(MP) In terms of your health insurance options under the Affordable Care Act (ACA) aka Obamacare there isn’t any one-size-fits-all solutions. Today before selecting a health coverage plan you should think about the benefits you’ll need, how much you can afford to pay for monthly premiums along with out-of-pocket expenses. Also, what providers are included in a plan’s network, and what—if-any financial subsidies you qualify for. Whether you plan to buy on the Health Insurance Marketplace or away from it –be aware of your options:
Available Health Insurance Options Under ACA
Option #1 Employer-sponsored coverage
Starting in 2015, large employers with 50 or more workers will offer employees health coverage. If they don’t, they may face fines, but only if their workers go to health insurance exchanges and have earnings low enough to qualify for federal subsidies. Stores and restaurants — less likely to offer insurance in the past — will be affected most. The coverage rule doesn’t affect workers who put in less than 30 hours a week.
People that are employed full-time, can have access to coverage through their workplace. This is often a desirable route since employers typically pay a percentage of premium costs. However, based on one’s age plus how much he or she pays for job-based health coverage, they may have other options. According to HealthCare.gov, “A job-based health plan is deemed ‘affordable’ if the employee’s share of premiums for the lowest cost self-only coverage that meets the smallest value standard is less than 9.5% of their family’s income.” If, by theses measures, workplace insurance coverage is not affordable, young people and others are able to shop the Health Insurance Marketplace ( HIM) and qualify for subsidies based on income.
Option #2 Parent’s health plan
Before the law, dependent children often “aged out” of their parents’ health plan at age 19, or 22 if they were full-time students. Now the law says young people may stay on their parents’ health coverage until age 26. This applies regardless of their financial, marital or dependent status. Adult children covered by a parent’s insurance plan don’t need to live in the same home. Even people having access to insurance coverage through an employer may stay on a parent’s health plan through their 26th birthday. Plus it applies no matter whether a parent’s health coverage is obtained through an employer, in the private marketplace or through the Marketplace (HIM).
Option #3 The Health Insurance Marketplace
If you don’t have access to employer or parental coverage you can opt to shop the state-based and federally facilitated exchanges known as the market.
Individuals who are not claimed as independents on their parents’ tax returns and have an income between 100 and 400 percent of the federal poverty level may be eligible for premium tax credits. Furthermore, those who buy a silver plan and earn up to 250 percent of FPL may qualify for more cost-sharing subsidies.
Those younger than 30 can buy a catastrophic plan through the Marketplace. Catastrophic health coverage means an individual pays a lower monthly premium and a higher deductible than he or she would with an individual major medical insurance plan. Benefits typically don’t kick in until the deductible has been met; however, under the Affordable Care Act catastrophic plans include three primary care visits and certain preventive care benefits before the deductible has been met.
Option #4 Non-exchange plans
Those whose financial position disqualifies them from receiving premium tax credits or other cost-sharing subsidies or those who don’t wish to buy from Obamacare exchanges may consider buying individual major medical insurance from the private marketplace.
These medical insurance plans must also fulfill the Affordable Care Act’s requirements for minimum essential coverage. Which means they are categorized by actuarial metal levels, include the 10 categories of essential health benefits as well as certain preventive care benefits, and are subject to the same provisions as plans sold in the HIM. As with health coverage sold through Obamacare exchanges, applicants can’t be denied or charged more based on health history.
Option #5 Student health plans
Some colleges and universities offer insurance coverage to students. These plans can be appealing to young people because they offer local provider networks—if a student is on a parent’s medical insurance plan, he or she may need to travel home to get in-network health care—and often lower premium rates. Students who are unsure if their academic institution’s health coverage plan meets Obamacare requirements should seek advice from the plan.
Student medical insurance plans do not qualify for premium tax credits and cost-sharing subsidies. And just because students have access to health coverage through their college or university does not mean they have to enroll in it.
Option #6 Medicaid
As part of the Affordable Care Act, many states opted to expand their Medicaid programs. Medicaid provides low-cost or free insurance for low-income people. In states where Medicaid has been expanded, adults younger than 65 who make up to 133 percent of the federal poverty level may be eligible, according to HealthCare.gov. For a single-person household, that is $15,800 per year.
Medicaid eligibility can be determined when applying for health coverage through the Marketplace. Click here to find out more at HealthCare.gov; scroll down to “Get State Information.”
Option #7 Temporary insurance
If you missed open enrollment, Are between jobs, Just turned 26 or recently divorced you may qualify for Temporary health insurance (THI). THI is also called short-term insurance, it was created to be economical and help with medical bills incurred from unexpected accidents and illnesses. Covered expenses may include inpatient hospital care, outpatient hospital care, and outpatient emergency room visits, among others. Policies may be obtained for 30 to 364 days, based on situation and state of residence.
Short-term medical insurance plans do not include essential health benefits, nor do they fulfill the need that most Americans have health coverage. Those who have it may owe a shared responsibility payment—the tax penalty owed by people and families who are not granted a hardship exemption and go without major medical health insurance. Applicants may be denied or charged more based on health history.
Working with a insurance agent or broker can be helpful and the Health Care Reform Calculator can help you estimate your tax credit.