Continuing the Coverage Under your Existing Plan with COBRA

Consolidated Omnibus Budget Reconciliation Act, or simply ‘COBRA’, means you get to stay with the coverage you have. Continuous coverage of the plan you had with your previous employer is a fit for some people. If you need an option for health insurance for self employed, or you are moving on to another job then this is one to consider.

The plan cost was covered by yourself and your employer before. This option means you cover that cost without an employer contributing a portion of it. There is also a form of an administrative fee. You would have 60 days to sign up for COBRA. For example, if you have coverage that ended February 1, your coverage under COBRA would begin April 2. Your effective date would go back to February 1 and you would pay back to that date, even if you did not use that insurance. If you have a family and have dependents, then they are all covered under the same price. 18 months of continued coverage is the eligibility picture under COBRA, as of 2021.

Individual Coverage Under a New Plan

If you are an individual looking for coverage, you can also purchase a plan on your own. Options include those plans available through Healthcare.gov. These are considered "on-marketplace". Some plans are only available separate from this online space. Those plans are known as "off-marketplace".

On Marketplace

Get in touch with a broker or insurance agent before you supply your personal information to the marketplace. You are probably going to be flooded with information that is not entirely useful to you at this stage. You may qualify for a subsidy for plans available here. These tax credits are based on income and will reflect on your monthly premium. Your adjusted gross income will need to be calculated with any deductions in mind. An accountant and an insurance professional will help you nail down the best option.

These plans are all required to provide essential services or essential benefits. That includes HMOs and PPOs. PPOs have a higher premium but more flexibility in what doctors you can visit.

Off-Marketplace

These plans are all qualified health plans. They meet the requirements under the Affordable Care Act. They allow you to buy directly from the insurer. Both on and off marketplace plans, as qualified health plans tend to be more expensive. They cover pre-existing conditions and that lack of exclusivity means higher costs.

Joining Employer Sponsored Plan of A Spouse or Partner

Most Qualified Health Plans do not allow a change to your plan coverage outside of what is called "Open Enrollment". In this period you can make adjustments to your coverage. If the size of your household changes, you can add a spouse or a newborn to your plan. Within 60 days of marriage, your plan would allow you to become a member of a spouse's plan.

Enroll in a Marketplace Plan

The Marketplace Plans are laid out in metal tiers. They are Bronze, Silver, Gold, and Platinum.

They are not based on the level of care you receive. Instead, these represent the cost-sharing between yourself and your insurer. With Bronze, your insurer pays 60% and you cover 40%. Silver requires you to pay 30% and your insurance company pays 70%. Gold is 80% in the hands of your insurer and you cover 20%. Finally, the platinum plans require 90% from your insurance company and you pay 10%

The bronze plan, with the lowest premium, also comes with the highest cost of care if you need medical assistance. This can save you money if you need protection from serious injury or illness but are not using medical care regularly.

Silver is moderate on premiums and costs for care, while Gold has low costs of care and high premiums. Paying more per month provides you with more coverage if you get medical treatment under these plans. Platinum marks the highest premiums, with the lowest costs of care if you need to see a doctor. If you have regular care visits, this is a good choice along with a willingness to pay a higher monthly premium.

Remember that your income can also mean you are eligible for a lower monthly premium. On your application to the marketplace, you will be able to determine if you qualify for the savings.

Get a Short-Term Plan

These short-term plans carry no open enrollment period and may provide some savings on the monthly premium. Regardless of family or household size changes, you can apply for a plan at any point. The short-term options as health insurance for self employed people also mean coverage quickly with fast approval windows.

If you make infrequent trips to the doctor, then this plan may work. If you are trying to start a family, are pregnant, or have chronic conditions then this may not be the best fit. Short-term plans are 12-month plans that allow for renewal after 36 months. They don't cover prenatal services. They are also not available in all states. You will need to know whether this coverage works for you. If you have pre-existing conditions, the plan won't likely cover these in year one. With children that have regular doctor’s visits, you will need to look closely as this plan comes with different costs in that scenario.

Weight the Advantages of a High-Deductible Health Plan

These high-deductible plans cover preventative care. Doctor’s visits and the cost of prescription drugs are wholly your responsibility to pay. MRIs, outpatient procedures, and small visits are applied to your annual deductible after being paid for by you.

It is important to meet with insurance brokers or professionals to be sure your choices meet your budget and your care needs. Getting insured is a way for entrepreneurs to protect themselves in the case of the unthinkable. Take care to review your needs, budget, and health considerations when you choose a plan that fits your lifestyle.