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As a working adult, it’s important that you have proper healthcare coverage. After all, you need that level of financial safety in case something horrible happens. And usually, the company you work for will have its own health insurance plans as a part of its employee benefits programs — the keyword there being usually.

It’s not uncommon for an employer not to offer any type of health insurance to their workers. So, if you happen to work for such a company, you will need to look into acquiring private health insurance. You will get that level of safety we mentioned earlier, but it comes at a slightly higher cost.

Typically, a company will cover some of your health insurance premiums, which usually get deducted from your salary. The word premium refers to the amount of money you need to pay the insurance company on a monthly basis. So, if you get private health insurance, your employer won’t cover any percentage of those premiums — you will have to pay their full price out of pocket.

Knowing all of that, people can be rightfully scared of the idea that they have to get individual health insurance. After all, it’s not as simple as picking a plan and having the premiums deducted every month. There are lots of different options out there, and you need to find the best health insurance plan that works for you and your specific situation.

With that in mind, this article will cover different types of insurance plans and how you can acquire them. Moreover, you will also learn where and how your insurance plan can help you.

How Can I Buy Health Insurance in the USA?

As of writing this article, you have one of four options for buying health insurance if you’re a US citizen. Depending on what demographic you belong to, or your employment status, you can pick one of the following:

  • Group health insurance plans
  • Medicare coverage
  • Medicaid coverage
  • Private health insurance plans

Group Health Insurance Plans

This type of health plan provides coverage for a group of employees. A company or an organization would buy these plans and sell them to the people it employs. However, you can’t opt for this plan unless you’re a part of a group.

Medicare Coverage

Medicare is a US-based federal health insurance program that happens to subsidize health services. In terms of insurance, it usually covers people aged 65 and over. In addition, you can qualify for Medicare coverage if you’re below this age, but meet certain criteria, or if you happen to suffer from a certain disease.

Medicaid Coverage

Medicaid is a public healthcare insurance program that covers people from low-income households. Aside from US citizens, permanent residents and legal immigrants can also apply for Medicaid coverage, as long as they meet the proper criteria.

Private Insurance Plans

As their name suggests, these plans come from private insurance companies. In other words, you cannot get them from either the state government or the federal government, These plans are your best option if you can’t get coverage from your employer and don’t qualify for either Medicare or Medicaid.

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Scenarios Where Private Health Insurance Can Come in Handy

Obviously, to most people, it doesn’t matter what kind of insurance plan they have, as long as it covers them when it counts. However, there are some circumstances where you might actually benefit from having a private rather than a company plan. The detailed list of those circumstances is down below.

Owning a Business (with Your Own Employees)

Let’s say that you want to start your own business and that you aim to employ a certain number of people. In order to be a successful employer, you might also want to purchase health insurance. Naturally, you don’t have to (after all, even some of the major companies out there don’t provide health insurance), but it will make your business stand out and attract more employees.

If you do decide on ensuring your employees, you will probably have to get a group plan. As stated earlier, it will cover the entire group of workers within your company and you will pay a fraction of the cost.

Being Self-Employed

Self-employed can cover anything from freelancing to owning a one-person company. Whatever the case may be, you will most likely need private insurance as a self-employed individual.

However, there are alternatives. If you happen to be married, you can be insured through your spouse’s plan. Of course, that might not work if your spouse is unemployed or self-employed, like yourself.

Being a Part-Timer

Part-time employment usually involves working less than the required amount of time during the week, i.e., 40 hours. That’s why employers tend to insure full-time workers and rarely, if ever, cover part-timers. So, if you happen to not work full-time at a company, you will need to apply for individual insurance coverage.

Losing Employment

It’s not uncommon for people to lose jobs, but try to maintain their health insurance. In fact, there’s an option for you to maintain insurance through your former employer even after they’ve let you go. All you have to do is enroll in a program called the Consolidated Omnibus Budget Reconciliation Act or COBRA.

