19 Health Insurance FAQs Answered
Are you a gig worker, starting your own small business, or venturing out into the exciting world of freelance?
Then, that means you’re now responsible for securing your own health insurance.
Of course, health insurance is extremely important.
After all, you want to choose a plan that covers what you need it to, remains within your monthly budget, and gives you 24/7 peace of mind. So if you do get sick or injured, you’re covered!
This is why (for your convenience) we’ve decided to compile all the health-insurance-related FAQs here.
Side note: If you’re 26 or younger, check with your parents; you may still be covered or eligible for coverage under their plan.
1. Why Do I Need Health Insurance?
Health insurance might seem frivolous and unnecessary if you’re young and healthy. That’s until you break an arm and pay between $2,500 and $16,000 for a cast and possible surgery.
Not to mention, we’ve all heard stories about people diagnosed with brain cancer in their 20s, despite being totally healthy otherwise.
Unforeseen medical expenses have been the main bankruptcy cause for many Americans. But unfortunately, we never know if or when a life event will require medical care.
2. How Do I Get Health Insurance Without a Job?
Gone are the days when the only way to get health insurance was through an employer that provided it.
The Affordable Care Act (ACA) or “Obamacare” allows everyone to get health insurance coverage. In addition, the ACA provides this coverage regardless of employment status.
Here’s how it works:
The website healthcare.gov will bring you to your state’s healthcare options.
If you’re unemployed or on the lower end of the income scale, you may qualify for Medicaid. Medicaid is run through a collaboration between the Federal Government and your particular state.
Remember, Medicaid is not the same as Medicare (which is for seniors or those with disabilities).
Fill out the information required to sign on and submit it.
Alternatively, you can choose to speak with a representative who will help you enroll. These reps can also answer any other health insurance marketplace questions.
Be aware that many companies are targeting people looking for insurance, all vying for your information. But you don’t need to go through any of them and can easily get health insurance (and get all your questions answered) by visiting healthcare.gov.
3. How Do I Get Health Insurance If I’m Self-Employed?
If you’re self-employed or have a small business, health insurance is still available for you and your family members. Visit healthcare.gov, which will bring you to your state’s website, and you’ll be able to sign up for health insurance there.
Gigly members enjoy even more discounts, health-related perks, and various additional benefits.
4. How Do I Get Affordable Health Insurance?
The amount you’ll pay for your monthly insurance premiums depends on your household income.
Those whose annual income is below a certain amount receive health benefits through Medicaid. Others can choose their health insurance plan and may have a certain amount paid for via government subsidies.
How much an individual pays monthly for insurance depends on income in real-time, not the gross annual amount from the previous tax year.
Tax credits are applied. As stated on the IRS website:
“The amount of the premium tax credit is generally equal to the premium for the second lowest cost silver plan available through the Marketplace that applies to the members of your coverage family, minus a certain percentage of your household income.”
5. How Do I Get My Own Health Insurance If I Have a Pre-Existing Condition?
Those with pre-existing conditions can still get health care coverage and will not have to pay more for their health plan.
If you have a pre-existing condition, simply visit healthcare.gov. Doing so will take you to your state’s health insurance marketplace, and you can sign up for health insurance there.
6. What And When Is Open Enrollment For Health Insurance?
The open enrollment period typically begins November 1 and ends January 15. This is when you can enroll, update, or change your plan coverage or switch health insurance companies.
However, those who have lost healthcare coverage can apply at any time under the special enrollment period.
7. How Do I Know How Much I Will Pay for Health Insurance?
If the idea of one more bill is the last thing you need in your life, you can check plans and prices here.
8. What Is the Difference Between Medicare and Medicaid?
Both Medicare and Medicaid are healthcare options. Medicare is for people 65 and older and younger people with disabilities or who are on dialysis.
9. What Is a Copay?
Copayments are a fixed amount you’re responsible for paying at the time of every visit. Depending on your chosen plan, they’re usually around $15 to $25.
Some people confuse copay with coinsurance, but they’re different.
10. What Is a Deductible?
A deductible is an amount each person is responsible for paying out-of-pocket before insurance starts to reimburse. It can range from $1,000 to $10,000 for individual plans, and family plan deductibles usually cap out at a little more.
