If you’ve been looking into getting health insurance but just found out that you can’t afford it, there are some things you can do. There are catastrophic plans, short-term medical insurance, cost-sharing assistance, and individual mandate penalties.
Short-Term Medical Insurance
Those unable to afford a long-term health plan may opt for short-term medical insurance. To provide interim coverage while people wait for their job to provide health insurance, you might choose uninsured health coverage. However, it may leave policyholders with expensive medical expenses.
Most short-term plans offer coverage for inpatient doctor visits, and the emergency room stays, and hospital stays. Some also cover some prescription medications. These plans can be a good fit for healthy adults who need to be covered temporarily.
But before you sign up for a short-term plan, ensure you understand how the coverage works. Many policies have a high deductible, so you’ll need to pay a portion of your medical bills before the insurance kicks in. If you’re looking for a cheaper plan, choose one with a lower deductible.
The best way to learn about a health plan is to shop around. Compare policies by line to see which fits your needs best.
During open enrollment, you can get a more comprehensive plan for cheaper. You can also get special enrollment periods for major life events like marriage or moving. E-Health agents can help you expand your coverage to include vision insurance and dental care.
Short-term plans are only for some. Seventy-one percent of short-term health insurance plans don’t include outpatient prescription drugs. Also, most don’t cover maternity care or mental health services.
Catastrophic plans are designed to protect you from the worst possible healthcare scenarios. While they may be more expensive than other types of coverage, they are often cheaper than no insurance.
A catastrophic plan can cover basic health services, including preventive services and some prescription drugs. It also offers some maternity care and emergency services. However, there are some important limitations to this type of coverage. For instance, it does not pay for out-of-network care.
Catastrophic health insurance can be the way to go if you need to pay for your medical bills upfront. It is not eligible for government subsidies or premium tax credits, but it does offer low monthly premiums and protection against high emergency medical costs.
However, if you need more coverage than your catastrophic plan provides, consider looking into a higher-tier plan.
These plans are designed to give you the most basic and essential health benefits without out-of-pocket costs. They typically provide at least three primary care visits per year and some preventive care.
In addition, a catastrophic plan will pay for most of the costs you incur after your deductible has been met. This is referred to as the “after-deductible” benefit. The maximum out-of-pocket cost varies from plan to plan.
The Affordable Care Act introduced cost-sharing reductions (CSRs). These reduce the out-of-pocket costs you pay for covered health care services. Unlike premium subsidies, which help lower the costs of insurance plans, cost-sharing assistance does not have to be based on your taxes.
Many people need to realize that many CSR plans are heavily subsidized. That’s because they’re only sometimes aware that the plan is silver-level.
Some medical cost-sharing plans limit the number of doctor visits a member can make and have a limited dollar amount for treating certain diseases. These limits are designed to keep healthcare costs affordable for low-income enrollees. However, they can also limit the coverage of illegal drugs or other expenses that clash with a member’s religious beliefs.
While CSRs have been less well understood than premium subsidies, it’s important to note that they can help you save on your out-of-pocket maximums. If you have a health care claim over $2,900, it’s worth your while to look into these benefits.
Individual Mandate Penalty
The individual mandate is a law that requires almost all Americans to have health insurance. If you don’t have insurance, you can face a tax penalty. Depending on your income, the penalty can be as high as $1,908 per year.
In addition to requiring health insurance, the individual mandate also subsidizes insurance. These subsidies adjust to help keep coverage affordable, even as premiums increase. There is no penalty if you qualify for Medicaid or another state program. You can also get exemptions if you experience personal hardship or have a religious health care sharing ministry.
During the open enrollment period, subsidies are available to make insurance more affordable for people who don’t qualify for other government programs. This includes coverage through Medicare and the Children’s Health Insurance Program.
The penalty amount is calculated based on the average cost of a bronze-level health plan. This plan is the national average and is adjusted annually to reflect changes in premiums.
Applying for an exemption or getting a waiver to buy a more expensive plan is possible. Some states are more active in helping people get covered.
The maximum penalties have increased slightly since they were first instituted. For example, the adult penalty will be $695 in 2016, and the penalty for children will be $347.