Question

Use Worksheet 9.1. Lexi Thomas, a recent college graduate, has decided to accept a job offer from a nonprofit organization. She’ll earn $44,000 a year but will receive no employee health benefits. Lexi estimates that her monthly living expenses will be about $2,000 a month, including rent, food, transportation, and clothing. She has no health problems and expects to remain in good health in the near future. Using the Internet or other resources, gather information about three health insurance policies that Lexi could purchase on her own. Include at least one HMO. Use Worksheet 9.1 to compare the policies’ features. Should Lexi buy health insurance? Why or why not? Assuming that she does decide to purchase health insurance, which of the three policies would you recommend and why

worksheet 9.1

Service Policy #1 Policy #2 Policy #3

Hospital care
Surgery (inpatient and outpatient)

Office visits to your doctor

Maternity/well-baby care

Pediatric care

Immunizations

Mammograms

Medical tests, X-rays

Mental health care
Dental care, braces, and cleaning

Vision care, eyeglasses, and exams

Prescription drugs

Home health care

Nursing home care

Services you need that are excluded

Choice of doctors

Location of doctors and hospitals

Ease of getting an appointment

Minimal paperwork

Waiting period for coverage

Answer 1

Health insurance is now available to more Americans than ever before. Subsidized options are easily available to low-income individuals and families. In the past, many people took the risk of not being insured, but with the Affordable Care Act (ACA) you can be fined if you don't have qualified health care insurance. Instead of paying a fine, people who have not been able to afford insurance before are looking for affordable medical insurance options.

While some may be asking themselves if it would it be cheaper to just pay the fine, statistics show that more Americans have health insurance now than before the ACA was enacted. There are several reasons why more people have insurance now, but one is certainly the increase in affordable health plan options, including subsidized, or tax credits, health insurance purchased through one of the state exchanges. Compliant insurance can also be purchased privately. The options available to you depend primarily on your income level.

Each insurance brand may offer one or more of these four common types of plans:

• Health maintenance organizations (HMOs)

• Preferred provider organizations (PPOs)

• Exclusive provider organizations (EPOs)

• Point-of-service (POS) plans

• High-deductible health plans (HDHPs), which may be linked to health savings accounts (HSAs)

Low Income: If your income is 100 to 400 percent of the national poverty rate ($11,490 - $45,960) for a single person, you may qualify for subsidized health insurance. In many cases this is not free health insurance but subsidized. This means you can get bronze-level health insurance for about $2570 per year through one of the state exchanges. Extremely low-income individuals and elderly persons often qualify for Medicare. If you paid the fine for 2014 you may still qualify for insurance via an exchange, even if it is not during the open-enrolment period, to avoid the fee in 2015.

Best Options for Low-Income Earners: Medicare, state exchange or fine exemption

Most Americans get private health insurance from their employer or union. Others get it from the government through Medicaid or Medicare.

Unfortunately, some are uninsured.

The rest typically buy their own health plan through a government-run health insurance marketplace, a private online health insurance marketplace like eHealth, or through a local broker or agent.

Obamacare requires everyone to have major medical health insurance policy or pay a tax penalty for being uninsured.

Whether you’re purchasing health insurance for the first time, wondering if you should change your health plan as your personal needs change, getting ready for the next Obamacare open enrollment period, or becoming qualified for a special enrollment period because of a major life change—you’ll want to take a look at the major types of health insurance available.

Major medical insurance plans

Under the ACA, medical plans must offer minimum essential coverage, meaning that no one can be turned down for a plan during the Open Enrollment Period for medical reasons, including pre-existing conditions. In addition, certain services and treatments must be offered in all health plans, regardless of where you buy the plan or from what insurance company.

Here are the average monthly premiums paid by eHealth shoppers not utilizing government subsidies who selected Obamacare plans during the 2016 Obamacare open enrollment period:

$321 per month for individuals

$833 per month for families

What is an HMO plan?

HMO means "Health Maintenance Organization." HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan.

How does an HMO plan work?

As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.

Though there are many variations, HMO plans typically enable members to have lower out-of-pocket healthcare expenses. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. You also typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage for services rendered by out-of-network providers or for services rendered without a proper referral from your PCP.

An HMO plan may be right for you if:

• You're shopping for a plan with lower premiums

• You want a plan without a deductible and don't mind having an out-of-pocket limit.

• You need preventive care services such as coverage for checkups and immunizations.

• *Definitions may vary by plan provider. Please read the provider's Summary of Benefits.

eHealthInsurance is the nation's leading online source of health insurance. eHealthInsurance offers thousands of health plans under written by more than 180 of the nation's health insurance companies, including Aetna and Blue Cross Blue Shield. Compare plans side by side, get health insurance quotes, apply online and find affordable today.

Medicaid and CHIP are available all year to provide coverage to low-income families. Alaska Native shareholders and other federally recognized tribes may enroll in marketplace plans year round.