The deductible is annual and usually resets at the beginning of the calendar year. PPO plans (plans that let you see out-of-network providers) tend to have two different deductibles:
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11. What Is a Monthly Premium?
A monthly premium is how much you’ll pay each month to maintain your insurance policy and be eligible for health care services.
The premium for those getting health insurance through their employer is deducted from their paycheck. Therefore, it’s reflected on their pay stub.
It’s slightly different for those getting their care through the health insurance marketplace. In that case, the monthly premium depends on a person’s current income and the plan they choose.
Generally, plans with a higher monthly premium have a lower annual deductible and maximum out-of-pocket. They may also have lower copays. And, plans with lower monthly premiums have a higher annual deductible, maximum out-of-pocket, etc.
12. What Is a Maximum Out-Of-Pocket?
The maximum out-of-pocket is the total amount you’ll pay each year before insurance reimburses all qualifying medical services at 100%.
Like copays and deductibles, all insurance policies have different maximum out-of-pocket amounts.
But once it’s met (through meeting the deductible and with copays), insurance will pay 100% for all services until:
- The end of the year
- The deductible gets renewed
However, the individual still needs to pay their monthly premium. The monthly premiums are like a membership fee. They also don’t count towards the deductible or any of the services gained through insurance.
13. What Does In-Network Mean?
In-network refers to the health care providers contracted with an insurance company to provide services for members.
14. What Does Out-Of-Network Mean?
15. What’s the Difference Between a PPO and an HMO?
PPO (Preferred Provider Organization) plans allow members to seek care outside their network of contracted providers. However, they usually pay less for these services than if they had gone in-network for services.
These plans saddle the policy holder with more of the bill by having to pick up out-of-pocket costs.
HMO (Health Maintenance Organization) plans only reimburse for services received from providers in their network.
On rare occasions, such as if a policy holder is diagnosed with something rare and no one in their HMO network provides treatment, a medical provider who does provide that care will contract for in-network services with the HMO insurance on a case-by-case basis, for each individual who needs care.
16. How Do I Know Which Health Insurance Plan Is Best for Me?
Insurance options can be overwhelming, and choosing the right plan can seem daunting.
Some people who only see a doctor for preventive care choose plans with a high deductible and a low monthly premium. Others with conditions requiring regular medical care will opt for a plan with a low deductible and higher monthly premium.
Some find it easier to choose their plan when considering their overall health: how much or how little they see a doctor.
The insurance option chosen isn’t set in stone, as people are free to change their policy during the open enrollment period.
At Gigly, we help our members select the best plan for them… and much more.
17. What Is COBRA?
Individuals who left a job can extend the healthcare coverage they received while working at that job through COBRA. COBRA is short for Consolidated Omnibus Budget Reconciliation Act.
COBRA benefits are available on a short-term basis only. This allows people to keep their old insurance a little longer as they search for a replacement.
18. What Is Supplemental Coverage?
Supplemental insurance coverage refers to an additional source of coverage. In layman’s terms, they supplement or help with the cost of your primary coverage.
Some companies (like us at Gigly!) go beyond just the financial component, offering their members additional benefits like:
- Patient advocacy
- Program discounts
- Teladoc appointments
- Virtual mental health services
- Discounts on prescription drugs
- The addition of vision and dental benefits – which aren’t covered under most health insurance plans
- 24-hour assistance for those who need help navigating the world of healthcare benefits
- … and so much more
Those on Medicare can receive supplemental benefits with Medigap sold through private companies.
“Bridging the gap” between what Medicare pays for and what’s left outstanding – copays, coinsurance, and the annual deductible.
19. What If I Chose the Wrong Plan?
The good news is:
You can change it!
Did you initially pick a plan with a low deductible and high monthly premium but only saw your doctor once?
If so, you can review your coverage options and switch plans during the open enrollment period. Open enrollment usually begins in November and ends in mid-January.
In the world of healthcare, there are many frequently asked questions. We hope this answers some of yours, but if you have more, know that there are a lot of resources out there… and we’re one of them!
We’re always happy to answer any questions you have, and our support extends beyond the reach of healthcare.
We know that launching yourself into something new requires a lot from you, and we’re here to support you on your exciting new journey.
Enroll in a membership with the Alliance of Gigly Workers for access to additional health benefits and resources.