America’s healthcare system sucks. Everyone knows it. But what most people don’t know is how to navigate it. That’s what I’m here to help with! In the previous article, we went over some of the confusing terms. Now in this article, we’re going to talk about where to even look for health insurance.
Note that most of this article will focus on US citizens; non-citizens are sometimes not eligible for various programs.
Anyway, depending on your life situation and your state, there are a few different options. We’ll start with the ones that are usually considered the best, and then move on to some of the less ideal and more niche options later.
Where can I get health insurance?
Depending on your life situation and your state, there are a few different options.
Your Employer
Everyone knows you can get healthcare through many employers. The main benefit here is that employers who offer health insurance often negotiate group rates for all of their employees at once, as well as pay for a chunk of your premiums. You can also usually get coverage even if you have a pre-existing health condition, and you may not even need a health screening at all.
If you have this option, chances are that it’s a decent one, but it’s still perhaps worth looking into other options if it seems like your plan isn’t great. We go over how to tell whether an insurance plan is “good” in our next article on how to choose an insurance plan, but a good rule of thumb is that if the if the premiums (usually taken directly out of your paycheck) are under $100-200 or so, and your deductible is under $3000, you have a pretty decent plan.
COBRA
If you had insurance through your employer, but then lost it for (almost) any reason (including a firing, layoff, reduction in hours, resignation, or retirement), you are entitled to COBRA coverage! COBRA is a system that allows you to continue your employer’s healthcare coverage for 18-36 months (depending on circumstances) so that you have plenty of time to arrange new healthcare coverage (or a new job). But be warned—you will usually have to pay the full cost of the premiums yourself. When your employer stops helping you out, what used to be a $50 paycheck deduction could easily become a $500 bill! But in some cases, the plan could still end up being better/cheaper than a comparable plan on the private market or ACA marketplace. You’ll definitely want to shop around to decide whether to continue with COBRA or not.
Note that COBRA coverage can even cover your spouse and dependents (e.g. children), just like your original healthcare plan. And in fact, they can even get COBRA coverage if you die (or get divorced, etc.). So among other things (TODO link to “Preparing for Death”), this is something you should chat about with your loved ones before you die.
For more info on COBRA, check out this Investopedia article.
One warning about COBRA: If you decide you enroll, you can’t just cancel it whenever you want and get ACA coverage instead. You can only get ACA coverage during the yearly open enrollment window or during a special enrollment period, and simply canceling COBRA on your own doesn’t count as one. You either have to enroll in an ACA plan when your job-based coverage ends (within 60 days), when COBRA runs out on its own, or if the price of your COBRA plan goes up.
Medicare
If you’re 65 or older, you’re likely eligible for Medicare! Many people don’t like the idea of “socialized healthcare”, but regardless of your political views, you’ll probably appreciate receiving the free (or cheap) health insurance if it’s available to you. To see if you’re eligible, check out hhs.gov for more info.
Note that Medicare comes in parts; Part A is the one that is potentially free. To be honest, I’m not super familiar with Medicare, so I’m not able to get into the details too much. But suffice it to say, if you’re 65 or older, you have some more research to do.
Medicaid
If you don’t make very much money (or none at all), you are likely eligible for Medicaid, which is another government-run program (like Medicare) that provides free or cheap health insurance. The main difference is that it’s aimed at low-income folks rather than older folks. Medicaid is a bit complicated because it’s funded by the federal government, but administered by each state, which means that each state provides different benefits and has different rules for eligibility. It even has a different name in each state!
Luckily, it’s actually not too hard to figure out whether you’re eligible; the federal government has a centralized website where everyone can put in their information, and it will let you know if you meet your state’s requirement. Just head here: https://www.healthcare.gov/lower-costs/
And the neat part is that even if you’re not eligible for Medicaid, the same site will use your information to show you available ACA (Affordable Care Act) plans. These plans are often offered at a discount to low-income folks that just barely make too much to get Medicaid. More on ACA plans farther down the page.
CHIP
CHIP, the Children’s Health Insurance Program, is very similar to Medicaid and is also administered by each state. The main difference is that it’s specifically meant to help cover children, even if their parents make too much money to qualify for Medicaid themselves. To see if you’re eligible, use the same link above (for Medicaid).
