Content of the material
- High Deductible Health Plans (HDHPs)
- 5. Consider Catastrophic Coverage as a Health Insurance
- Can I be denied treatment in the emergency room if I dont have insurance?
- Limited Benefit Insurance Coverage for Everyday Medical Needs
- American Rescue Plan Makes Coverage More Affordable
- Obamacare—Increasing Costs and Lower Benefits
- Increasing health insurance premiums.
- Lower benefits due to higher deductibles and out-of-pocket maximum amounts.
- 3. Get Short Term Health Insurance
- The American Rescue Plan and Subsidies
- Alternative Health Insurance Options
High Deductible Health Plans (HDHPs)
If you are struggling to find health insurance with monthly premiums you can afford, you might want to look into getting a high deductible health plan (HDHP). An HDHP covers many of the same services as a standard plan, including costs for awful events that could otherwise bankrupt you, but it comes with a higher deductible. In exchange for lower bills each month, you’ll have to pay more out of pocket before the plan kicks in and pays for the rest.
The IRS sets upper and lower limits for plans to be defined as HDHPs. For the years 2020 through 2022, the deductible had to be at least $1,400 for a single person or $2,800 for a family. Any extra costs out of pocket (deductibles, copays, and coinsurance) for these plans would have been no more than $6,900 for a single person and $13,800 for a family, per year for 2020. These out-of-pocket limits increase to $7,000 ($14,000 for a family) for 2021 and $7,050 ($14,100 for a family) in 2022.
Limits for costs out of pocket only apply to services within a plan's network. If you see a doctor or other care provider out of network, it will be at your own expense, and the payment won't count toward your deductible.
These figures may seem daunting, but it is a lot less daunting to pay $1,400 than it would be to pay $7,500 for a broken leg. If you have an extended hospital stay, costs can add up even more quickly; a three-day stay alone can set you back up to $30,000 or more. The perks should be clear: if you've paid your (low) monthly bill for an HDHP, once you meet the limit, the plan kicks in and covers a large portion of the costs still due, while you must only pay a small portion of coinsurance. Copays are not included in the limit, so those will be added to your bill as well, but they tend to be quite minor.
Often, the best and cheapest HDHP is the one offered through your workplace. You may be able to find a cheaper option by looking through the health exchanges set up under the Affordable Care Act (ACA) or directly through insurance companies. Plans under the ACA may offer extra discounts based on your current financial status, though this varies by state and by plan.
5. Consider Catastrophic Coverage as a Health Insurance
While catastrophic coverage is an affordable type of health insurance, it’s not the best option out there. You can only qualify for it if you’re under 30 and can’t afford any other type of health insurance.
Catastrophic coverage gives you all the usual services of health insurance, but with an extremely high deductible. The only treatment this type of health insurance covers is basic doctor visits. If you need any further treatment, you’ll need to pay for that out of pocket until you reach your deductible amount.
While catastrophic coverage and an HDHP sound really similar, their coverage, eligibility criteria, and service providers are different. Be sure to read up on them before choosing a health care plan. This will ensure you find the best one for you, so you don’t have to pay more for your health care.
Can I be denied treatment in the emergency room if I dont have insurance?
According to the federal Emergency Medical Treatment & Labor Act (EMTALA), people have a right to access emergency medical services even if they don't have the ability to pay for them.
Limited Benefit Insurance Coverage for Everyday Medical Needs
If you want to save money and also receive coverage for everyday medical expenses, then zero-deductible, limited benefit indemnity insurance plans may be right for you.
This type of insurance provides cash benefits to you, triggered by specific medical events, such as doctor office visits, hospitalization, medical tests, surgeries, childhood immunizations and more. You receive the same dollar benefit, no matter what the facility charges and without having to meet an upfront deductible.
You receive benefits to help you pay for these types of medical costs—or to use the cash for any other expenses you wish.
Some benefit highlights include:
- Specific dollar amount payments triggered by covered services.
- Savings to you, if you use the large medical network provided. NOTE: You are not required to use this network, but you will receive a discount on your medical services if you do, and that means your insurance cash benefits will go even further to pay expenses.
- Critical illness coverage in addition to the plan’s daily cash benefits, for certain catastrophic medical events, such as stroke, heart attack, invasive cancer and end-stage kidney failure (certain state restrictions apply).
- Benefits in the event of fractures, burns and dislocations.
- Discount prescription drug card.
- Ground and air ambulance service benefits.
- Mental health and substance abuse care included.
- Accidental death and life insurance benefits (certain state restrictions apply).
These affordable insurance plans are a great fit for many individuals and families and helps take the worry out of everyday medical care.
American Rescue Plan Makes Coverage More Affordable
The American Rescue Plan (ARP), enacted in March 2021, makes premium subsidies larger and more widely available for people who purchase coverage in the exchange/marketplace in 2021 and 2022. And if it's enacted, the Build Back Better Act will extend these subsidy enhancements for another few years.
The ARP eliminated the “subsidy cliff” for those two years, so the income cap that normally applies to subsidy eligibility (400% of the poverty level) is not applicable in 2021 or 2022. Instead, a household earning more than 400% of the poverty level can qualify for a subsidy if the benchmark plan would otherwise cost more than 8.5% of the household’s income.
The ARP also reduced the percentage of income that people earning less than 400% of the poverty level have to pay for their coverage, so households that were already eligible for subsidies are now eligible for larger subsidies. And it also makes $0 premium silver plans with full cost-sharing reductions available in 2021 to anyone who receives unemployment compensation at any point during the year. (The Build Back Better Act would only extend the unemployment-related subsidies for one additional year, but would extend the other subsidy improvements through 2025.)
