If you need to buy health insurance, you are in good company. In 2020, the number of uninsured people in the United States increased (for the fourth year in a row) to nearly 30 million individuals.
We’ll explain each option for buying your own health insurance so you can decide which route might be best for you.
Option 1: Use the government’s health insurance
The health insurance marketplace is often referred to as the health insurance “exchange”. Depending on your income and your eligibility for other health insurance coverage, you may qualify for a subsidy — also called a premium tax credit — when you buy health insurance through the Marketplace.
If you’re eligible for insurance through your employer, you can still buy a Marketplace policy, and it doesn’t hurt to see if you can find a better plan for your situation. If you have access to job-based coverage, you probably won’t be eligible for subsidies.
Open enrollment for 2022 coverage begins November 1, 2021. You had until December 15 to enroll for coverage starting January 1, 2022.
In 2021, the open enrollment period was extended from February 15 to May 15, amid the ongoing COVID-19 pandemic.
Enrollment dates may vary slightly across state exchanges. It is important to purchase a policy during this annual enrollment period because you will not be able to purchase a policy for the rest of the year unless you have a qualifying life event such as moving, getting married, or having a child.
You can apply online, by phone, or in person. If you need help applying, you can work with a Marketplace Navigator, a Certified Application Counselor, or in-person assistance personnel in some states. You must be a US citizen or legally present in the country to purchase a Marketplace plan.
Start your search for a Marketplace policy at HealthCare.gov. Enter your zip code and you will be directed to purchase a policy through the Federal Marketplace. If your state has its own market, you will be redirected to your state’s website. You can also find direct links to state exchanges on Healthcare.gov’s The Marketplace on your state’s site.
If you’re not sure whether you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can find out by visiting your state’s Medicaid website or filling out an application at HealthCare.gov.
Option 2: Work with an agent or broker
An agent or broker can help you find a good policy for you as they have experience in evaluating health insurance plans. The federal government’s Find Local Help tool can help you locate a market-tested private insurance broker. To be exposed to the greatest number of options and receive the least amount of biased advice, you may want to work with a broker who sells both marketplace and non-marketplace plans.
Health insurance companies pay brokers when they sell policies. Consumers do not pay fees to brokers, nor pay high premiums to work with them. “Agent” usually refers to someone who sells policies from only one insurance company, while “broker” refers to someone who sells policies from multiple insurance companies.
Private insurance brokers can also show you options from insurance companies and web brokers at private enrollment sites. If you want to qualify for subsidies, however, you must apply through Healthcare.gov or your state exchange.
The government’s Health Insurance Navigator will only show you Marketplace plans available through Healthcare.gov. All of these schemes are eligible for subsidies, and a navigator’s help is free.
Option 3: Buy Directly from the Insurer
Health Insurance Not every health insurance plan available in the marketplace is covered. Some people may be able to find a plan that better meets their coverage needs or their budget outside the marketplace. When you are shopping for a policy on the website of an insurer, of course, you will see the options available from only one insurer. If you want to buy direct, you will need to visit the websites of multiple insurers to see all your options.
Affordable Care Act (ACA)—Plans sold outside the federal and state exchanges must meet the ACA’s minimum essential coverage standards, such as covering pre-existing conditions, providing essential benefits, and preventive care at no cost to offer,
You can also buy non-ACA-compliant short-term plans (up to 12 months) outside the exchanges that may have more exclusions and fewer benefits. Those who are among insurance carriers may think that having some insurance is better than none at all. Short-term health insurance plans market their purported coverage as an excellent alternative to ACA-compliant insurance that comes with lower premium costs.
But those lower costs don’t mean the same coverage for the consumer. Most short-term plans deny coverage to patients with pre-existing conditions and the ACA sharply limits critical essential health benefits (prescription drugs, mental health services, prescription drugs, and maternal care), leaving many with costly balances. She goes. These strategic policy limits on applicants and the coverage plan are the real reasons behind this perceived affordability. Proceed with caution with regard to short-term health insurance as the financial risk may outweigh the financial benefit in cost savings.
In short, if you apply through a private exchange and consider any so-called alternatives to traditional health plans, pay close attention to what you’re signing up for. If you do not apply through the Federal Marketplace, be aware that you will not be eligible for subsidies. If your state operates its own health insurance marketplace, you must purchase your health insurance plan through your state’s marketplace to make sure that your plan is eligible for subsidies.
If your income is too high to qualify for the subsidy, you may not care. But if you earn less than expected in the coming year, you may be unexpectedly eligible for a subsidy, so you may want to keep your options open. The subsidy is based on how much you earn in the year you are buying the coverage. When you enroll, you will only receive an estimate of your subsidy based on your estimated income.
Option 4: Buy through an online health insurance brokerage
Online health insurance brokerages—also called private enrollment websites or private exchanges—offer to help you compare health insurance plans or find the best available plan based on the information you provide. Comparison shopping is smart, but consumers should understand that these sites won’t show them every plan on the market that meets their needs.
Instead, these private exchanges will show a selection of plans that will pay a commission to the consumer when they enroll. They may display more prominently or provide more information about the schemes which earn the brokerage a higher commission.
These marketing incentives do not mean that the plans offered by these sites are not good plans. It just means that consumers should be aware that they may not be getting the full picture of their options when they visit one of these sites.
