No employer health insurance? Here’s what you need to know

Are you one of the more than 500,000 Washington residents who don’t have health coverage? Did you know that the federal government requires you to have health insurance?

In this article, you’ll find health care options if you’re self-employed, doing contract work, unemployed, or have a job that doesn’t offer health benefits for you and your family. There’s never a one-size-fits-all formula for choosing the right health plan, but understanding your options is the first step to making a good decision.

KP Washington health planWords you need to know

Here are some key insurance terms we’ll be using in this article, and that you’ll see when you start looking at health plans. You can also watch these short videos for more help.

  • Premium: The amount paid to an insurer monthly, quarterly, or yearly to have health insurance.
  • Deductible: The fixed amount you pay for health care services before your health insurance begins to pay.
  • Copay: A flat fee you pay for a specific health care service, usually when you receive the service.
  • Coinsurance: Your share of the costs for a health care service; this is a percentage of the total charge for the service.
  • Out-of-pocket maximum: The most you will pay for medical care in a plan year.

Kinds of coverage available

If your employer doesn’t offer health coverage or you’re unemployed, here are your options:

A metal plan on the health insurance marketplace

Metal plans are categorized as bronze, silver, gold or platinum on and off the health insurance exchange, an online health insurance marketplace, created by the Affordable Care Act. Metal levels refer to how you and your plan split the cost of health care, not the quality of the care you receive. If you receive a subsidy to help cover the costs of your health care, you can apply it to these plans.

  • Bronze plans have lower monthly premiums but higher costs when you get care.
  • Gold plans have higher premiums but lower costs when you get care.
  • Silver plans fall below Gold.

Catastrophic plans

These plans are available if you’re under 30, or you qualify for a hardship exemption from the “individual mandate” (the ACA-requirement to have health coverage). They have the lowest premium of all the plans offered on the exchange. And they include full coverage for 3 primary care visits and all preventive care visits. The annual deductible applies to all other kinds of health services.

Looking for a health plan?

Health savings account (HSA) + an HSA-compatible plan

An HSA is a medical savings account. You can contribute to it and withdraw money from it, tax-free for medical expenses. An HSA alone is not much better than having no insurance but when you combine it with an HSA-compatible health plan, it’s a very practical choice. Here’s how an HSA works:

  • If you qualify for a subsidy and have an HSA, you must enroll in a plan that is compatible with an HSA. These generally have higher deductibles and out-of-pocket maximums.
  • You use your HSA to pay out-of-pocket costs for all care — except for preventive care which is covered in full — before your deductible is reached.
  • If you need more costly care, you have health coverage for costs beyond your plan’s deductible.
  • If you put money into your HSA and don’t use it by the end of the year, you can use that money in your next year because your balance will roll over.

Medicaid

If the options above are financially out-of-reach, you might qualify for Medicaid. This is insurance provided by the government. It’s for people with incomes up to 138% of the federal poverty level, which is $16,394. Children in families earning up to 200% of the poverty line (which varies by household size) also qualify. If you qualify, you don’t need to pay a premium for this coverage.

The risks of not having insurance

  • You could be liable for significant costs if you have a major illness or injury and get care.
  • If you can afford insurance and don’t qualify for a hardship exemption, you can be fined. When you compare the cost of the fine to the cost of a plan with a low premium, the health plan is almost always the better option.
  • You might delay important medical care because of cost. And that means you could do long-term damage to your health.

Things to consider

As you think about your options, carefully consider your health and the care you might need. You should also think about your financial situation and the risk of not having insurance, or not having a plan with enough coverage. For more information on choosing a health plan, read, Great care, competitive rates: a health plan that’s the best of both worlds.

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