As of 2021, this is the most current advice for getting medical insurance in the United States. I am not an expert, if you need further help, please contact one of the places I mention in the article below.
I have always been blessed with pretty good health and didn’t think about medical insurance when I was a young adult. It wasn’t until I had children that medical insurance became a necessity in my life, and even then, I just took what was offered and didn’t think much of it.
The first time I was covered with medical insurance was when I got pregnant with my first child. I had to apply at our county assistance office to get the prenatal care I needed. I was subsequently provided insurance through the next few years and pregnancies. Eventually, my husband had moved up to full time at his job, which offered us medical, dental, and vision insurance. Even though it was offered to us, we didn’t know we had options and we just took what we could get.
Over they years, the concept of health and wellness has grown and the argument of how much help we should get with medical insurance has become a hot topic issue. It is now something of a conversation piece and a political statement. It is thought of in the abstract…which does nothing for those of us who need it now, especially in the days of side hustles and gig employment, all considered self employment and not eligible for employer covered insurance.
HOW DO I GET MEDICAL INSURANCE?
There are three different options for you to obtain health coverage: Through government programs, through your employer, or buying it yourself. Let’s go through all three options to see what is best for you.
MEDICAID/CHIP
Medicaid/CHIP and Medicare (for those who are disabled or 65 or older) are government funded options United States residents have for Medical Insurance. Medicaid is for those with a low income who do not have other options for medical insurance, while CHIP is the Children’s Health Insurance Premium, for those children whose parents earn too much for Medicaid, but not enough to buy their own insurance. Both have eligibility requirements, which may change based on government guidelines. While these programs are offered by the Federal government, the state governments are allowed to make changes as they see fit, as long as they meet Federal requirements, meaning that some states will offer more benefits to more people, than others.
CHIP eligibility requirements include:
- Under 19 years old.
- Uninsured by someone else.
- A U.S. Citizen or meet immigration requirements
- A resident of the state you are applying in.
- Meet certain income guidelines.
Those who aren’t eligible include inmates of public institutions, patients in institutions for mental disease, and children eligible for coverage through someone else.
Some states also offer CHIP coverage for low income pregnant women through all the stages of pregnancy, including postpartum care. Infant are then eligible for their medical coverage to continue for 1 year.
Those who are eligible for Medicaid include:
- Low income families (based on a Modified Adjusted Gross Income score).
- Qualified pregnant women and children.
- SSI recipients
- Resident of state you are applying in.
- U.S. Citizen or lawful permanent resident.
- OR medically needy: meaning you have a major medical condition that needs to be covered, but your income is too high for income guidelines.
To apply for either of these programs, you can visit your local county assistance office or find your state’s online portal by checking out Medicaid.gov and searching for your state.
MEDICAL INSURANCE PROVIDED BY EMPLOYER
Almost half our our country’s workforce is covered by medical insurance provided by their employer. When your parents and grandparents talk about getting a “good job with benefits,” they typically mean medical benefits. Medical insurance used to be an incentive for people to work full time and still seems to be…although not all medical insurance covers the same things.
Employers offer medical insurance because they are able to get cheaper plans for their workforce (who must meet certain requirements) and typically pay for half of the premiums for you. The other half comes out of your paycheck. While there are some companies who offer up to 100% coverage, this isn’t always the case. If you are like me, you didn’t realize how much was being taken out of your paycheck for your health insurance and just assumed they were paying it all. This is not the case. However, it is easier to not have to come up with the full amount each month on your own.
How much of your paycheck is being taken out? I checked my husband’s W-2 for last year, and the total amount of health insurance paid by him and his employer was $20,102.85. That is for basic coverage for just him and I, including vision and dental, with $500 deductible for each of us. We still have copays and percentages and exclusions, so we have to make sure whatever we need done is covered before we have something done.
While we could buy better insurance on our own, it is much easier in our circumstance to have that money taken out before we ever even see it and, being in pretty good health, we barely need to use our insurance.
When you apply for a company, check to see when you are eligible for health insurance if they offer it. If you are part time and need coverage, apply for Medicaid until you can receive benefits.
BUYING MEDICAL INSURANCE ON YOUR OWN
If you are self employed or a gig employee (indepedent contractor) and you make too much money for Medicaid, you may have to look into buying your own medical insurance. You can start shopping for your own medical insurance by finding a private insurance group who will help you find the best coverage for your needs or by shopping on the health insurance marketplace at healthcare.gov during open enrollment periods.
When buying your own medical insurance, you need to know certain terms and you need to understand your medical needs. There are HMO’s, PPO’s, EPO’s, health savings accounts, and more. There are deductibles, premiums, coverage areas. I will go more into this in next week’s post and help you figure out which type of medical insurance is right for you.
The Affordable Care Act allows parents to keep medical insurance coverage on their children until the age of 26. If you are 26 or under, find out if you are still covered by your parent’s insurance. If you are 26 or older, it is time to start looking at other options. Check back weekly for more about what you need to know about medical insurance.
Being Grown Up 