Health insurance can cover not just you, but your spouse and dependents as well. What do you need to know to make the best decision for your family?
Group Health Insurance
If you are working full time for a company with at least 50 full time employees you must be offered health insurance. This is part of the affordable care act. The insurance offered must be deemed “affordable”. In 2022, your insurance costs cannot exceed 9.61% of your income.
If this is not the case, your insurance would not be deemed “affordable”. You might therefore be eligible for a premium tax credit on a marketplace plan if you so choose. Unfortunately, currently, this does not apply to family plans, but there are hopes to change that in the near future.
You will be able to keep your children on your employer plan until they are 26. If you leave your job for anything other than gross misconduct, you are eligible for COBRA. You and your family can keep your coverage for a period of up to 18 months, although it will be very expensive. If you retire and transition to Medicare, your spouse and dependents can keep their coverage for up to 36 months.
You can enroll in group health insurance during your annual enrollment as dictated by your company or during a special enrollment period. You will likely be able to choose between a PPO or HMO. PPOs will give you more flexibility but with a higher premium. HMOs will be less expensive but you will be more limited. If you or a family member has higher or more specific medical needs, a PPO may be the way to go.
If you don’t get insurance for through your employer, you may want to consider a marketplace insurance plan. You may be eligible for a premium tax credit based on your income and household size. This can save your family thousands of dollars per year.
All marketplace plans must offer the 10 essential benefits. Many of these services are covered with a $0 copay even prior to meeting your deductible. There are many plans to choose from and you can filter based on your needs. If you have doctors or hospitals you want to use, confirm that they accept your plan in advance.
You can also add on dental and vision services if you so choose. For both employer health insurance and marketplace plans you cannot be charged more or denied based on pre existing conditions.
If you have children and your income is below a certain threshold, you may want to look into CHIP. CHIP is the Children’s Health Insurance Program. Even if you do not qualify for Medicaid based on income, it is possible that your children may qualify for CHIP. If this is the case, you will need to contact Medicaid directly. Insurance brokers and agents are unable to assist with Medicaid sponsored programs.
However, if you are denied Medicaid, this will trigger a special enrollment period for marketplace plans. At that point, you can contact an insurance agent or broker if you are in need of assistance.
Short Term Medical Plans/Private Insurance.
If you don’t qualify for a premium tax credit and don’t have employer group health insurance, you may want to consider a short term medical plan. Short term medical plans are a type of private insurance. They are not subject to the rules of the affordable care act.
These types of plans are highly customizable and affordable. A young, healthy person could find a plan for about $100 per month. They offer nationwide PPO coverage as well. However, STM are not available in all states and they are not ideal for all people. They are especially not idea for people with young children or those wishing to start families because pregnancy will not be covered. Pre-existing conditions will also not be covered in the first year or possibly not at all.
Family Deductible & OOP Max
Regardless of what type of plan you choose, you need to understand the difference between family and individual deductibles and OOP Max.
Your deductible is the amount that you must meet out of pocket before your insurance begins to contribute to the cost share. With a family plan you will have an individual and a family deductible. This is designed to save you money.
Let’s say your plan has an individual deductible of of $1500 and a family deductible of $3000. Once you have met your individual deductible, your insurance will begin to contribute to the cost share, but just for you. However, as your family begins to spend money on your medical needs, once the amount meets $3000, the entire family will be considered to have met their deductible. For example, let’s say you, your spouse and your child have all spend $1000 towards your deductibles. That’s a total of $3000. Even though none of you have met your individual deductible, the family deductible has been met so your insurance will begin to cost share. At that point you would be responsible for copays or coinsurance instead of the full amount.
It’s the same for the OOP max. Once you meet an OOP max, your insurance will take over for the rest of your medical bills.
If you have questions about your health insurance, call iHealthBrokers at 888-918-0518. Our services are 100% FREE!
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.