Many people have found themselves in a very trying and unfamiliar situation. After being laid off or experiencing a company-wide shut down, many are finding themselves without health insurance for the first time in their lives. As you embark on your new journey into the unfamiliar world of individual health insurance, there is a lot you will need to know. Here is the “who,” “what,” “when,” “where,” “why,” and “how” of the individual market to try and help ease the stress level.
Who will need coverage going forward?
Can members of the family go onto a spouse’s plan that is still employed? In cases of a split family, can the children go onto an ex-spouse’s plan? Does anyone have any conditions that may limit the plan types you may want to consider? Now that we know who is going to need the coverage we can move on to the next step.
What type of plan will make the most sense for my family and me?
One plan type will not fit everyone. Have you been laid off, but know you will be returning to the same job? Are you considering early retirement? Do you really not know and are unsure, but know you need coverage? With a change of income, will you be eligible for a tax credit? Will you be comfortable with pre-existing conditions clauses or plan limitations? What type of deductible and copays would you feel comfortable with? These are all things that will have a bearing on which type of plan you will want to consider.
A short-term plan, for example, may work for a healthy individual or family, especially if they know they may only be laid off for a short period of time. The short-term plans will have underwriting questions and pre-existing conditions clauses. Some may want the comfortability of copays and prescription coverage and others will be eligible for a tax credit to lower the monthly premium. Remember you want your plan to fit your needs.
When will you need your plan?
Did your coverage end immediately at the end of employment? Does your coverage run through the end of the month? This is a very important question. Affordable Care Act (ACA) plans can only start on the first of the month, while short-term plans can start next day if you get through underwriting. If you lose coverage on the tenth of the month, you may want to look at a short-term plan for the rest of the month then an ACA plan starting at the beginning of the next month. If you know ahead of time, try to be prepared. This is not always possible, but you want to try to avoid a gap in coverage if at all possible.
Where would you like to be seen?
Get a list of your doctors and preferred hospitals together. Unlike the employer benefit plans you may be used to, individual plans have narrow networks that may align with as little as one hospital group. If you have a doctor or doctors that you do not want to lose, you may want to prioritize your list to make sure you get the most important doctors covered on the plan you pick. If you have any non-generic medications, you will also want to check the plan’s drug formulary to make sure your prescription is covered.
Why do I need the health insurance?
You may plan on being back to work in a month or two. You may think, I only go to the doctor once a year so I can go without coverage for a while. The average cost for a single day in the hospital is $3,949. The average hospital stay is $15,743. It is a big risk and with the rising cost of services, going uncovered is not an option.
How do I get the new coverage?
Depending on the type of plan you choose, there are different avenues to getting coverage. A plan with a tax credit must be purchased through the Marketplace at Healthcare.gov. ACA plans are sold through the Marketplace, but a few carriers offer private plans that do not have a tax credit. The short-term plans are available directly through carriers, so you can visit their websites or call the sales department. However, the easiest way to ensure you are choosing a plan that suits your needs and budget is to work with an insurance agent. We help clients in your situation every day and we can help you find a plan that simplifies your life.
Remember, you need to feel comfortable with your plan and the premium. It’s really no benefit to you if you can’t afford the plan you pick or if you’re not getting the coverage you need. Try to purchase what you know you will use. If you go to the doctor once a year, for example, consider what you’re getting out of the plan versus what you’re paying. The goal should be balance and comfort. Remember, just because someone else says they found a great plan that doesn’t mean it is right for you. Do your homework and use the “who,” “what,” “when,” “where,” “why,” and “hows” to help narrow down your choices to get to the right plan.
ARC Benefit Solutions’ licensed sales agents are prepared with the expertise you need to make an informed decision about your health insurance during this uncertain time. Our experts have an average tenure of 17 years and work every day to help clients just like you find plans that work for their situation and their budget. Contact us today to get started.