Ideally, every job would come with a health insurance plan. Unfortunately, this is not the case, and many people find themselves in difficult positions where their employer does not offer health insurance benefits.
If you’re a freelancer, part-time worker, entrepreneur, or someone whose employer doesn’t offer healthcare, you must seek it out elsewhere. However, many options are available to protect yourself with affordable health insurance.
The Importance Of Health Insurance
Health insurance is more than just a simple benefit. It can protect you and your family against overwhelming costs and provide access to necessary medical care.
- Financial Protection: Health insurance provides financial protection by covering medical expenses, including doctor’s visits, hospitalizations, surgeries, medications, and preventive care. Without insurance, individuals and families would have to pay these costs out of pocket, which can be prohibitively expensive.
- Access to Healthcare: Health insurance ensures that individuals have access to a wide range of healthcare services and providers. Without insurance, people may delay or forgo necessary medical care, worsening health outcomes.
- Preventive Care: Many health insurance plans cover preventive services such as vaccinations, screenings, and wellness checks. These services help detect and address health issues early, often leading to better health outcomes and lower healthcare costs in the long run.
- Reduced Out-of-Pocket Costs: Health insurance typically requires individuals to pay only a portion of their medical expenses through premiums, deductibles, and co-payments. This reduces the financial burden on individuals and families needing medical care.
- Preventing Medical Bankruptcy: Medical bills can quickly add up, leading some individuals to bankruptcy. Health insurance helps protect against the financial devastation of unexpected medical expenses.
Must Your Employer Offer Health Insurance?
In the United States, the employer mandate requires certain employers to provide health insurance to their full-time employees. If they fail to do so, they can face financial penalties.
Large employers with 50 or more full-time employees must offer health insurance to at least 95% of their full-time workers and dependents up to age 26. These employers must also offer plans that provide minimum value and are affordable based on the employee’s income.
Smaller businesses with fewer than 50 full-time employees are generally not required to offer health insurance under the employer mandate. However, if they choose to provide coverage, tax credits are available to help offset the costs.
It’s important to note that some states have their regulations regarding employer-provided health coverage, which may be more stringent than federal laws.
Affordable Health Insurance Options To Consider If Your Job Doesn’t Offer Coverage
The Affordable Care Act (ACA) has been a game-changer for individuals and families who do not have access to employer-sponsored health insurance. It’s made it easier and more affordable to find coverage.
The ACA also stops insurance companies from turning people down or charging them more because of pre-existing conditions, making sure those with health issues can find affordable plans.
Additionally, the law introduced minimum federal standards to ensure that ACA health plans all cover the Essential Health Benefits, further enhancing the value of ACA plans.
If your job doesn’t offer health insurance and you’re looking for the right plan, Enhance Health can help you find the best fit for your needs.
Qualified Health Plans
A qualified health plan is an insurance plan that meets specific standards set by the ACA. In simple terms, these plans have received a “stamp of approval,” indicating that they comply with the federal guidelines for coverage and benefits.
These plans need to provide the Essential Health Benefits mandated by the ACA. These are a set of 10 categories of services that the plan, such as outpatient care, emergency services, and prescription drugs, must cover. They must also follow cost-sharing limitations and be licensed.
Metal Tier Plans
ACA plans comprise four tiers categorized by metal types. These are Bronze, Silver, Gold, and Platinum.
- Bronze Plans: These plans come with the lowest monthly premiums among the metal tiers. This makes them attractive for those looking to minimize their upfront costs. But it’s important to note that these plans also have the highest out-of-pocket costs. This means you’ll be paying more for every visit to the doctor’s office and prescriptions, among other services.
- Silver Plans: These are mid-tier plans that have a moderate level of premiums and out-of-pocket costs. Silver plans can be a good fit for people who expect to use moderate medical services but still want to keep their monthly costs relatively low.
- Gold Plans: These plans are the second-highest tier available. They have low cost-sharing when you access different medical services. They’re best for those who know they will use more medical services and are willing to pay a higher premium to minimize out-of-pocket expenses.
- Platinum Plans: These plans have the highest monthly premiums but offer the lowest out-of-pocket costs when you get medical care. They are perfect for families or individuals who expect to use significant medical services and want to avoid the high costs.
The plan you choose will depend entirely on your circumstances. You must consider your budget, health concerns, location, and more.
Subsidies are another essential part of the marketplace that you should be aware of. These come in two primary forms: Premium Tax Credits and Cost-Sharing Reductions.
- Premium tax credits refer to an amount that helps you lower your monthly premium costs. The size of the tax credit you can receive is based on your income. You can use the entire credit upfront to lower your monthly payments or a portion and claim the rest on your tax return.
- Cost-sharing reductions are subsidies that reduce your out-of-pocket costs for medical services. This includes lowering the amount you’ll need to pay for deductibles, co-payments, and coinsurance. Cost-sharing reductions are generally only available on Silver plans.
To be eligible for either of these subsidies, you must meet certain income level and household size criteria.
Check If You Qualify For Government Programs
There are also government programs like Medicaid and Medicare that offer affordable health insurance options:
Medicaid is a program that’s designed to provide coverage to low-income families, including adults, children, pregnant women, older adults, and people with disabilities. These programs follow specific federal guidelines that vary from state to state.
To qualify, you’ll need to meet a certain income level based on the federal poverty level, which varies by state, especially for states that have expanded Medicaid under the Affordable Care Act.
You must apply to your state’s Medicaid agency or the Health Insurance Marketplace.
Medicare is similar but is a program that provides health coverage for individuals aged 65 and older and younger people with specific disabilities or conditions like End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
Most people become eligible for Medicare when they turn 65. But there are some other requirements. For example, you or your spouse must have worked and paid Medicare taxes for at least ten years to qualify for benefits without paying premiums.
To apply, you need to go through the Social Security Administration online, by phone, or in person.
QSEHRA Or ICHRA
For employees who don’t get healthcare through their employer, Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) and Individual Coverage Health Reimbursement Arrangements (ICHRAs) can also offer alternative solutions you might be interested in.
QSEHRA is specifically designed for small employers with fewer than 50 full-time employees. This program allows employers to set aside a specific amount of pre-tax money for employees, which can be used to reimburse medical expenses and health insurance premiums.
ICHRA, on the other hand, can be offered by employers of any size, offering a bit more flexibility. With this program, employers can allocate funds for employees to purchase individual health plans or vary offerings based on different employee levels.
Health Coverage For Part-Time Employees
When working part-time, understanding healthcare can be more complicated. Often, part-time employees are not covered by employer-sponsored health benefits.
If this is the case, you may have access to employer-sponsored insurance through your spouse. Alternatively, as discussed above, you can look at ACA plans to cover you. Short-term health plans and student plans are also available, depending on your circumstances.
While it might initially seem overwhelming, finding affordable healthcare can be easy with the right help. Consult with Enhance Health’s team of professionals to determine which plan is best for you and navigate all the steps to applying for it and starting your coverage.
Enhance Health offers an easy way to get affordable health insurance without all the stress of navigating the marketplace.