COBRA allows workers to keep their insurance plans even after they lose their job or get reduced working hours. Under specific circumstances, you can keep the COBRA coverage for up to 36 months. However, you will have to pay the entire cost of the premiums while using this program, and the cost of enrolling in COBRA can be quite high.

Adults Under 26

Within the USA, your insurance policy can cover your offspring even after they reach adulthood. However, according to one of the provisions of the Affordable Care Act or ACA, the upper limit of a young adult dependent’s age is 26. Any person aged 26 and over will have to look for a private insurance plan.

Retirement

Retirement comes with its own set of issues when it comes to healthcare coverage. For example, you might retire under the age of 65, without any major disability, which means you can’t apply for Medicare. And since you are no longer employed, your former employer will not cover the cost of premiums.

If you do retire before turning 65, you can always apply for a Medicare Advantage plan or a Medigap plan. These options provide you with even more comprehensive coverage. In fact, some retirees tend to opt for private Medicare Advantage plans completely when they compare health insurance quotes with those of regular Medicare.

Of course, there are some disadvantages to private plans for retirees. The biggest one is the fact that they can only cover individuals. So, your spouse or any other dependant will not be included in these plans. So, if you retire, the other dependants will have to buy their own private insurance plans.

Getting Dropped By the Current Insurance Company

There are certain times when an insurer can cancel your coverage. For instance, it might become too expensive for you to maintain. Of course, if you made a mistake on the application or happen to have a particular health condition, the insurer is legally forbidden from dropping you thanks to the ACA.

Choosing the Best Option

There are quite a few health insurance plan options out there for you to choose from. Each comes with its own set of benefits and setbacks. So, before you decide on one, it’s instructive to know just what they cover and what they entail.

Point-of-Service Plan

A point-of-service or POS plan will provide benefits depending on what type of healthcare providers you use. In other words, it will differ if a policyholder uses an in-network or an out-of-network provider.

By far, most policyholders opt for either a health maintenance organization or a preferred provider organization plan. Very few choose POS plans, since they combine elements of both HMO and PPO. Though POS plans offer lower costs than other options, their list of providers can be limited, which is why not too many employees opt for them.

High-Deductible Health Plan

High-deductible health plans or HDHPs are perfect for young employees who don’t expect to need healthcare services unless it’s an absolute emergency. It has a couple of key characteristics:

  • Unlike other plans, it has a high annual deductible
  • It has lower monthly premiums than other plans
  • Users of HDHP have access to the Health Savings Account or HSA, which is quite tax-advantaged

Before moving on, we should define a few terms. First off, this plan is named for its high annual deductibles, so you need to know what a deductible is. In the simplest terms, it is the amount you have to cover for health services before the insurance plan itself can begin covering you.

Next, there’s the HSA; this account is quite useful since you can contribute funds to it regularly. Later on, if there are some medical costs that your HDHP plan can’t cover, you can use the funds from the HSA to do it. The best part of an HSA is that it isn’t subject to the federal income tax when you start making the deposits into it.

Consumer-Driven Health Plan

A consumer-driven health plan or CDHP is actually a type of HDHP. With this plan, an individual can set aside some pretax money and pay for the qualified health expenses that are not covered by their health plan. One major benefit of CDHP is that both employers and employees can use it, either individually or as a group.

Like any other HDHP, this type of plan has high annual deductibles. However, you do get to pay lower monthly premiums than a typical HDHP. Moreover, you can link them to both HSAs and HRAs (health reimbursement arrangements).

Preferred Provider Organization

A preferred provider organization, also known as PPO, is a type of medical arrangement where medical facilities or professionals provide health insurance services to subscribers at reduced rates. Healthcare providers that come from inside of these organizations are called preferred providers, hence the name. However, they also go by a different name, i.e. in-network providers.

With PPO, you get your health insurance directly from an in-network provider. Of course, there are no limitations and if you want, you can seek a healthcare provider outside of the network. But keep in mind that an out-of-network provider charges high rates.

