Health insurance is a necessity, but finding a suitable insurance plan that offers the coverage you need, and that is kind to your pocketbook, can be quite a hassle. Let’s take a look at what to know about affordable insurance and where to find an affordable health insurance plan.
What Is an Affordable Health Insurance Plan?
An affordable healthcare plan provides you with the coverage you need at a price that fits within your budget. The specific amount will vary from household to household. Under the Affordable Care Act, affordable plans are those that cost less than 9.61% of a person’s household income for a self-only plan (a plan that doesn’t cover spouse or family). So, for a person earning $3,000 per month, the IRS estimates an insurance plan with a premium of $288.30 or less per month would be affordable.
Most people look at the monthly premium as a basic judge of affordability, but the overall affordability of a plan is influenced by several factors:
- Income. How much you make doesn’t change what your premium will be, but it does impact how much coverage you can afford.
- Family Size. In general, coverage for a family is more expensive than for an individual.
- Premiums. The premium changes based on what the deductible is, what services are covered, where you live, and many other factors.
- Out-of-pocket costs. The deductible (what you pay before insurance kicks in), coinsurance, and copays all impact overall cost and affordability.
- Coverages. The premium for a plan changes based on what services are covered. Not having services you need covered can get expensive fast.
It’s important to remember that the premium you pay every month is only a part of the equation–the cheapest health insurance isn’t necessarily the best or most affordable health insurance plan.
What Do Affordable Health Insurance Plans Typically Include?
Health insurance shouldn’t just cover catastrophic events. You need it even for day-to-day medical events like prescriptions, checkups, and more. The Affordable Care Act, passed in 2010, labeled ten health care services as essential benefits that all affordable plans should have:
- Preventative services and chronic disease management coverage
- Pediatric care (For children, this includes oral and vision care.)
- Pregnancy, maternity, and newborn care
- Prescription drug coverage
- Labwork coverage
- Coverage for emergency services
- Hospitalization coverage
- Outpatient care (also called ambulatory patient services)
- Mental health services and substance use disorder services
- Coverage for rehabilitative and habilitative services and devices (services to help people recover after injuries or to manage chronic conditions
Additional benefits, like dental and vision, may be included in a plan, but their inclusion may increase the premium of the plan.
Best Affordable Health Insurance Plans
Health insurance varies in price based on your location, your household size, your health history, the deductible level you can afford, and more. One of the benefits of the Affordable Care Act is the creation of the Healthcare Marketplace, where those needing insurance can seek plans that are guaranteed to cover the ten essential benefits. Subsidies that can help lower premiums are also available for those who need them. These are some companies that have affordable healthcare plans available through the Marketplace:
Blue Cross Blue Shield
Blue Cross Blue Shield has coverage options available in all 50 states. The company has been around for a long time, so it is widely recognized and accepted by providers and provides a wide variety of plan types and coverage levels. In addition, Blue Cross Blue Shield offers global health insurance for when you are traveling.
Kaiser Permanente has long been recognized as a leading provider of Health Maintenance Organization, or HMO, plans, meaning that coverage is only provided for the providers and facilities that are in their network. But they do also provide PPO plans and HSAs (health savings accounts). One downside–coverage is only offered in Washington D.C. and eight states.
Cigna is arguably the oldest health insurance company on the list. It’s been around since 1792! Cigna’s plans are affordable, and their plans come with perks that keep costs down, including $0 virtual care and many low-cost prescriptions. Cigna recently added a Take Control Rewards program, where individuals and families can earn points like scheduling wellness checks or establishing an account through Cigna’s app to manage your health information. Points can be redeemed for up to $275 in cash that can be used to make healthcare even more affordable.
Created in 2012, Oscar has a wide variety of digital options available to make healthcare access convenient and affordable for all. In addition to ACA-compliant policies, Oscar offers a $0 call with a healthcare practitioner and the ability to schedule appointments online through their mobile app. Oscar is newer, so it has fewer reviews than other long-standing providers, but it is available in 19 states, with plans to expand to more.
Although Humana no longer offers traditional insurance plans, it’s one of the largest insurers in the nation. Why? It offers a wide variety of coverage for Medicare Advantage (Medicare Part C) plans, Medicare Part D (Prescription) plans, and Medicare Supplement (Medigap) plans. These plans help make insurance more affordable for Medicare-eligible individuals.
How to Get Affordable Health Insurance
If you’re shopping for health insurance, the best way to find an affordable plan is to shop around and look at plans from several insurers. It’s also wise to check the Healthcare Marketplace to see whether you qualify for any subsidies that might lower your costs.
Consider the out-of-pocket costs and any coverage gaps as well. If services you regularly need aren’t covered, you might not save any money, even with a lower premium. Calculate the maximum out-of-pocket expenses you would have to cover on a plan to make sure it’s an amount you can manage.
Can I Get Affordable Health Insurance at Any Time?
Those who are shopping for affordable insurance on their own can switch their plans at any time, but plans and subsidies that are available through the Affordable Care Act are only available during open enrollment, which usually takes place during the fall and early winter months.
After the open enrollment period ends, you cannot enroll in an ACA-eligible plan unless you meet certain qualifications, such as a change in employment, a move, the loss of coverage, or addition of a family member to the plan. These events qualify you for a special enrollment period.