So for the time being, coverage that people purchase themselves is more affordable than it normally is.
Obamacare—Increasing Costs and Lower Benefits
You may be thinking that Obamacare was supposed to take care of the affordability of health insurance and medical care. After all, the legislation was named the “Affordable” Care Act.
Many of the supporters of the ACA truly believed that it would not only increase access to health insurance but also stabilize premium costs. They thought the “affordable” part would come through increased competition that was expected with the federal government paying tax credits.
However, it hasn’t worked out that way; the Affordable Care Act has made health insurance affordable only for those who can qualify for tax credits. For the rest of the American population, the ACA has been part of the cause of increasing premiums.
Increasing health insurance premiums
As the ACA was rolled out over the last decade, health insurance companies have struggled with the high claims costs for Obamacare policies and the failure to get the majority of younger healthy people to buy Obamacare policies and thus stabilize the risk pool.
Because of this and the specific mandated benefits included in Obamacare plans, monthly premiums skyrocketed.
- By 2017, average monthly premiums for individual health insurance had more than doubled since 2013 in the 39 states using the federal exchange—from $232 in 2013 to $476 in 2017. Some states had even higher increases during the same period.
- However, between 2019-2020, the marketplace stabilized. Between 2019 and 2020, the lowest cost Bronze premium went down 2.6%.
Lower benefits due to higher deductibles and out-of-pocket maximum amounts
In an attempt to keep premiums from being even higher than they otherwise would be in order to cover all of the claims costs, insurance companies began designing their Obamacare policies with higher and higher deductibles and higher and higher out-of-pocket maximums. The federal government has been consistently increasing the out-of-pocket limits that qualified health insurance policies can have.
From 2013 to 2017 period, individual health insurance deductibles soared:
- Average individual health deductibles increased by more than $1,000
- Average family health deductibles increased by more than $4,000
By 2020, the average individual deductible rose to $7,767. In addition, the average family of four has an average monthly premium of $1,437 per month, or $17,244 annually .
Beginning in 2014, the federal government, as part of the ACA, annually sets out-of-pocket limits for Obamacare plans. These limits have increased significantly from 2014 to 2020:
- In 2014, the out-of-pocket limits were:
- $6,350 for an individual.
- $12,700 for a family.
- By 2020, the out-of-pocket limits were:
- $8,150 for a family.
- $16,300 for family.
By ACA’s own definition, Obamacare policies are becoming “unaffordable” for more and more Americans. The high premiums and high deductibles combine to cost families many thousands of dollars each year BEFORE any insurance benefits are paid by the insurance plans.
This is why so many people are considering and purchasing other insurance coverage options now available to them.
3. Get Short Term Health Insurance
If you can’t afford standard health insurance, consider short term health care coverage. These plans have a time limit. But even a short amount of coverage is better than none at all. How long are these plans? Short term health insurance usually runs for 3 to 12 months.
Typically, this type of insurance covers hospital visits, surgeries, or other major expenses. However, doctor’s visits, prescriptions, and preventive healthcare is often not included in these plans.
The American Rescue Plan and Subsidies
The American Rescue Plan Act (ARPA), signed into law by President Biden in 2021, expanded eligibility for subsidies to make health insurance affordable for even more Americans. People that are already enrolled in health plans through the marketplace may find they qualify for more subsidies to bring down the cost of their monthly premiums. Those that could not afford to enroll in a plan due to the “subsidy cliff” may now have the opportunity to sign up for coverage.
The new law allows people with incomes below 150% of the poverty level to enroll in silver plans with a zero premium. Deductibles for these plans will also be dramatically reduced allowing individuals and families with lower incomes the ability to have affordable health benefits. The ARPA also reduces the amount people must pay if they have income between 100% and 400% of the federal poverty level.
The ARPA also provides subsidies for some people with income between 400% and 600% of the poverty line, those considered on the “subsidy cliff” in the past. This may allow individuals and families within these income levels to find more affordable, ACA-compliant plans, which could positively impact more than 2 million people. Check out our guide to the American Rescue Plan Act to find out more about how it may affect your ability to qualify for subsidies.
Alternative Health Insurance Options
If you are and individual under the age of 30 – or qualify for a hardship exemption – and are in generally good health, you may be eligible for a catastrophic plan. Catastrophic plans are low-premium plans that tend to have a high-deductible but offer ACA-compliant coverage.
In most states, you can also buy short-term health insurance plans. Premiums for short-term plans tend to be substantially lower than those of comprehensive health plans available on the marketplace.
Although they are called short-term plans, you typically can keep your coverage up to 3 years in most states by simply renewing your plan annually. While these plans do not offer the comprehensive coverage of a major-medical health insurance plan, they do provide an affordable alternative to ACA-compliant plans that can keep you covered in worst-case scenarios.
If you enroll in a short-term plan, you will pay a monthly premium and a deductible. These plans typically offer the following benefits:
- Some prescription medications
- Visits to your doctor
- Hospitalization due to illness or injury
Keep in mind that short-term plans can deny coverage for these services based on a pre-existing medical condition.
Whether you are in the market for a comprehensive health plan due to changes in your subsidy eligibility, or a more affordable alternative that you can pay for out of your own pocket, eHealth can help. We offer a wide range of insurance plans in every state so you can find the plan that works best for your family and your budget. Enroll in a plan through our website or live chat, or on a phone call with one of our licensed agents. We offer 24/7 support, and our services are always free of charge for you. Check out all of your individual and family health insurance options to start comparing plans in your area today.