CHARLOTTE – Not having health insurance can take a toll on your health – and your wallet. Without it, an accident, unexpected illness or even a relatively simple injury can cost thousands of dollars out of pocket.
Life during the pandemic has shown there’s never been a more important time to have health insurance. More than 45 million Americans were infected with COVID-19 in 2020 and 2021, many of them hospitalized.
Cost aside, research shows people with insurance are more likely to have regular doctor visits and receive care when they need it. Early detection of illness and other health conditions is critical for the 6 in 10 Americans who live with at least one chronic disease.
Still, some 28 million people in the U.S. lacked health insurance coverage in 2020. If you don’t have insurance through your employer, you can choose a plan through the Affordable Care Act (sometimes called Obamacare).
These plans not only cover part of your health care costs – they provide free preventive and screening services that help you stay healthy and find problems earlier.
U.S. citizens who don’t have insurance through a job, and those who cannot get Medicaid or Medicare, can choose a plan through the Health Insurance Marketplace.
Can I get financial assistance?
Millions of Americans qualify for a premium tax credit that lowers their monthly payment, also known as a premium. More than 430,000 North Carolinians qualified in 2020.
Eligibility depends on income and household size. This includes people with an annual income up to about $51,000 or $106,000 for a family of four.
In 2021, the average monthly premium in North Carolina was $633, but those who qualified for a premium tax credit paid an average monthly cost of $125 – about $6,000 in annual savings.
Pro tip: If your income rises during the year you also should report it, so your monthly premium subsidy is reduced, helping you avoid a potentially hefty tax bill come April.
Find out if your estimated income is in the range to qualify for a premium tax credit.
Things to consider
Short-term plans (or association plans) are not equivalent to the health insurance plans on the marketplace. They may look less expensive, but the low monthly premium often comes with a high deductible that will actually cost you more in the long run.
A deductible is the amount of money you must pay for health care out of your own pocket before your insurance plan starts covering some of the cost. For example, if your deductible is $1,200, that’s the amount you’ll pay out of your own pocket for health services before your insurance starts covering some services.
Another expense to watch for is the amount of your copayment or copay. That’s a flat fee that patients are expected to cover every time they use a health care service. For example, even with insurance, you might be expected to pay $25 every time you see a doctor or pick up a prescription.
It’s important to think about both kinds of costs when shopping for a plan.
The cheapest plan may not be the best option
Comparison shopping is straightforward on the Health Insurance Marketplace, because at each of the four levels of coverage — bronze, silver, gold, and platinum — benefits are uniform from insurer to insurer. Generally, plans in categories with lower premiums pay less of your total costs. Categories with higher premiums usually pay more.
The lowest premium, a bronze plan, is not necessarily the wisest — or cheapest — choice. Higher deductibles and coinsurance rates could cost more than a higher premium plan if you become ill or have an accident. Coinsurance is the portion you pay for health services once you’ve met your deductible. For example, after your deductible is met, your coinsurance rate could be 20%.
Also, pay close attention to plan and network types. Some plan types allow you to use almost any doctor or health care facility. Others limit your choices or charge you more if you use providers outside their network.
Need help choosing a plan? You can call the Health Insurance Marketplace helpline at 800-318-2596.
What do marketplace plans cover?
- Preexisting conditions: No insurance plan can reject you, charge you more or refuse to pay for essential health benefits for any condition you had before your coverage started, including disabilities, chronic health conditions, and pregnancy.
- Essential health benefits: These include prescription drugs, lab costs, outpatient care, emergency services such as hospitalization, treatment for mental health and substance abuse disorders, rehabilitative services, devices to help people with injuries, preventive and wellness services, and chronic condition management, and pediatric services, including oral and vision care. Birth control and breastfeeding coverage also are offered with every plan.
- Preventive care: Preventive services, such as shots and screening tests, are covered by most health plans at no cost to you. It’s important to note these services are free only when delivered by a doctor or provider who is in your plan’s network.