If you’ve lost employer-provided health insurance, you might have been told you “have COBRA,” or maybe you’ve received texts from your state about ACA open enrollment. What does it all mean?!
The options and the acronyms used in health insurance can be mind-numbing. But, don’t give up! You have a narrow window (~60 days from losing your health insurance) to elect a new plan. We created this mini-guide to lay out your options, and make it easier to find a plan that works for you.
P.S. In case you’re wavering...I just went on this journey, and feel unexpectedly fantastic about having this adult life knowledge.
1. Figure out your medical needs
2. Understand your insurance plan options
3. Go forth and get that plan 💪
Before you dive in...
If you can join a partner's or parent’s plan (i.e. you're under 26 in most states), this could be a much cheaper option. As phones and Netflix have taught us, family plans are 🔥.
Let’s start by evaluating your healthcare habit, and what you might need in the coming months.. If you don’t fit neatly into one of these categories, don’t worry! Use them as a starting point.
We'll dive into the three main categories of insurance:
COBRA — Continuing with your current insurer’s plan; likely most expensive option
ACA Marketplace — Plans made available on your state’s public marketplace; typically more affordable options and you might be eligible for tax credits/subsidies to cover the costs
ACA Off Marketplace — Buy direct from private insurers; potentially more expensive than what you could find in ACA Marketplace, but if you don't qualify for subsidies, have specific needs, or you are looking for more tailored options, this may be right for you
COBRA lets you continue with the same health insurance plan that you had at your job -- only now you’re responsible for the majority if not all of the monthly premium.
It sounds like a no brainer, but your plan will likely be a lot more expensive:
Your new monthly cost = your employer’s monthly cost + your monthly cost + up to 2% admin fees
➖You have immediate medical needs (i.e. you’re pregnant or undergoing treatment)
➖You’ve (mostly) paid your deductible/out-of-pocket costs in your annual period (and so most of your medical expenses beyond your monthly premium will be covered)
If you want to know more about COBRA, including how to enroll, check out our guide.
ACA, or Obamacare, plans are insurance places provided by private and government insurers to all citizens, regardless of pre-existing conditions. They follow certain guidelines, such as the price and minimum care requirements. Plans are sold on either your state or a federal public health exchange -- which is really like cars.com, but for insurance plans.
On-exchange healthcare provides the widest range of healthcare options. If you are a peace of mind, basic, or family customer we suggest you make this your first stop. This is also a great place to start for those that still aren't sure what category they fit in.
➖If you’re relatively young, healthy and a “basic” healthcare user
➖Your employer plan becomes unaffordable (~ > 9.78% of monthly income spent on your plan)
➖You anticipate low income this year ( ~100-400% below poverty line) and think you could qualify for subsidies
Check out our ACA 101 guide for more.
Off-exchange healthcare plans are still ACA compliant, so they still meet the same minimum benefits as on-exchange plans, but they can be purchased at any time and offer additional diversity of plans and prices. One of the main benefits of selecting on-exchange plans is the access to subsidies. So, if you don't qualify, check out off-exchange plans to see if they’re cheaper.
This could be best for the frequent/preventative, frequent/pre-existing condition, and Family category of customers - especially if you or your family has a high gross income. If you can’t find a plan that works for you on the public exchange, this could be a cheaper option than COBRA
Still curious about the difference between on/off marketplace plans? We found this article to be super helpful.
Depending on your age and financial situation, you may also be eligible for government-sponsored healthcare.
Medicaid & CHIP cover healthcare costs for low-income households (~$36k for a family of four) and children. If you’ve lost your income and can no longer afford insurance, Medicaid is a quality solution. One thing to note: Medicaid is not accepted by all service providers, and it’s primary purpose is to cover only your core health care needs. Check out medicaid.gov for more.
Medicare is government sponsored health insurance that primarily serves people over the age of 65 (with some exceptions). Patients pay part of their services through small monthly premiums and deductibles. Check out medicare.gov for more information.
Ok, so now that you have a better idea of your coverage options, it’s time to go shopping. Fortunately, there are a bunch of sites that make it way easier to find a plan.
A quick heads-up → plans are organized by the type of plan (PPO, HMO, EPO, etc) and metal/tier (Bronze, Silver, Gold, Platinum). These designations influence the pricing scheme and access to a network of service providers/benefits available. The sites below will help you make sense of it all, but be sure to read the plan details and not just the plan price.
Stride has a ton of large plan options, including those on your state’s ACA exchange. It’s easy to organize your plan by type, see which providers it includes, and how much you can anticipate spending overall and for basic things like birth control (TYSM!).
HealthSherpa can help you price check ACA plans , and they provide hands-on application support.
Healthcare.gov to find your state’s exchange
Hot tip: When you express interest in a plan, insurance brokers get your digits and will SPAM you like wild. It’s actually super annoying, BUT you should really pick up the phone to speak to a few brokers and see if you can negotiate the price down for a plan you like.
If you're self-employed, there are new companies and plans being created just for you. Check out Catch.
Ultimately, health insurance decisions are very personal, and they do take a bit of time to sort out -- but you’re not alone! Send us your questions if you’re feeling stuck because this is really important (pardon the 90s dialogue box - we do answer all messages!). If we don’t know the answer, we’ll find you someone who does :) .
All the health insurance <3,
Your friends at Mento
(aka Jordan, a recovering healthcare consultant, & Jamie, an aspiring health insurance aficionado who only recently learned the definition of 'deductible')
P.S. Did we get you the health insurance #mood? Indulge in some of our favorite reads ⤵️
Food for thought →
Plan Specifics →
Comparing plans →
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