Answers to 5 common questions on health insurance
Health insurance is now a requirement for nearly all Americans. However, not every American will find happiness with the same health insurance plan.
Below are answers to some of today’s most common questions about shopping for health insurance.
What happens if I do not have health insurance?
The Patient Protection and Affordable Care Act, the law that requires most Americans to have health insurance, was enacted in 2010. Nevertheless, it was only in 2014 that you might have had to pay a penalty if you did not have health insurance.
Compared to 2014’s numbers, the penalties for not having health coverage have increased significantly in 2015: Families could owe $325 per adult and $162.50 per child, up to a family maximum of $975 — or 2 percent of their household income if that number is greater.
For those who skipped coverage in 2015, these penalties will be due at tax time in 2016.
Is my employer required to offer me health insurance?
For plan year 2016, companies with 50 or more employees must offer 95 percent of their full-time workers (those who work more than 30 hours a week) health insurance that is of minimum value and affordable.
Minimum value means that the plan pays at least 60 percent of covered services. Affordable means that the employees’ share of the premiums costs them less than 9.5 percent of their annual salary.
When compared with plans you purchase on your own, job-based coverage is almost always the better deal because your employer is likely to pay some of your monthly premiums.
Where can I buy health insurance?
If you do not have coverage through your work, you can buy coverage through the government-run marketplaces called exchanges. Some states run their own exchanges while others rely on the federal government. If your state doesn’t have its own marketplace, you shop for health insurance through Healthcare.gov.
However, you are not required to buy your health insurance on the marketplace. You can buy an individual or family health insurance plan directly from an insurance broker or company. (To compare prices on various plans, fill out the form near the top of this page to get quotes from leading carriers.)
However, if you are eligible for government subsidies to help pay your monthly premiums and you wish to use them, you must buy through the government-run marketplace. You may be eligible for these subsidies or tax credits if your income is low to moderate and you do not qualify for Medicaid.
Can I buy health insurance at any time?
You can enroll in health insurance plans only during open enrollment periods. Open enrollment for plan year 2016 began Nov. 1, 2015 and ended Jan. 31, 2016.
However, you may qualify for a special exception and enroll in a health insurance plan at any time if you or someone in your immediate family:
What kind of health insurance is best for me?
There are five categories of marketplace insurance plans: bronze, silver, gold, platinum, and catastrophic. The categories have nothing to do with the quality or amount of care you receive. Instead, they determine how much you pay out of pocket for the services you use.
If you visit the doctor regularly and take prescription drugs, you probably want a gold or platinum plan because they pay 80 to 90 percent of the cost of services and you pay 10 to 20 percent out of pocket.
If you are healthy and do not take prescription drugs, you can pay less in premiums with a silver or bronze plan. However, if you become ill, you will pay a greater share of your medical bills.
If you are under 30 and in good health — or you’re able to claim a hardship exemption — you may opt for a catastrophic plan that protects you in worst-case scenarios only, like accidents or serious illnesses.