The Federal marketplace open enrollment period, for the Affordable Care Act (ACA), ended on March 31, 2014 and will reopen on November 15, 2014 for coverage starting in 2015. If you need to buy your own health insurance, and you missed the open enrollment, you might qualify for a special enrollment period 30 days after a major life event.
If you qualify for the special enrollment period, you may be able to enroll in a healthcare plan with a subsidy to reduce the cost. If you don’t qualify for the special enrollment, or if you earn more than the minimum income to qualify for the subsidy, you will have to pay full price for a plan.
Although the ACA is designed to make healthcare more affordable for everyone, a large part of that depends on the subsidies. Without them, insurance may not be extraordinarily expensive, but it could cost more than you want to pay.
Still, there are ways that you can save on healthcare, even without the subsidy.
1. Enroll in a Lower Level.
If you are on the marketplace, you will notice that there are plans at four different levels: platinum, gold, silver, and bronze. All of the plans are required to offer the same basic coverage including preventative care and coverage for pre-existing conditions, like thyroid disease. The main difference between the different levels is how much of the costs are covered by the insurance company, versus how much you’ll pay out of pocket. A platinum plan usually covers 90 percent of the costs, and you pay ten percent. A bronze plan usually pays 60 percent, which means you would need to pay 40 percent. A bronze plan will also have much lower premiums.
Keep in mind that this 60/40 split does not apply to preventive care, office copays, or prescription coverage. It applies only to things like hospital stays and physical therapy.
If you are in good health, and don’t foresee any medical expenses beyond office visits and prescriptions, you could be fine with a bronze or silver plan. You would save a lot in premiums and still get the coverage you need.
One thing to keep in mind is that you can’t always predict your future health. If you select a bronze plan, it’s a good idea to put some of that money you save aside, in case you get hit with a serious illness.
2. Go Outside the Marketplace.
Just because the marketplace is available doesn’t mean you have to shop there. If you are certain that you do not qualify for the subsidy, or if you are unable to get special enrollment consideration, you could be better off going directly to the vendor.
You may find that, in certain states, companies such as USHealth Group Private and Humana both offer slightly different plans than what’s available on the marketplace. In some cases the plans could even be cheaper than the marketplace plans, before the subsidy.
You can also contact an agent, or broker, to help you compare plans from multiple providers.
3. Find a way to reduce your income.
If you did not qualify for the subsidy this year you can always try again in November, for coverage the following year.
One way to qualify is by lowering your income. You don’t need to make less money, or lie on your taxes; there are legal ways to lower your gross income to let you qualify.
For example, the upper income limit for a single individual is $45,960. If you earn $50,000, you can contribute $5,000 to a retirement account, which would lower your income enough to qualify for a subsidy.
It might not change your overall cash flow but, instead of spending that money on insurance, you would have set it aside for the future and, in many cases, tax-free at that.
The Kaiser Foundation has one of several sites to help you calculate your income, and possible subsidies.