Just because you work for a company does not mean the company must offer insurance to you. And, just because the company offers insurance does not mean you must take it! If it’s available to you, consider the monthly premium (your employer will pay a portion), the deductible (how much you are responsible for before the insurance will pay a portion), the out-of-pocket maximum (how much you would not pay beyond in an insurance year), required co-pays, and your co-insurance portion (for example, insurance may cover 80% of a cost and you are expected to cover the remaining 20%. That 20% is your co-insurance.) Know that specific needs may also be handled a bit differently: preventive care like wellness checks, maternity needs, lab work, ER visits, physical therapy, etc. may all be laid out slightly differently than the overall plan. Also understand who you are allowed to see – some groups require you to stay in a particular group or network of providers – and that network or group can change at any time. Also understand that service coverage may be limited. Just because somebody has insurance coverage does NOT mean the insurance will, in fact, cover every necessary treatment.
For example, you know cosmetic or elective procedures would not be covered. But what about non-frequent procedures like a transabdominal cerclage? Or genetic testing for things like MTHFR? Very often, procedures are NOT covered – and people don’t find out until the need arises. There is no way to get a copy of what is covered prior to signing up, and insurance companies have no obligation to keep covered services the same for the length of your membership. Hear that again: covered services fluctuate and insurance companies are under no obligation whatsoever to cover anything. Reassuring, huh?
You are also not eligible to begin/end your membership with the insurance company at any time – you can enroll or decline to re-enroll at the end of the insurance year (called open enrollment) or a qualifying event such as death, divorce, or employment termination can get you into or out of that plan. IF you have a qualifying event, also know you can look into COBRA to extend coverage. For example, if you are laid off, you will be allowed to still participate in your existing insurance plan for up to 18 months (you can un-enroll at any time), but you incur the full cost with no employer contribution.
Private insurance secured individually
The required understanding for this is the same as a group plan through your employer. However, nobody will necessarily be contributing to your monthly premiums (as the employer does). And obviously COBRA doesn’t apply here, either. Often the premiums are similar to an employer group plan, but the deductibles and out of pocket maximums may be significantly higher. Perhaps you make the amount of money that allows for some sort of federal assistance on this, in which case you must secure your plan through the ACA marketplace. If you are not looking for federal assistance on this, you can still purchase through the ACA marketplace if you want. Or you can contact individual companies for other plans. The marketplace plans are still individual plans – they are just plans earmarked by private insurance companies as plans eligible for federal assistance.
I find the best approach for considering this option – federal assistance or not – is to contact a private insurance agent. We adore Dave Ramsey’s ELP program and found Marvin Greer through him about six years ago. We don’t pay Marvin anything – not sure how he makes his money! – but he has the heart of an educator and truly wants what’s best for your family and helps you to analyze and decide various options. Marvin can be contacted at 877-632-6418 or via email at firstname.lastname@example.org.
Short-term medical plans
These plans can be purchased in 30 day increments through a variety of private companies. Again, I recommend utilizing an insurance agent like Marvin Greerto help sift through quotes. These will not satisfy federal guidelines and tax penalties may occur depending on how long you carry it instead of a qualifying plan, but they will work for catastrophic coverage (which is another term for these types of plans). The key with this approach is to not plan on using it. The premiums are very reasonable, but the deductibles and out-of-pocket max are incredibly high. Also, if you get coverage for x during one term, x will then be considered pre-existing for the next term and not covered. Be sure to ask your insurance agent all the ways these short-term plans are different than the insurance you already know.
For our family, we did end up carrying a short-term plan for a set time period and it worked well for us – probably because we never utilized it.
Medical ministries are groups of people who unite around sharing the costs of each other’s health care needs. Several groups exist and each have different ins/outs, but they are well worth exploring. The commonality between all the medical ministries is a commitment to living in a way that honors Jesus Christ. A statement of faith is required and some of the ministries require church membership and attendance verification via clergy.
Beyond that, each medical ministry group varies in monthly cost and incident coverage.