Affordable Health Insurance: Everything you need to know

In the United States, monthly health insurance rates can vary from $320 to $840 per person, making it expensive for certain American families. Many people in gainful employment might not be concerned about this because their employers pay for most of their insurance.

However, those who do not have access to company-sponsored health insurance must look for a plan and fund the entire cost of coverage. This raises the question of where to look for the most cost-effective health insurance plans.

Insurance Business explores the various choices accessible to individuals looking for reasonably priced health insurance in this article. As part of our client education series, we invite brokers and insurance agents to forward this material to their clients so they may help them locate the most affordable health plans.

Where can I find reasonably priced health insurance?

According to the most recent analysis, the average monthly cost of health insurance premiums is $456, according to the national health non-profit Kaiser Family Foundation (KFF). On the other hand, the amount paid varies greatly depending on one’s place of residence.

For example, New Hampshire residents pay the lowest monthly premium for health insurance, $323 per person, according to KFF’s most recent benchmark. The cost is more than twice as much as the average premium for Vermont, which is $841, the highest monthly premium of any state.

However, there are several alternatives for many Americans to access reasonably priced health insurance plans even in cases where employer-sponsored coverage is not an option. Here are a few of them:

1. Medicaid

This government-funded health program, which is regarded as the cheapest alternative, has certain qualifying requirements that differ based on the state in which the participant resides. States are required by law to offer Medicaid assistance to the following groups:

• Adults who are past 65
• People who are disabled
• Families with low incomes
• Children and pregnant moms with low incomes

Individuals who fit into the aforementioned groups are eligible to get free or affordable healthcare provided they fulfill the eligibility standards.

• Either they are lawfully admitted foreign nationals or US citizens in good standing.
• The state in which they are requesting coverage must be their place of residence.
• They can seek coverage once they are released from prison, but they cannot be an inmate at the moment.

There are now 38 states that permit eligibility based only on income. Typically, the threshold is set at 133% of the federal poverty level (FPL) or roughly $17,774 per individual. A greater income ceiling corresponds to a larger household. Except for Alaska and Hawaii, nearly all 38 states have the same income threshold.

Medicaid eligibility based only on income is not available in the remaining 12 states. These are the following:

1. Alabama
2. Florida
3. Georgia
4. Kansas
5. Mississippi
6. North Carolina
7. South Carolina
8. South Dakota
9. Tennessee
10. Texas
11. Wisconsin
12. Wyoming

The governments of these states impose extra requirements for eligibility, such as guardianship of a child or being older than 65.

Medicaid plan holders are eligible for free family planning, child healthcare, and emergency treatment. They might also have copays for prescription drugs, inpatient hospital care, and doctor visits, depending on their state and income brackets.

The benefits that each state is required by federal law to offer are included in the tables below, along with a list of optional benefits.

2. Medicare

Medicare is a different government-funded program that provides affordable health insurance to US citizens and permanent residents who are 65 years of age or older. Younger individuals with specific disabilities and those with end-stage renal disease (ESRD), or persistent kidney failure requiring dialysis or transplantation, can also participate in the program.

There are four components to Medicare:

Medicare Part A, or hospital insurance, provides coverage for skilled nursing facility care, hospice care, inpatient hospital stays, and a portion of home health care.

Medicare Part B (medical insurance): Covers preventive care, outpatient care, medical supplies, and certain doctor visits.
Medicare Part C: Formerly known as the Medicare Advantage Plan, it is a single plan that includes all of Parts A and B’s benefits and services.
Prescription drug coverage under Medicare Part D: This helps pay for the majority of advised vaccinations and immunizations as well as prescription medications.
The last two are available for purchase through private insurance companies, while the first two are provided by the government.

People frequently misunderstand what Medicaid and Medicare cover due to their similar names. The fact that certain persons might be able to apply for both in specific circumstances is another element that could confuse them.