So you quit your job or got laid off and can’t get on COBRA for whatever reason. Obamacare penalties for going without are fairly low, but probably it’s a good idea to play it safe and get health insurance anyway, in case you actually need to use it. So what are your options? Here’s a very basic overview–many of us probably know all these things, but a lot of people don’t, so make sure to share it with any friends who may be trying to get a handle on this but probably won’t ask. (And if you’re on COBRA, make sure to pay on time–they pull coverage in lightning speed if you don’t.)
So your health insurance options depend on what’s available in your area, but your best bet is to call a broker. Just stick your city name and “health insurance broker” in Google. They will likely be able to find the best plans in your state for whatever your needs are, and save you the hassle of calling 20 different insurance companies to try to negotiate prices. I’ve also found that brokers could get me a better deal than health insurance options available by various professional organizations. YMMV, but worth a try.
But wait! First make sure you can’t get on your parents’ insurance (if you’re under 26), a spouse’s, or free insurance through your state. Children may be eligible for a Children’s Health Insurance Program, and if you’re reading this and are in serious need due to an emergency, there are often free or sliding scale clinics available, especially in major cities. There’s also Medicaid, which you may be eligible for, so ask your broker and do a little digging on your own, too. (Also, your state may allow you to purchase small employer health insurance, so check out your State Department of Insurance.
Here’s some things to pay attention to when selecting your plan:
What is the waiting period, if any? Some plans will make you wait up to 90 days until you can use the benefits.
Do your doctors need to be within the network? Whether the price difference justifies it or not is entirely your decision.
What is your copay? That’s the amount you need to pay simply for showing up to an appointment. There are different fees as well for emergency care and urgent care.
What is your deductible? That’s what you generally have to pay out-of-pocket, even if an insurance company would generally cover a larger percentage of it. As a rule, I try to keep deductibles to a dollar amount I’m comfortable with maintaining on my credit card for six to 12 months.
What is your monthly payment? You may decide, for instance, that it’s better to have insurance that only covers emergencies (catastrophic care) but can afford to pay each month than signing up for a plan out of your price range (which will get canceled when you can’t make payments). Another option with wiggle room is how high of a deductible you’re comfortable with. In general, the higher your deductible is, the lower your monthly cost will be.
What is the out-of-pocket limit? This is the limit each year for costs which you will have to pay under a health insurance plan, often including copays, and almost always including your deductible. So if you get $10,000 in medical care and your deductible is $2000, you’ll only pay $2000 for that year. There are, of course, exceptions–such as services not covered by your plan, or work by doctors outside of your network.
Dental and Vision?
Then there’s dental insurance, which is a bit of a catch-22. Basically, most dental insurance providers will not cover…that thing you have that you need insurance for (root canals, periodontal cleaning, etc.) until after a certain amount of time. But if you’re getting dental insurance in advance, you’re likely also getting regular cleanings that will probably prevent the need for such things. It may be better to simply stash away some cash each month (whether in an HSA or an account you don’t touch), depending on your teeth. If you do end up needing dental work, often there are student clinics that will provide services at a steep discount. It takes a little longer to set up an appointment, and the appointment itself is often not as quick, but for some services the savings are huge. (For example, in Minneapolis, the dental school offers periodontal cleaning for only $50 per quadrant, whereas the same exact procedure costs as much as $400 per quadrant in private practice. That means you can save $1400.)
As far as vision, again it’s often less expensive to simply stash some money aside for the occasional check-up, depending on the condition of your eyes. With Groupon deals and online options for contacts and glasses, eye care is cheaper than ever. Again, though, your mileage may vary–so look at your options and pick the one that’s best for your unique situation.
Some news with the Affordable Care Act: If you can’t get health insurance because of pre-existing conditions, and have been uninsured for six months or longer, you are eligible for coverage at a premium capped at the average cost of private coverage in your state’s market. And in January 2014, you’ll be eligible for the same insurance as people without pre-existing conditions, and for the same cost.