable to having none at all. Short-term health insurance plans promote their perceived coverage as a superior alternative to ACA-compliant insurance with lower premium costs.

However, lower costs do not imply equal coverage for consumers. Most short-term plans deny coverage to patients with pre-existing conditions and severely restrict mandated ACA vital essential health benefits (prescription drugs, mental health services, prescription drugs, and maternal care), leaving many with an expensive remaining balance. The true reasons for this alleged affordability are strategic policy limitations on applicants and the coverage plan. Proceed with caution when it comes to short-term health insurance because the financial risk may outweigh the financial savings.

In short, if you apply through a private exchange or consider any so-called alternative to traditional health plans, pay close attention to what you're signing up for. If you do not apply through the federal marketplace, you will not be eligible for subsidies. If your state has its own health insurance marketplace, you should purchase your health insurance plan through it to ensure that you are eligible for subsidies.

You might not care if your income is too high to qualify for subsidies. However, if you earn less than expected in the coming year, you may qualify for subsidies unexpectedly, so you should keep your options open. Subsidies are calculated based on how much you earn in the year you purchase coverage. When you enroll, you will only receive an estimate of your subsidies based on your projected income.

Option 4: Purchase from an online health insurance brokerage.

Online health insurance brokerages, also known as private enrollment websites or private exchanges, provide assistance in comparing health insurance plans or finding the best available plan based on the information you provide. Comparison shopping is a good idea, but customers should understand that these sites will not show them every plan available in the market that meets their needs.

Instead, these private exchanges will present a variety of plans in exchange for a commission if the consumer enrolls. They may highlight or provide additional information on the plans that earn the brokerage a higher commission.

These marketing incentives do not necessarily imply that the plans offered by these sites are bad. It simply means that consumers should be aware that when they visit one of these sites, they may not be getting a complete picture of their options.

Private enrollment websites may request personal information from you that the federal and state marketplaces do not. They may inquire about your height, weight, and pre-existing conditions—factors that can affect your eligibility for non-ACA-compliant plans. The company behind the website, as well as their business partners, may use the personal information you provide to market other products to you.

If you purchase your health insurance policy through a private exchange, you will not be eligible for premium tax credits (subsidies), as you would if you purchased it directly from a health insurance company.

Option 5: Purchase from a Membership Organization

If you are a member of a union, alumni association, professional organization, or other large group, you may be able to purchase health insurance at group rates through it. For example, Freelancers Union provides health insurance through its subsidiary, Freelancers Insurance Agency, and one of its partners, HealthPlanServices.

When looking for health insurance through an association or membership organization, make sure you're buying insurance rather than just a health services discount plan. Discount plans may help you save money on prescriptions or glasses, but they will not help you if you develop cancer. Also, even if the association is a non-profit organization, it may be affiliated with or even established by a for-profit insurance agency that sells policies to association members.

How Much Is Health Insurance?

According to Kaiser Family Foundation research, the average annual premium for single coverage in 2021 will be $7,739 and $22,221 for family coverage. Prices are expected to rise in 2022, as they do most years: For example, the year 2020 saw a 2.1% increase. Premiums increased by 4% in 2019 compared to the previous year. Willis Towers Watson forecasted a 5.2% increase in healthcare premiums in 2022.

The average premium for single coverage rose by 4% in 2021, while the average premium for family coverage rose by 4%. According to KFF, the average family premium has risen 47% since 2011 and 22% since 2016.

In conclusion

If you do not have health insurance through your employer or Medicare, you can apply for coverage in a variety of ways.

If you're comfortable doing your own research and comparing plans, you can apply through Healthcare.gov. You can also find out if you're eligible for Medicaid and/or CHIP by visiting the government's website.

If you need assistance selecting or applying for a plan, you can consult with a marketplace assistance counselor, navigator, or broker. All of these people's services are provided for free.

You are not required to purchase health insurance through the federal or state exchanges (or at all), but you will not be eligible for premium tax credits unless you do.

Finally, purchase a policy during the annual open enrollment period. It's your best chance to get low-cost, comprehensive coverage.