The Art of Getting Covered

health-insurance1This article was written for individuals newly entering the healthcare system, particularly our growing group of young adults who will be transitioning from their parents’ insurance. 

By Kaitlyn Petronglo

As a young adult you may be unfamiliar with the way the health insurance system works, especially in light of the new changes that will go into effect next year as a result of the Affordable Care Act (ACA). If you are generally healthy, you may not feel that you need health insurance or, if you have suffered from health problems in the past, you may know that you need health insurance but be unsure about how to get coverage that you can afford.

I need health insurance, how do I get it?

If you are under 26 years of age you can be covered through your parent’s health insurance plan. If this is not an option for you or you do not meet the age requirement, there are other options to consider.

A major change made by the ACA is the creation of health insurance exchanges or marketplaces in every state. The Health Insurance Marketplace in your state will offer private health insurance plans at a range of prices along with tools that help you compare plans based on price, benefits, and other features, before you make a choice. More information about the Health Insurance Marketplace is available at or through a toll free call center, (1-800-318-2596)—open 24 hours a day, seven days a week.

If you meet certain income requirements you may be eligible for a tax credit or lower premium if you buy through the Marketplace. In order to find out if you qualify for financial assistance (a lower monthly premium or tax credit) you must submit an application to the Marketplace in your state during the open enrollment period which runs from October 1st of this year to March 31st, 2014.

Once you enroll, plan coverage can begin as early as January 1, 2014. Applying to the Marketplace is a simple process that can be completed online, in person, by mail or over the phone. You only need to fill out one application to find out what you qualify for, including whether you are eligible for programs like Medicaid.

Using the Marketplace

Additionally, under the ACA insurance companies will no longer be able to deny coverage or charge you more because you have a preexisting condition. This means that if you are currently uninsured and have been diagnosed with a disease, take hydrocephalus for example, you can still enroll in a health insurance plan.

What If I Have a Pre-existing Condition?

This rule applies to all health insurance plans, whether they are offered by an employer or bought through the individual market. Note that if a plan has been offered since March 23, 2010, it may be considered a grandfathered plan and be exempt from this protection and some other provisions of the ACA. If you have one of these plans you can switch to a Marketplace plan during open enrollment if you choose and immediately get coverage for your pre-existing conditions.

What if I work full-time?

If you work full-time, you more than likely already have a plan through your employer. When you get health insurance through your employer, you share the cost of the plan with the employer and, if you become sick, are entitled to the health benefits that you and your insurer agreed upon.

If your employer has not offered health insurance in the past, it is important to know that, starting in 2015 any employer with more than 50 full-time equivalent employees that does not provide coverage to all full-time employees, may have to pay a fee to the government (called an Employer Shared Responsibility payment). Such employers will have to make the payment if:

• the coverage isn’t “affordable” (because it costs more than 9.5% of your family income,to buy employee-only coverage)

• doesn’t provide “ minimum value,” (a minimum value plan is designed to pay at least 60% of the total cost of medical services for a standard population), and

• at least one employee qualifies to save money on monthly premiums in the Marketplace.

Remember that, under the ACA, you are considered a full-time employee if you work an average of 30 or more hours a week.

By the same token, if your employer offers coverage to full-time employees in 2015 that is affordable and meets the minimum value, you won’t be eligible to save money on monthly premium if you purchase coverage for yourself through the Marketplace, and you may lose any employer contribution toward the coverage your employer offers.

If your employer will not offer coverage for 2014, you may want to look into other options, such as buying individual coverage through the Marketplace, so that you do not have to pay a fee for not having insurance, and don’t have to pay all your medical bills directly out of your own pocket..

What if I do not work?

If you do not work and are over the age of 26, then the Marketplace is an option worth considering. When you submit your application to the Marketplace in your state you will also find out if you qualify for any free or low-cost coverage through government health benefit programs like Medicaid or the Children’s Health Insurance Program (CHIP).

What if I don’t want health insurance or feel I can’t afford it?

Anyone who fails to enroll in a health insurance program in 2014 may be required to pay a fee when taxes are filed in the spring of 2015. This fee will be $95.00 or 1% of your total income. If you do not enroll in coverage for the 2015 plan year, you may be required to pay 2% of your family income or $325 per person (whichever amount is higher) when you file taxes in the spring of 2016. The fee increases every year, and by 2019 it will likely be cheaper to enroll in a plan then to pay the fee.

What if Someone Doesn’t Have Health Coverage in 2014?

Why Should I Have Health Coverage?


Open enrollment begins on Tuesday, October 1, 2013! 

Learn about your options now so you can make the best decision for yourself and your health.


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