Health Maintenance Organization

An HMO provides its subscribers with coverage through a network of different healthcare providers. This network includes any physicians and personnel that have a contract with the HMO you’re subscribing to. As a user, you can pay for your insurance through annual or monthly fees.

If you subscribe to an HMO, you will only have access to the healthcare providers that the HMO has contracts with. That’s quite limiting, but it does come with one major advantage. Namely, you will pay a lot less for your premiums than you would for other types of healthcare coverage.

When compared to a PPO, an HMO is not nearly as comprehensive and detailed. However, in terms of prices, a PPO arrangement is far more expensive, so you might want to opt for an HMO if you need to save some money.

Exclusive Provider Organization

Generally speaking, most people opt for either an HMO or a PPO. The first of the two usually want low rates and premiums, while the ones who prefer PPO need a comprehensive plan and the possibility of outside providers. However, there’s a plan out there that combines these two, and that’s exclusive provider organization or EPO.

Just like HMO, the EPO provides access to healthcare professionals that it has contracts with. So, users of EPO can only receive services from a provider that belongs to a certain in-network. However, if there’s an emergency, you can seek an outside provider instead.

There are a few other noteworthy characteristics of EPO plans. For instance, with an EPO plan, you will have to pick a primary care physician who will treat you for minor illnesses and cover preventative care. In addition, if you need to see a specialist, you don’t need to get a referral from your PCP.

Short-term Insurance Policy

As its name suggests, short-term insurance only covers a brief period of time. However, just how brief it is will vary from state to state. Usually, it can be anywhere between three months and a year.

Short-term policies are perfect for people who have a gap in their insurance coverage for any number of reasons. In other words, you can apply for a short-term policy if you:

  • Are still waiting for coverage from a different plan to begin
  • Haven’t become eligible for Medicare coverage yet
  • Are between jobs and need insurance in the meantime
  • Need insurance, but it’s not within your designated period for open enrollment.

One major benefit of short-term insurance is that you can cover more than one individual with it. In other words, a single policy can also cover your spouse, your family, or any other dependent.

It should be noted that, if you happen to have a particular pre-existing condition, it might disqualify you from getting short-term insurance. Normally, it’s an illness that you have been diagnosed with or that you have received a particular treatment for in the period between 2 and 5 years.

Short-term insurance also goes by a few other names. In some states, it is also called term health insurance or temporary health insurance.

Catastrophic Coverage

Catastrophic coverage is intended for people who can’t pay a lot of money for monthly premiums, but need insurance in case something unexpected happens. For example, they might end up in a car crash or a fire or any other type of catastrophe.

This type of insurance is usually only available to adults below 30. In addition to this age limit, you would also need a hardship exemption from the government before you can qualify for catastrophic coverage.

Because this plan has lower premiums than others, it’s perfect for young adults who need to spend as little as possible. However, catastrophic coverage does have one major setback. Given such low premiums, the annual deductibles are incredibly high.

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Where Can I Buy Health Insurance?

Now that you know about the different types of health coverage plans, you’re ready to start looking for the one that fits you best. And in order to do that, you need to know where to look. With that in mind, here are some options you can look into when buying private health insurance.

Healthcare.gov

Healthcare.gov is an excellent place to start looking for health insurance options. It was created in 2014 as a direct result of the ACA. Not only does it cover all options for each of the 50 states, but you can also use it to see if you can qualify for any cost-saving measures with your choice of insurance plans.

Interestingly, you can also find information about private plans that you can purchase outside of healthcare.gov. However, if you decide on buying one of them, you will not be able to apply for any subsidies that are under the ACA.

You can purchase a plan on healthcare.gov during a particular open enrollment period, which is usually between November 1st and December 15th each year. However, as of early 2021, there’s also a so-called Special Enrollment Period, which lasts from February 15th to May 15th. Anyone can be eligible for this period, provided they meet one of these criteria:

  • They changed households
  • They’ve gotten married or divorced
  • They had (or adopted) a child
  • There was a death in the family
  • They moved or are in the process of moving
  • They’ve lost their health insurance
  • They were in a national catastrophe
  • They experienced a disability.

