How Family Caregivers Can Find Health Insurance When Unemployed

This article guides unpaid or informal family caregivers through different health insurance options, how to assess your health insurance needs, compare different types of plans, and apply for coverage.

How to assess your health insurance needs

Before shopping for health insurance, you need a clear idea of what kind of coverage you need and how much you can afford. Here are some steps to help you assess your health insurance needs:

Identify your potential risks. Think about your personal health, family situation, and lifestyle. Do you have any chronic conditions, disabilities, or special needs? Do you have dependents who rely on your income or care? Do you engage in risky activities or travel frequently? These factors may affect the type and amount of coverage you need.

Estimate your health care expenses. Based on your current and expected healthcare needs, estimate how much you would spend on medical services and prescriptions in a typical year. You can use online tools like HealthCare.gov's out-of-pocket cost estimator or NerdWallet's health insurance calculator to understand your potential costs.

Compare different types of plans. Health insurance plans vary in terms of how they cover different services, how much they charge for premiums, deductibles, copayments, and coinsurance, and which providers they include in their networks. Ahead, we compare the main types of insurance plans like HMOs, PPOs, EPOs, and POS plans. You can also check ratings and reviews of different insurers and plans on websites like Morningstar or Financialzy.

Choose a plan that suits your budget and needs. Once you have narrowed down your options, you can choose a plan that offers adequate coverage for your risks, has reasonable out-of-pocket costs, and includes your preferred doctors and hospitals in its network. You can also look for benefits like wellness programs, telehealth services, or preventive care.

Remember that health insurance is not a one-time decision. You should review your plan annually and make changes if your needs or circumstances change. You should also shop for the best deal and take advantage of any subsidies or tax credits you qualify for.

Understanding different types of plans

Here is a summary of the main features and differences of HMOs, PPOs, EPOs, and POS plans:

HMO (Health Maintenance Organization) plans are the most restrictive but tend to have lower premiums and out-of-pocket costs. With an HMO plan, you must choose a primary care physician from a network of providers and get referrals from your PCP to see specialists or other providers. You must also get all your care from in-network providers, except for emergencies or rare situations when no in-network options are available.

PPO (Preferred Provider Organization) plans are the most flexible but tend to have higher premiums and out-of-pocket costs. With a PPO plan, you do not need to choose a PCP or get referrals to see specialists or other providers. You can also get care from out-of-network providers, but you will pay more than using in-network providers.

EPO (Exclusive Provider Organization) plans are a hybrid type of plans offering flexibility and cost savings. With an EPO plan, you do not need to choose a PCP or get referrals to see specialists or other providers. However, you must get all your care from in-network providers, except for emergencies. EPO plans usually have more extensive networks than HMO plans but smaller networks than PPO plans.

POS (Point of Service) plans are another hybrid type of plan that combines features of HMO and PPO plans. With a POS plan, you must choose a PCP from a network of providers and get referrals from your PCP to see specialists or other providers. However, you can also get care from out-of-network providers, but you will pay more than if you use in-network providers. POS plans usually have lower premiums than PPO plans but higher premiums than HMO plans.

The best type of plan for you depends on your personal preferences, health needs, budget, and availability of providers in your area. You should compare each plan's benefits and costs before deciding.

How to get health insurance without a job

Unemployment can be stressful and challenging, especially if you normally get health insurance from your employer. However, you don't have to go without coverage or pay a fortune. There are several options to get health insurance without a job, depending on your eligibility, budget, and preferences. Here are some of the most common ways to get health insurance if you're unemployed:

COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that allows you to continue your employer-sponsored health plan for up to 18 months after you lose your job. You have to pay the entire premium plus a 2% administrative fee, but you can keep the same benefits and network of providers. You have 60 days from the date you lose your job or receive a COBRA notice to enroll in this option.

Marketplace: The Health Insurance Marketplace is a website where you can compare and buy health insurance plans that meet the Affordable Care Act (ACA) standards. Depending on your income and household size, you can qualify for premium tax credits and cost-sharing reductions that lower your monthly payments and out-of-pocket costs. You can enroll in a Marketplace plan during the annual open enrollment period, which runs from November 1 to January 15, or during a particular enrollment period if you lose your job-based coverage or experience other qualifying life events.

Medicaid: Medicaid is a joint federal and state program that provides free or low-cost health coverage to low-income people, children, pregnant women, seniors, and people with disabilities. Each state has its own eligibility rules and benefits, but most states have expanded their Medicaid programs under the ACA to cover more people. You can apply for Medicaid anytime during the year through your state's Medicaid agency or the Marketplace.

Medicare: Medicare is a federal health insurance program for people who are 65 or older, disabled, or have certain diseases. Medicare has four parts: Part A covers hospital services, Part B covers doctor visits and other outpatient services, Part C offers private health plans that include Part A and B benefits, and Part D covers prescription drugs. You can enroll in Medicare during the initial enrollment period, starting three months before your 65th birthday and ending three months after it, or during the general enrollment period, which spans from January 1 to March 31 each year.

Short-term health insurance: Short-term health insurance plans are temporary plans that provide limited coverage for a short period, usually less than a year. They are cheaper than other types of health insurance but offer fewer benefits and protections. They may not cover pre-existing conditions, preventive care, maternity care, mental health services, or prescription drugs. They also do not comply with the ACA requirements, so you may have to pay a tax penalty if you don't have other minimum essential coverage.

How to apply for Marketplace coverage

If you want to get health insurance through the Health Insurance Marketplace, you need to follow these steps:

Visit healthcare.gov or call 1-800-318-2596. You can also use an approved enrollment partner to enroll in the Health Insurance Marketplace.

Create a Marketplace account and enter basic information, like your name, address, email address, and zip code. If your state runs its own Marketplace, you will be directed to their website.

Submit your application and learn if you qualify for a health insurance plan with savings, such as tax credits, lower out-of-pocket costs, or free or reduced-cost coverage through Medicaid or CHIP. You can use online tools like KFF's health insurance market calculator or NerdWallet's health insurance calculator to understand your potential costs and savings.

Compare plans and pricing available in your area to enroll in the one that best suits your needs and budget. You can compare the main types of plans, such as HMOs, PPOs, EPOs, and POS plans.

You can only enroll in a Marketplace plan during the Open Enrollment Period, which runs from November 1 to January 15, unless you qualify for a Special Enrollment Period due to a life event like losing other coverage, getting married, or having a baby. You can enroll in Medicaid or CHIP at any time.

Find the right healthcare for your family

Unemployment may be temporary, but your healthcare doesn't have to be compromised. Equipped with accessible health coverage avenues, you can confidently navigate this challenging phase, knowing you can still provide your family with the care they deserve.

Amidst job loss and caregiving responsibilities, your health remains a priority. By tapping into the available supportive resources, you're guaranteeing your family's health and well-being to continue to thrive, regardless of your employment challenges.