If you’re one of the 12% of people in the United States without health insurance, you know it can be tricky to stay on top of health concerns. Many part-time, freelance, and contract workers don’t get health benefits as part of their employment, and often, a job loss can mean a loss of long-term coverage.
Should you get insurance, and if so, how do you find affordable plans? What if you’re relatively healthy—is it best to skip the expense? If you find yourself in this situation, you have options. Below, you’ll find a deeper dive into each of these questions.
Should your employer provide insurance?
The Affordable Care Act requires employers with 50 or more full-time workers to give employees health care coverage. Employers are only required to extend coverage to full-time employees—anyone who works 30 hours or more a week, or 130 hours or more a month.
The employer’s plan should meet "minimum value" coverage and affordability standards. For instance, the plan should cover preventative care (like checkups) and at least 60% of the total cost of medical services.
A smaller organization might not be able to offer benefits, but if your employer has enough full-time workers to meet the criteria above, you may be entitled to health insurance. Ask your organization’s human resources representative for details about what the employer can provide.
The Health Insurance Marketplace
If your job doesn’t provide a plan, your next step is to check out the Health Insurance Marketplace at healthcare.gov. The site is designed to be a one-stop shop for health plan comparison and advice.
The Marketplace can be confusing, so let’s run through some fast facts.
- The enrollment period, a time when you can compare and pick a plan, generally starts in the fall of the calendar year before coverage begins. You can enroll in the fall of 2018 for coverage in 2019, for instance.
- There’s a deadline for enrollment each year, usually in December of the calendar year before coverage begins.
- What if you miss the deadline? You won’t be able to enroll in the regular Marketplace, but you might qualify for a Special Enrollment Period which lets you apply for insurance at any time.
- The Special Enrollment Period is offered to people who have experienced recent major life changes. The Marketplace defines "recent" as the past 60 days, so act quickly! These changes include:
- Losing or expecting to lose health care coverage (for instance, if you know a job is ending)
- Moving to a new zip code or county, or to the United States from another country
- Losing coverage because of a divorce or separation
- Getting married
- Having a child
- Moving to or from a shelter/transitional housing
Pro tip: You can appeal a decision if the Marketplace denies coverage or a Special Enrollment Period. There are no guarantees, but it may be worth a shot depending on your situation.
It is possible to buy private health insurance outside of the Marketplace. You can visit sites like eHealth or go to the websites of individual providers. Plans tend to be pricier this way, so run a cost comparison and make sure you know what each plan covers.
Medicaid and other income-sensitive options
Jobs without coverage usually don’t come with huge salaries. Managing your money on a limited income takes some planning, but it doesn’t mean you have to go without insurance.
You might qualify for Medicaid, the low-income health insurance program. Medicaid offers affordable and sometimes free services from qualifying health care providers. You can enroll year-round and there is no deadline to apply. The income guidelines for Medicaid are slightly different for each state, so look up your state on Medicaid’s website to find out if you qualify.
Here’s where you have to crunch some numbers. Medicaid eligibility is based on how your income compares to the federal poverty level. Let’s say you make an annual income of $12,000 (for individuals). This is about 100% of the federal poverty level for an individual. If you earn less than this annual amount, you’ll most likely qualify for Medicaid if your state has expanded Medicaid coverage. If you earn more, you might still be eligible for premium tax credits which save you money on a Marketplace plan.
The application process is paperwork-heavy, so get your important documents together. Be prepared to provide proof of identity like a birth certificate or Social Security card, proof of income, and proof of address.
If you have children, you may be able to get them low-cost health coverage through the Children’s Health Insurance Program (CHIP). Like Medicaid, CHIP takes applications all year so you don’t have to meet the Marketplace deadline.
Stay tuned for Part 2 of this two-part post which covers dental and vision care, preparation for medical emergencies, and what to know if you stay uninsured.