Medicare.gov

As stated earlier, Medicare is perfect for people who are either retiring or planning to retire. The official website will provide you with the basic information on the standard Medicare package. From there, you can figure out if you want to supplement it with a Medicare Advantage or a Medigap policy.

Each of these supplemental policies comes with its own set of rules and limitations. Therefore, make sure to do your research and figure out how they work in conjunction with the standard package before buying.

Private Insurance Companies

Each individual insurance company has a website that lists everything it has to offer, including premium rates, deductibles, etc. However, not only will these features vary from state to state, but also from company to company. After all, no two private health insurance plans are ever the same.

A good rule of thumb is the following: all of the prices you see on a company’s website are the lowest available, plus they assume that you are perfectly healthy. In addition, decide what your price range is and what are all of the features you need before buying. That way, you can narrow down a personal range of plans to choose from.

Before moving on to choosing a particular plan, go over the user reviews and see if there are some common setbacks that you should worry about. Moreover, if you’re buying insurance for multiple people (i.e., your family or your employees), you need to take their own coverage needs into consideration.

The Key Factors in Picking the Best Individual Insurance

So, now you know where you can buy a plan and how much it might cost. But even with all that information, you might still have plenty of questions. After all, the wrong kind of insurance plan might end up crippling you financially, so you have to cover all bases before you decide.

With that in mind, here’s a handy list of key factors you need to consider when choosing the best private health insurance plan:

  • What hospitals are part of the in-network?
  • Does your plan cover chiropractic and acupuncture visits, as well as physical therapy?
  • Are prescription drugs part of the coverage?
  • What is the copayment for office visits?
  • What is the copayment for specialized visits that include X-rays and surgery?
  • Do you require pregnancy benefits?
  • Should your plan allow dental coverage and add-on vision?
  • Can the plan include your preferred doctor in the provider network?
  • Do annual maximum benefits and lifetime benefits apply?
  • Are there any discounts or free services for preventive care?
  • What are the costs for out-of-network services (if you plan on a PPO plan)?

Private Health Insurance: Final Thoughts

Getting proper private insurance is a process. You need to learn as much as possible about every single option and figure out what works best for you. Moreover, you should consider the setbacks of every plan, since no solution is perfect.

However, once you have it all figured out, you can purchase healthcare coverage that suits your exact needs. In addition, you might even end up paying less than you thought you would through subsidies and tax deductions. In short, while it might seem like a non-safe option, private health insurance has plenty of benefits to offer to everyone, from part-timers to business owners of all ages.

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Why Pick Private Insurance?

It’s always a good idea to stay insured. After all, you can never predict if you’ll be in an accident or if something will cause a serious injury that requires complex medical treatment. And without insurance to cover part of the costs, these treatments can be incredibly expensive. Before 2019, if you didn’t have insurance, you had to pay a fee when filing federal taxes. That fee is no longer in effect, but that doesn’t take away from the importance of having an insurance plan in handy. Luckily, with the help of the ACA, the US citizens now have access to the Health Insurance Market at healthcare.gov. That way, all Americans have access to enrollment in health insurance. In addition, each individual state offers its own insurance marketplace, while the residents of other states can access an exchange that the federal government runs and manages.

How Much Does Insurance Cost?

Interestingly enough, the cost of private health insurance can, at times, be lower than that of employer-sponsored insurance. For example, according to one study from 2019 by the Kaiser Family Foundation, average monthly premiums for employer-sponsored plans were $603 for individual and $1,725 for family coverage. Individual health insurance plans premiums for the same year were $440 and $1,168 respectively. Most people tend to avoid getting private insurance plans precisely because they think the premiums might be too high. However, not only is that not the case, but you can even reduce the current rates further. If you buy a plan through the Marketplace, you might qualify for Advanced Premium Tax credits or a Cost-sharing Reduction subsidy.
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