Private enrollment websites may ask you for personal information that the federal and state marketplaces do not. They may ask about your height, weight, and pre-existing conditions — factors that may affect your eligibility for plans that don’t comply with the Affordable Care Act. The company behind the website may also use the personal information you provide as well as their business partners to market other products to you.
In the case of buying a policy directly from a health insurance company, you may not get the premium tax credit (subsidy) if you buy your health insurance policy through a private exchange.
Option 5: Buy Through a Membership Organization
If you belong to a union, alumni association, professional organization, or any other large group, you may be able to purchase health insurance through it at group rates. Freelancers Union, for example, offers health insurance through its subsidiary, Freelancers Insurance Agency, and through one of its partners, HealthPlanServices.
When looking for health insurance through an association or membership organization, be sure you are actually buying insurance, not just a healthcare discount plan. Discount plans may save you money on prescriptions or glasses, but they won’t help you if you get cancer. Also note that even though the association itself is a non-profit organization, it may be tied to or set up a for-profit insurance agency through which it sells policies to association members.
Beware of Healthcare-Sharing Ministries
The misconception that healthcare-sharing ministries are a form of health insurance can put patients in financial trouble. Healthcare-sharing ministries are operated by non-profit organizations made up of like-minded people who agree to help pay each other’s medical bills. They may be attractive to healthy individuals looking for low-cost coverage, but they do not provide real health insurance and are not held to the same standards as regular health insurance companies. In fact, they are not obligated to pay the medical bills of their members. As a result, some procedures and costs cannot be paid for through membership, and other mandatory ACA critical benefits for substance abuse and mental health are not covered.
Healthcare-sharing ministries typically do not cover pre-existing conditions, often charge high rates based on health conditions using a process known as underwriting, and do not guarantee reimbursement, even Same for the conditions they cover.
Although the upfront cost of joining a healthcare-sharing organization may be less than the premiums and other costs of an ACA plan, it can increase financial stress over the long term. Several states have taken legal action against healthcare-sharing ministries and warned consumers.
How much does health insurance cost?
According to research from the Kaiser Family Foundation, the average annual premium in 2021 was $7,739 for single coverage and $22,221 for family coverage. Prices are expected to increase for 2022, as they do in most years: for example, 2020 saw a 2.1% increase. Premiums jumped 4% in 2019 over the previous year. For 2022, Willis Towers Watson projects a 5.2% increase in healthcare premiums.
In 2021, the average premium for single coverage increases by 4%, and the average premium for family coverage increases by 4%. According to KFF, the average family premium has increased by 47% since 2011 and 22% since 2016.
How do I get health insurance if I’m retired?
If you are retired but still under age 65 and you no longer have employment health insurance because of a job loss, you can apply for coverage through the Healthcare Marketplace. Losing coverage will qualify you for a special enrollment period.
Depending on household size and income, you may qualify for premium tax credits and lower out-of-pocket costs.
Retirees age 65 and older will qualify for Medicare and Medicare Advantage. If you have retiree health coverage, but you’re not eligible for tax credits and reduced out-of-pocket benefits or special enrollment periods, you can also switch to a Marketplace plan. If you turn 65 in the middle of the year, you can apply for a Marketplace plan to cover you until Medicare begins.
If you’re 65 but don’t qualify for premium-free Medicare, you can buy insurance through the Marketplace and get lower costs with tax credits.
How do I get health insurance if I am disabled?
If you have a terminal illness, need daily assistance with care at home or in a group setting, live in long-term care or group home, have a disability, or have a condition that limits your employment, options are available. Disabilities are covered under pre-existing health conditions, and plans cannot charge you more because of your health conditions prior to coverage.
With Social Security Disability Income (SSI), you can apply for coverage through Medicaid. Most states automatically provide Medicaid when you are approved for SSI based on disability, although in some states, SSI does not guarantee Medicaid. It pays to check your state’s rules. In some states, SSI guarantees eligibility, but separate registration is still required.
If you have Social Security Disability Insurance (SSDI), you can apply for coverage through Medicare.
Unfortunately, you cannot supplement or convert your insurance into a Marketplace plan if you already have Medicare. If you enrolled in a Marketplace plan before your Medicare application, you can keep it as supplemental insurance — but you’ll lose any premium tax credits and additional savings it offers.
How do I get health insurance if I’m self-employed?
If you own your business, you can apply for health insurance coverage through the Marketplace. Your income and household size may qualify you for premium tax credits and other insurance savings.
Your state may also have free or low-cost coverage through the CHIP or Medicaid programs.
Marketplace plans allow business owners to ensure their children and spouse. Healthcare savings are based on an estimate of net earnings in the year you apply, not the previous year’s income.
If you don’t get health insurance through work or through Medicare, you have several ways to apply for coverage.
If you’re comfortable doing your own research and comparing plans, you can apply through Healthcare.gov. You can also find out if you qualify for Medicaid and/or CHIP by visiting the government’s website.
If you need help finding or applying for the right plan, you can work with a Marketplace Assistance Counselor, Navigator, or Broker. The services of all these persons are free of cost.
You don’t have to buy health insurance through the federal exchange or your state’s exchange (or at all), but you won’t be eligible for the premium tax credit until you do.
Finally, be sure to buy a policy during the annual open enrollment window. This is your best opportunity to purchase affordable, comprehensive coverage.