Health insurance is essential — even if you feel healthy, accidents and sudden illnesses can happen. The first step has to be to check through your parents, employer, or school — wherever you can qualify for insurance now. See what they cover and don’t cover. Are your pregnancy costs covered? Which pregnancy costs? Is your child covered? What will insurance cover for your child?
If you cannot be covered through any of the above or you are insufficiently covered, it is time to look elsewhere. Through the Affordable Care Act, you can purchase health insurance through special exchanges. The federal exchange can be found here. Just plug in your ZIP code, and if there is a state or local exchange where you live, it will direct you there.
Medical expenses can be quite high if you’re attempting to cover them out of pocket. Without health insurance, paying for the services you may need can seem overwhelming if you’re in a tight financial situation. There’s a lot of information out there about how to afford the benefits you may need if you’re on a tight budget, and while it may seem confusing, walking through each plan step by step can help you see what kind of care you may need.
Here is a glossary of the sometimes confusing terms you will run into while choosing and applying for health insurance:
Premium: The amount you pay for the coverage, usually monthly.
Deductible: The amount you have to pay out of pocket for services before insurance will kick in and pay for some of it.
Copay: The amount you have to pay upfront for a service after the deductible has been met.
Nonprofit hospitals are required to have a financial assistance plan in place, also called charity care, for those who may not have the ability to pay. This policy provides patients with free or discounted medical services, so long as they meet certain eligibility standards. To verify if you qualify, you may need to contact the facility you receive treatment from to see if they offer this kind of program.
Since for-profit medical centers are not federally required to offer financial assistance, they may not have something like this, so it may be more likely that you’ll receive this kind of care through a nonprofit hospital.
Eligibility cutoffs are typically based on your family size and income level. You may qualify for partial or complete financial assistance, depending on your earnings, and the type of procedure you undergo will usually determine if you’re covered. Things such as cosmetic procedures or dental care are typically not enough to render you eligible for assistance. If you have questions about how a hospital-based plan may work, you may be able to contact the facility’s billing office for more information.
A health insurance program sponsored by the government, Medicaid ensures families with a lower income are provided with adequate medical services. Pregnant women can often rely on Medicaid to help pay for prenatal and postpartum care.
While eligibility guidelines are typically determined by the federal government, each state will usually set up their own Medicaid requirements. These standards may vary from state to state, but the application is typically processed on paper, online, or by phone.
To qualify for Medicaid, you may be required to submit proof of your family income and documentation verifying a pregnancy. If you’re receiving these benefits, then you’ll be given a list of Medicaid providers and health care facilities who can treat you under the program. After contacting your local Medicaid office to see if you qualify, all of your mandatory benefits will be covered.
Medicaid benefits usually include inpatient and outpatient hospital services, pregnancy-related care up to 60 days postpartum, physician care, laboratory and X-ray services, and home health services. Some optional benefits may include prescription drugs, as well as physical and occupational therapy.
Children’s Health Insurance Program (CHIP)
After applying for Medicaid, the state will determine if your income level qualifies you for the program. If your income is considered too high for Medicaid, but you still need help accessing affordable health care, then you may be eligible for CHIP. This federal and state program can also help you find low-cost medical care, and since you already applied for Medicaid, additional applications should not be necessary.
Federally Qualified Health Centers (FQHCs)
Regardless of your ability to pay, FQHCs are community-based medical centers that offer primary and preventive care. These patient-centered organizations work with the unique needs of clients through a bevy of services, such as women’s health, mental health and substance abuse assistance, dental care, and so much more at little to no cost.
Coverage Under Your Parent’s Plan
If you are under the age of 26, then you are likely still eligible to remain on your parent’s health insurance. Your parent may add you to a job-based plan during what’s known as an Open Enrollment Period, or during a Special Enrollment Period. Prior to turning 26, you usually can remain on your parent’s plan even if you get married, parent a child, begin or end school, or move out. You may also be able to remain on your parent’s health insurance if you are not claimed as a tax dependent.
Some colleges and universities may offer a student health plan that present a simple way of affording basic healthcare expenses. Since student health plans typically mean you are covered under the health care law, this means you do not have to pay a penalty for not having insurance. But it’s always a good idea to research the plan through your school to be certain.
While some states run their own marketplaces that help you shop around for affordable health insurance, this service is usually operated by the federal government. If you live in a state with its own marketplace, then you may be sent information about your state’s application process. Through the Health Insurance Marketplace, you’ll have access to remote and in-person assistance when it comes to enrolling in a plan. You’ll likely need to provide proof of income and information about the number of people in your household when applying for coverage. Depending on eligibility, you may qualify for premium tax credits and other benefits that make insurance more affordable, as well as coverage through the Medicaid and Children’s Health Insurance Program (CHIP) in your state.
Marketplace Affordability Exemption
Purchasing health insurance coverage through the marketplace may be unaffordable for some. To file for a marketplace affordability exemption, you’ll be required to complete and mail an application. You will likely have to include copies of your tax returns, pay stubs, or 1099s as proof of income. If any other form of documentation is needed, then it should be listed on your application. The Marketplace may respond within four weeks to notify you if your exemption has been approved. For those who are determined eligible, an Exemption Certificate Number (ECN) is awarded to each member of the household who qualifies. Each person’s ECN will then be included on your IRS Form 8965 that you will file with your federal tax return. If your exemption application is not approved, then you do have the option of filing for an appeal within 90 days of receiving your eligibility notice.
People under the age of 30 who may not be able to afford marketplace or job-based insurance may be eligible for a catastrophic health plan. Under this, your essential health benefits are covered, and certain preventive services are available at no cost. Before you’ve met your deductible, a catastrophic plan will cover three primary care visits per year. These types of plans generally have low monthly premiums, but depending on your income, you may not be able to use a premium tax credit. This is why before you commit to a catastrophic health plan, it’s recommended that you shop around to compare what sort of plan is likely to be of better value. It should be noted that under this kind of coverage, the amount you must pay before your coverage kicks in — known as a deductible — tends to be quite high. While choosing this form of insurance may protect you during worst-case scenarios where you’re grievously ill or injured, you may still have to pay for your regular medical expenses.
While navigating healthcare choices may take a bit of an effort, it is well worth your time.
By Samantha Kamman