ACA (Affordable Care Act) Marketplace, AKA Obamacare, AKA healthcare.gov
If none of the above options are available to you, the ACA marketplace may be your best bet! Through the ACA, many Americans are eligible for private health insurance plans that they otherwise either wouldn’t be able to afford, or would be rejected from due to having pre-existing medical conditions. Indeed, for a plan to be listed in the ACA marketplace, they need to accept all citizens (no matter how unhealthy) and meet certain affordability and coverage requirements. And in fact, depending on your situation (e.g. income), you can even get a subsidy to have your premiums reduced even further, potentially saving you thousands of dollars per year!
Usually, the ACA marketplace is open during a period at the end of each calendar year called Open Enrollment; this is your chance to sign up for health insurance for the next year. But you can also enroll any time you have a qualifying life event, which is basically any major life change, including (but not limited to):
- Losing your existing health coverage
- Getting married or divorced, having a child, etc.
- Moving
- A change in income
Unfortunately, the ACA marketplace often suffers from having too many options, which means it can be very difficult to decide on a healthcare plan. If this is where you’re at now, don’t fret, because that’s what our next healthcare post is about!
Private Insurance
If the ACA or other above options don’t work out for you, you can always try to find a non-ACA private insurance plan through insurance providers directly. Of course, you’ll probably end up with even more choice overload, and it’s likely you must submit to potentially invasive health screenings and questionnaires (because the insurance companies will make your premiums higher if they think you’ll need lots of healthcare). But on the flip side, if you have very specific needs, you can probably find something out there to meet them.
Health Insurance Co-ops
Depending on where you live and what your situation is, a health insurance co-op might be an option for you. As they are member-owned non-profits, their plans are often cheaper than those from their for-profit competitors. But they may also come with additional restrictions on who can join and what kind of care they reimburse, as well as not be subject to the same sort of consumer protection regulations as regular health insurance companies.
TRICARE, Veteran’s Insurance, Peace Corps
US military personnel and veterans may receive healthcare via TRICARE and/or the VA. If you’re in this boat, you probably know more about it than I do.
Those actively serving in the US Peace Corps also receive full medical coverage.
…no insurance?
In some cases, your best bet is to go entirely without insurance. Maybe you simply can’t afford it, or maybe you’re very certain that insurance won’t be worth it for you. Before you go this route though, consider the risk carefully—according to healthcare.gov, a 3-day hospital stay often costs around $30,000, and cancer treatment can be $200,000 or more. You may wish to at least consider something like a catastrophic plan. Otherwise, you may be putting your life on the line if you’re not able to get the care you need. In some cases, you can get your bills delayed, reduced, or even forgiven (especially at non-profit hospitals). For others, bankruptcy may be a way out. But do you really want to take your chances?
Regardless, going without insurance is at least slightly easier now in the US, ever since the ACA’s penalty for going without insurance was changed to $0, essentially removing it. But without insurance, the question becomes this: What do you do when you need healthcare? Luckily, you have some options.
Paying out-of-pocket
This option is simple: just pay for care yourself as you need it. When talking with your healthcare provider, ask if they offer discounted rates for those without insurance; many providers will be willing to work with you. You can also use a website like FAIR Health Consumer to try and find out how much your care should cost, and use that number as a bargaining tool. You can also use sites like GoodRx to save on prescription medications.
Charity care
Under the ACA, all non-profit hospitals are required to offer some amount of financial assistance to their patients. The trick is in figuring out how to access it, because many do not make it easy. This article provides a good overview of how charity care works and how you can receive it, and dollarfor.org is another great site whose mission is to help advocate for patients in order to reduce their medical bills.
Student care
In some cases, you may be able to get care for cheap or even free through nearby colleges, particularly for dental work. While there is some risk involved in letting students perform on you, they will be overseen by their professors, and the cost savings could definitely be worth it.
Medical tourism
Medical tourism involves specifically traveling to another country just for medical care—often for some particular procedure or surgery that you can schedule in advance. Many countries can offer care on par with what you could get in the US (at least for certain procedures) for a small fraction of the cost. In fact, sometimes the cost difference is so large that medical tourism can be a better option even if you do have regular health insurance in the US—especially if you have a high deductible/out-of-pocket maximum, or if the procedure is not covered.
Indeed, there are entire communities in Mexico, right across the border, that specialize in serving the medical needs of those in the US and Canada. As many as a million Americans travel to Mexico each year for medical procedures, and those that do often save 30% to 70% over what they would pay in the US.
Conclusion
I don’t have one for you today!
Next up, we’ll talk about how to compare plans, as well as how to tell if you have a good one.
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