1. It's illegal to be uninsured, so just get health insurance.Under the Affordable Care Act (ACA), you're required to buy health insurance. If you don't enroll and go more than three months without insurance, you could face a penalty of $325 or 2percent of your annual household income,whichever is higher.
Or, you could end up participating in a mud run, going blind from a flesh-eating disease, and owing the hospital $100,000, like this woman did recently.
2. If you're a full-time employee, your employer has to offer you insurance —but not right away.Most companies require employees work for a set period before they can enroll in benefits. "It can be as long as, but no longer than, 90 calendar days from your date of hire," saysSandy Ageloff, a senior consultant at human resources consulting firm Towers Watson. "At that point, if you are a full-time employee, your employer has to offer you coverage."
3. Your parents may still be able to cover you. "If you are under age 26, you should strongly consider looking at your parents' coverage," suggests Ageloff. "They can generally cover you at a much more modest [monthly] premium cost."
4. You can do it alone.If being covered by your parents' plan or purchasing insurance through your employer is not an option, you can shop online for your insurance just like you would books or shoes. New health insurance marketplaces like the one at HealthCare.govmake it easier for individuals to select and buy the right insurance plan.
How to you pick an insurance plan?"It's a very individualized choice to make," says Ageloff. "If you are the stereotypical healthy young person who wants their well-woman exam, access to birth control, and a physical exam every year or two,that can be a very low cost." But if you have a disease or condition that requires on-going care, Ageloff says that "you need to consider what it will cost you to seek services.What will it cost you to see a doctor? You need to think beyond what comes out of your paycheck."
5. There are two major types of health insurance networks:health maintenance organizations (HMOs) and preferred provider organizations (PPOs).HMOs typically have lower monthly premiums and require patients to see doctors within their network. If you see an out-of-network physician, you'll be on the hook for the full cost of services, except in the case of an emergency.PPOs often have higher monthly premiums but are more flexible, allowing patients to see doctors outside of their network for additional fees.
If you want more control over which physicians you seeor have existing physician relationships outside of an HMO that you want to maintain, a PPO is probably your best bet. But if you prefer the convenience of a "one-stop shop" as Ageloff calls them, go with an HMO.
6.You need to know what your deductible is. Your deductible is the portion of your health care costs that you are responsible for. If you have a $500 deductible, your insurance will begin paying its portion of your health care costs once you've exceeded $500 in medical costs (aka paid for that much out of pocket first). There is a huge range in deductibles. Many HMOs have no deductible at all, and under the ACA, the highest your deductible can be is $6,600.
If you have a high deductible, defined by the IRS as $1,300 or more, you qualify for a Health Savings Account (HSA). You or your employer can make pre-tax deposits directly into an HSA and that money can be used to help cover your medical expenses.
7. You can make sure you're covered in an emergency without spending a ton every month.If you don't have major health concerns and the cost of monthly premiums is deterring you from buying insurance, Ageloff suggests looking into a plan with a low monthly premium but higher deductible. "It can still be affordable and provide you with that emergency protection at a more affordable rate as far as what you're paying monthly."
Warning: Low-premium, high-deductible plans mean bigger out-of-pocket costs when you get treated. That means you could end up spending hundreds of dollars to treat a bad cold or a UTI. (In a case like this, if you're debating whether you should go to the urgent care center or the doctor's office, opt for the latter. It's always going to be cheaper to make a regular doctor's appointment.)
8. Once you're covered, manybasic exams won't cost you anything.Under the ACA, many women's preventive health care services, such as the well-woman examination, which includes a pap smear and breast exam, are required to be 100percentcovered by your insurance.
9. You may qualify for a taxbreak.If you make up to $29,425 a year, you qualify for the premium tax credit, which can be paid directly to your insurance company, lowering your monthly premium and giving you more plan options.Even midrange earners can qualify for subsidies. Those making up to just over $47,000a year and shopping the health insurance marketplaces may be eligible for federal tax credits.
10. You could be leaving free money on the table. Many companies now offer wellness incentives — basically,financial rewards for healthy behavior. "It could be a fitness activity, healthy eating, or completing a [confidential] health questionnaire," explained Ageloff, who encourages readers to ask about these incentives. "It's important for people to understand what's offered by their employer to offset their costs. What we find in looking at our data and talking to employers is that a lot of people are leaving money on the table."In April, New England health services company Harvard Pilgrim began a healthy eating incentive that tracks employees' grocery purchases and pays those who buy healthy foods $20 every month.
11. Your medical information is private and protected by law.Whichever route you take to enroll in health insurance, no one has a right to your private health information. The Health Insurance Portability and Accountability Act, commonly referred to as HIPAA, requires that all protected health information is handled confidentially. That means, even if you are on your parents' health insurance plan, they cannot access your medical records. "As long as you are over 18, you're not their legal dependent anymore and you have to provide consent for your parents to have access to any medical information," assures Ageloff.
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