Health insurance can get confusing when you do not receive it from an employer. Just over 54 percent of the population receives health benefits from their jobs. With just under 9 percent choosing to go without insurance, this leaves around 36 percent on the hunt for insurance. Most will keep in line with the Affordable Care Act mandates and sign up with a plan under the health insurance marketplace. However, there are options for individuals and families who want choice and a more affordable option.
What is the Health Insurance Marketplace?
The health insurance marketplace was created as a result of what was known as the Affordable Care Act, or Obamacare, in 2010. It was designed to provide all Americans with an inexpensive option to obtain health insurance for their families without having to go through a job or government assistance program.
There is an annual Open Enrollment Period (OEP) where individuals and families sign up to begin coverage for the following plan year. No one is denied coverage, and cost depends on the plan you choose, your family size, age, and where you live. Health does not play a part in cost; however, being a smoker will factor into your monthly premium.
Am I Required to Get Health Insurance with the Marketplace?
No, you are not required to, but in some states, the law does require residents to carry health insurance. You can obtain qualifying health coverage through the marketplace or a private carrier. Currently, only five states plus the District of Columbia still carry the mandate due to the Affordable Care Act: California, Vermont, New Jersey, Massachusetts, and Rhode Island. There are tax penalties in these states if you do not have credible coverage for longer than two consecutive months.
What are My Options for Health Insurance Outside of the Marketplace?
The good news is that in 2019 that federal mandate was eliminated, except in those mentioned states above. But it is still wise to carry health insurance in case you or your family need to see a doctor or have an accident and be hospitalized. Costs can be greater without insurance than they are to pay a monthly premium. So, what if you don’t want to purchase health insurance using the marketplace?
Employer-Sponsored Insurance
As we have mentioned, most jobs will provide full-time employees insurance. This was one of the mandates of the Affordable Care Act. But some employers try to skirt the mandate by cutting employees’ hours to just below the mandate of 30 hours, The government is trying to crack down on these employers and provide workers the insurance they deserve without having to purchase it through the marketplace or on their own.
Individual insurance carriers
Individual insurance carriers can help you obtain health insurance for you and your family. These are insurers that are not part of an employer. The OEP (Open Enrollment Period) of November 1 – December 15 still applies. There is also a special enrollment period for cases such as job loss or marriage. For instance, if you lose your job and your employer-sponsored insurance, then you may qualify to apply for an individual insurance policy outside of the open enrollment period.
Private Insurance and the Government
Now that the Affordable Care Act is not mandatory, you can obtain health insurance through a private carrier without penalties. If you are lower income, you can find it through government-sponsored programs like Medicaid and CHIPS. If you are older, Medicare is your best option. But if you are reading this article, chances are you are looking for affordable insurance coverage that will help you: pay for doctor visits when you are sick, help with immunizations, and be there when the occasional bigger events occur. This is where the open market can assist you with obtaining the coverage you desire.
Other insurance options
If you are younger and just getting started in life, there are other options that may be better suited for your situation:
A parent’s plan up until you are 25: Yes, you may not be under this list, but it is outside the marketplace and worth the mention. If you are younger than 25 and on your own, you still may be on your parent’s plan. You don’t have to live with them in order to have coverage. Before you spend your money on coverage, check to see if you are still covered.
Your college student plan: If you are attending a college or university, check to see if they offer health insurance to students.
An association you are affiliated with: This can vary from unions, churches, and other private organizations.
Government programs: These vary from Medicare, Medicaid, and CHIP programs.
Am I Penalized for Getting Insurance Outside the Marketplace?
If you live within one of the states still requiring you to carry health insurance, there are things to consider when shopping for insurance outside the marketplace. The primary concern is that the insurance must be ACA-compliant. If it does not meet certain standards, you will be fined, and it would be as if you did not have health insurance at all.
Fines for not carrying Affordable Care Act compliant insurance can be steep. For instance, in California, the penalty is 2.5% of the annual income or $750 per adult and $250 per child, whichever is greater. There are exemptions like hardships and religious consciousness.
Can I Go Back to the Marketplace If I Don’t Like My Health Insurance Provider?
The short answer is yes. The long answer is yes, but you can only reapply for Affordable Care Act providers during the OEP from November 1 through December 15 of every year. The one benefit you have is that your health condition cannot be considered, and you cannot be denied coverage.
Final Thoughts
Understanding your options can be confusing, especially when you live within one of the states that still adhere to the Affordable Care Act mandate. When you need to find health insurance outside the marketplace, contact the professionals at Covermile. They will walk you through the process of finding the best health insurance policy that fits your needs without breaking the bank.
