When you’re experiencing a medical emergency such as a broken bone or the need for surgery, the last thing you want to worry about is whether you can afford treatment.
Having coverage from health insurance can ease your cost worries, whether you need to go to a routine appointment, or you have a more serious, unexpected health expense. That can be especially true if you work part time, or for yourself. If you’re a freelance worker, or your employer doesn’t offer you insurance, you can have access to health insurance too, and the following guide can help you navigate the open enrollment period.
Why do you need health insurance?
Health insurance can pay for your care and your dependents’ care in the event of emergencies, and also provide for routine care.
Having health insurance can protect you from incurring massive, unplanned costs. For example, without health insurance a three-day stay in the hospital costs $30,000 on average and treating a broken arm can cost up to $7,500, and while the average annual premium for one person is $7,188 and $20,576 for a family. Having healthcare can defray those costs.
When you have health insurance, you’ll pay a monthly premium. In exchange, depending on your policy, you can typically get preventative care like annual physicals, cancer screenings, and vaccines without any additional cost. And, again, depending on your policy, you can go see doctors, typically at a fixed copay, or fee, for the visit. You may want to make sure that you go to doctors that are in your network to keep your costs down. (More on that below.)
What could your costs be?
In addition to paying a monthly premium, many plans will have something called a deductible, which is the amount of money you’re responsible for in healthcare costs before your insurance provider takes on the remaining costs. For example, you might have a $2,000 deductible. As a hypothetical example, let’s say you need to get surgery that costs $20,000. You might have to pay up to that $2,000 before your insurer will cover the remaining cost. (But keep in mind that some things might be covered by your insurance whether you’ve met the deductible or not. This is typically true of something like annual physicals.)
Your plan might also require you to pay coinsurance, or a percentage of your healthcare costs, after you’ve hit your deductible. Typically plans have an out-of-pocket maximum for your coinsurance, which is the most you’ll pay for health coverage in a given year.
Your health insurance can also help you avoid paying the full ticket price for some prescription drugs, which can be very expensive upfront. Some prescription drugs are entirely covered by your insurance, so you may not have out-of-pocket costs for them.
Good to know: Some plans may offer only in-network coverage, which means you must use a pre-approved network of providers, otherwise your care may not be covered and you may have to pay the full cost for treatment. Some plans may also allow you to seek out-of-the network care in addition to in-network care, but at a higher cost to you.
What’s an open enrollment period?
Health care insurance isn’t like car insurance, which you can purchase at any time. You generally have to apply for it during something called an open enrollment period (OEP), which is the annual period of time during which you can sign up for major healthcare plan coverage. Remember though, you have to re-enroll for coverage every year, whether you want to make changes to your plan or not.
If your employer offers you health insurance, you’ll probably hear from your human resources department. But if you’re unemployed, a contractor or freelancer, or your employer doesn’t offer you health insurance, you should be aware of the general deadlines for the Health Insurance Marketplace established by the Affordable Care Act, where anyone can get a plan.
Open enrollment for the 2021 Health Insurance Marketplace starts on November 1, 2020, and runs through December 15, 2020. (Some states may extend the deadline, though. You can learn more about deadlines here.)
What is a qualifying life event?
You can often adjust your coverage outside of the OEP if you experience a qualifying life event. Qualifying life events include life changes that can make you eligible for a special enrollment period outside of the OEP.
Losing your health coverage, or experiencing a change in residence or household might qualify you for a special enrollment period. For example, if you turn 26 and are no longer on your parent’s insurance, or you get married, you may need to enroll outside of the OEP.
What to look for when signing up for health insurance
It’s important to know what to look for in a health insurance policy if you need to shop for a plan on your own. If you already have a doctor or doctors that you like, you may want to check if those doctors would be in-network or covered under certain plans. This is also true of any specialists you might visit. For example, if you go to therapy, you should check that your plan has mental health coverage. Additionally, if you take certain prescriptions, you should check if the plan covers those prescriptions, and how much of the cost it covers.
When comparing different plans that meet your needs, you can also compare costs. Find out the monthly premium for each plan. Make sure there’s room in your budget for monthly costs. And know what you’re getting with each plan. For example, a lower premium might give you less coverage than you want, and cost you more in the end if you need care.
Take a look at the deductibles and the coinsurance of the plans you’re considering. Remember, the deductible is the amount of money that you’ll be obligated to pay before your insurer starts paying, and coinsurance can also add another layer of cost. You’ll also want to see what your copays will be for in-network and out-of-network doctors. You may want to find a policy with extra coverage if you go to the doctors, or to specialists, often. If you have dependents who’ll also rely on your health coverage, make sure you find a plan that works for your entire family.
Stash and Stride
Stash partners with Stride* to help you find health insurance coverage through the Health Insurance Marketplace. Stride works with major health insurance providers, and can help you navigate the Affordable Care Act’s Health Insurance Marketplace, providing you with competitively-priced options for health care coverage. If you work part-time for a company such as Uber or Etsy, your company might even work with Stride to make insurance more accessible.
The deadline to enroll in health coverage is December 15th** and your coverage will start as soon as January 1, 2021.
Get started with Stride and enroll today.