You might be surprised by how expensive the cost ofhealth insuranceis in the United States is.
However, the cost isnt the only challenge for people navigating health insuranceit’s also a complex system.
Insurance can be provided by the government or by your job or university.
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It’s important that you understand what they mean.
This will help you make an informed choice about coverage.
Here is an overview of several options for free or low-cost health insurance.
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You’ll learn who is eligible, how to apply, and what to expect from each option.
Medicaid
Medicaidis a social welfare program.
The insurance covers almost all medically necessary services, which means that it’s comprehensive.
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In most cases, Medicaid is free health insurance for people who qualify.
A few states charge small premiums for people on the higher end of the Medicaid-eligible income scale.
Who Qualifies?
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Medicaid works slightly differently in each state.
Can Immigrants Qualify?
This ensures that low-income immigrants can still obtain affordable coverage while they wait five years to qualify for Medicaid.
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Medicaid is not usually available to undocumented immigrants, but there can be exceptions.
One example is short-term limited Medicaid coverage in an emergency or emergency coverage for people who are pregnant.
Medicaid eligibility varies from state to state.
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Who Pays for Medicaid?
Medicaid is paid for by federal and state taxes.
It is administered at the state level.
That’s why coverage and eligibility rules vary from one state to another.
Most states contract with private insurance companies to administer coverage.
On your ID card, you might have the name and logo of a well-known insurance provider.
Recap
Medicaid is free or low-cost insurance that is paid for federal and state taxes.
you’re able to get it if you have a low income and meet other eligibility requirements.
That said, states have different rules about Medicaid.
This coverage is also called Obamacare.
The law includespremium tax credits (premium subsidies)that offset some or all of the monthly premiums.
The government pays part of your monthly insurance premium and you pay the rest.
Subsidies can only be used to buyObamacarehealth insurance sold on the ACA’s health insurance exchangesalso called the Marketplace.
During the COVID-19 pandemic, the American Rescue Plan changed the rules.
And the Inflation Reduction Act has extended this through 2025.
So for now, there is no specific income limit on premium subsidy eligibility.
But for that to continue after 2025, Congress would have to take additional action.
Who Qualifies for Subsidies?
Obamacare subsidies are not available to undocumented immigrants.
However, most legally-residing immigrants can apply.
Most people get health insurance from their employer or from the government (Medicare, Medicaid, CHIP).
CSR benefits are part of the ACA.
For eligible applicants, CSR is built into Silver-level plans in the exchange/marketplace.
Since then, insurers in most states have added the cost of CSR to premiums of on-exchange Silver-level plans.
This results in higher Silver premiums, which in turn results in larger premium subsidies.
But nothing has changed about the CSR benefits themselves, or eligibility for these benefits.
it’s possible for you to find your states health insurance exchange using the HealthCare.gov tool.
The ACA or “Obamacare” is health insurance you’re free to purchase through the Marketplace.
Short-term Health Insurance
Short-term health insuranceoften costs less than more comprehensive plans.
In some states, plans are sold in terms of up to 364 days of coverage.
And some insurers allow their plans to be renewed for up to a total of 36 months.
These are currently the upper limits allowed by the federal government.
Some states do not allow short-term plans to be sold at all.
Is a Short-Term Plan Right for Me?
Although short-term health insurance can be a low-cost option, it isnt right for everyone.
You will need to understand what the plans will cover, and how long you will have that coverage.
It’s important to know that short-term health insurance plans do not have to follow theACA’s rules.
For example, a short-term health insurance policy can place a cap on benefits.
This limits the insurers potential losses if you get seriously ill while you’re covered.
If you get very sick and need a lot of medical care, that’s expensive for the insurer.
Short-term plans also do not have to coveressential health benefitsthat includes things like maternity care and mental health care.
Many plans also do not include outpatient prescription drug coverage.
If an insurer thinks that you’re a risk to cover, they can turn you down.
Short-term health plans are not consideredminimum essential coverage.
Moving is another example.
Short-term health insurance only covers you for a limited time.
It also does not cover a lot of services, including some essential care.
The plans can be low-cost, but you might not be able to get covered.
You have a limited time to sign up for the health insurance your employer offers.
Employers set their own open enrollment periods, so the specific dates vary from one employer to another.
You may have a short waiting period before your coverage beginsusually 30 to 90 days.
Once the coverage takes effect,pre-existing conditionsare covered right away, with no additional waiting period.
Who Pays for Coverage?
That means you dont have to remember to pay the bill each month.
The payroll deduction is usually made before your income taxes are calculated.
However, some employers offer savings plans likeFlexible Spending Accounts,Health Savings Accounts, orHealth Reimbursement Arrangements.
What If I Quit or Lose My Job?
In most cases, when youquit or lose your job, you also lose your job-based health insurance coverage.
Youmight be eligibleto temporarily continue your coverage withCOBRAorstate continuation.
Your employer may offer a health insurance plan as part of your benefits package.
They will pay for some of your insurance costs and the rest is taken out of your paycheck pre-tax.
If you lose your job, you will also lose your insurance.
However, you might be able to continue it for a while through COBRA or state continuation.
Most employers extend the offer of job-based health insurance to their employees spouses, children, and step-children.
Can I Choose Different Coverage?
You and the kids can opt for other coverage.
Prior to 2023, subsidy eligibility in this situation was very limited due to the “family glitch.”
But as of 2023, the Biden administration fixed that issue, at least somewhat.
Employers will generally subsidize an employees job-based health insurance by paying a portion of the monthly premiums.
However, an employer may not subsidize spousal or family coverage.
Many employers do subsidize family members' coverage.
The employer usually pays a smaller percentage of the total cost of family health insurance than for employee-only coverage.
However, you also have the option of looking elsewhere for coverage.
You may want to do this if you could find a plan that would cost less.
Some employers subsidize their employees health insurance and health insurance coverage for employees families.
Other employers pay a portion of their employees health insurance premiums but do not subsidize premiums for family members.
The rest will be taken out of your parents paycheck.
They don’t have to claim you as a dependent for you to be covered.
You could even be living on your own or married and still be eligible for coverage through their plan.
Summary
There are a variety of ways to access subsidized health coverage in the U.S.
Some plans are free, including most Medicaid plans.
Other plans have small premiums.
These are not right for everyone and are generally a “last resort” for coverage.
HealthCare.gov.Federal poverty level (FPL).
Centers for Medicare and Medicaid Services.Medicaid, childrens health insurance program, & basic health program eligibility levels.
MedicareResources.org.Medicare assistance program options by state.
Kaiser Family Foundation.Status of state action on the Medicaid expansion decision.
HealthCare.gov.Coverage for lawfully present immigrants.
HealthInsurance.org.How immigrants can obtain health coverage.
Kaiser Family Foundation.Medicaid managed care market tracker.
Centers for Medicare and Medicaid Services (CMS).American rescue plan and the marketplace.
Kaiser Family Foundation.Health insurance coverage of the total population.
Kaiser Family Foundation.Explaining health care reform: Questions about health insurance subsidies.
Federal Register.Short-term, limited-duration insurance and independent, noncoordinated excepted benefits coverage.
HealthInsurance.org.Finalized federal rule reduces total duration of short-term health plans to 4 months.
Kaiser Family Foundation.ACA open enrollment: For consumers considering short-term policies.
Kaiser Family Foundation.2023 employer health benefits survey.
Internal Revenue Service.Affordability of employer coverage for family members of employees.
HealthInsurance.org.Will the family glitch fix help my family?
U.S. Department of Health & Human Services.Young adult coverage.
