Introduction:
Health insurance lasts for some time, depending on your circumstances. You can choose to go with a short-term plan that provides coverage for only six months, or you can choose something that extends coverage for a number of years. Many people do not know how long they have to pay for health insurance.
I used to work for a large health insurance company and we would always tell our clients that they have 60 days after receiving the bill to pay it. All of this information is important to know so you can make educated decisions that will help you sleep better at night.
Paying for health insurance is just one part of the equation, with everything else about signing up for a plan, choosing a doctor, and dealing with claims all being equally important. The health insurance bill is a complicated nerve-racking experience.
Until you turn 26
If you’re under 26, you can stay on your parent’s health insurance until you turn 26. After that, you can get coverage through the Health Insurance Marketplace or from a private insurer.
If your parents don’t have health insurance and you’re not covered by another source, like a student loan, then you’ll need to pay for coverage yourself.
If your parents do have insurance through their job or some other source (like a retirement plan), they may be able to keep paying for it if they want to keep getting coverage. But if they decide not to use it anymore, they’ll need to find another way of paying for their own health care — like signing up with HealthCare. gov or with a private insurer.
As long as you are a full-time student, you can get health insurance coverage through your school. You’ll need to pay the full premium, but your school will bill the insurance company directly and then forward the bill to you.
If you’re younger than 26, you can’t get health insurance through your job. You may be able to get coverage through one of the following ways: If you’re under 26, the amount will depend on whether your parents have some sort of health insurance plan through their employer or are self-employed.
If they don’t have insurance, they may qualify for Medicaid, which provides health coverage for low-income people. If they do have insurance and are still paying it off from years ago, consider buying yourself a few months’ worths of coverage to tide you over until you can get into the system.
If you lose your job
If you lose your job and your health insurance stops, you have 60 days from the date of termination to enroll in COBRA coverage. If you didn’t have COBRA coverage before and go without it for more than 30 days, you’re eligible for Medicaid or Medicare coverage if you meet income requirements.
If you lose your job and don’t get a new one, or if you quit your job for another reason, your health insurance will end.
If you are covered by COBRA and you lose your job, the employer pays the cost of COBRA coverage for up to 18 months after the date of termination. If the employer doesn’t offer COBRA continuation coverage to its employees, then the employee must pay 100% of the cost of COBRA coverage during that time period.
If you are covered by COBRA and have a limited-duration group policy that expires within 12 months after losing your job, the premium paid through this policy will continue until it runs out. The premium will then be due in full on a prorated basis until it runs out again.
When you lose your job, you will have to pay for health insurance yourself. You may also receive a health insurance subsidy if you are eligible. If you are under 65 years old and not covered by an employer-sponsored plan, you will have to pay for your own health insurance.
If you are 65 years old or older and not covered by a spouse’s plan, or if the spouse has stopped working, you may be eligible for Medicare.
If your employer offers health benefits and they were not fully paid for by the employer, you may be eligible for COBRA coverage which allows you to continue any health coverage that was in place when employment ended.
If your income goes down significantly
If you have a job, the Affordable Care Act requires you to buy health insurance or pay a fine. But if your income goes down significantly, you can qualify for an exemption.
Your income must be below 400 percent of the federal poverty line (FPL) to be exempt from the individual mandate. The FPL is $12,060 for an individual in 2019; $24,600 for a family of four.
You may qualify for an exemption if:
Your income dropped below 350 percent of the FPL; or
You had health insurance before Jan. 1, 2014, but now have no coverage because your hours have been cut back or because your employer no longer offers coverage; or You lost health insurance because your employer discontinued offering coverage (but you’re still working for that employer); or
You were uninsured from Nov. 1 through March 31, 2018, and didn’t qualify for Medicaid or CHIP during that time (if you qualified for Medicaid/CHIP before that date). If your income goes down significantly, you can apply for premium subsidies. This will lower the monthly cost of your insurance.
You also have to pay for your health insurance in advance. The amount is based on how much you’re expected to make annually for each month in the year that you enroll.
For example, if you’re predicted to make $40,000 per year and decide to sign up for a plan with a monthly premium of $1,000 and a 12% deductible (that’s $100 per month), then you’ll need to pay $48,000 ($40,000 x 12%) of your income to the insurer during the year in which you enroll.
If your income goes down significantly, you may qualify for a special category of health insurance known as COBRA, which stands for “covering other benefits.” COBRA policies are available to people who lose their employer-provided coverage because their job ends or they move to a new job.
You can choose from two types of COBRA policies:
A continuation plan covers basic health care at the same rate as your former coverage, usually for up to 18 months. A continuation with a premium assistance plan pays higher premiums than your previous policy but includes some extra benefits.
After you get married
If you’re married, you’ll get a new spouse’s health insurance coverage after your wedding. If you’re divorced, you’ll continue to have coverage under the plan your former spouse had. If your spouse dies, his or her insurance continues for a year after the death. After that, the surviving spouse can buy separate coverage on his or her own.
If you’re also covered by another policy that covers some of your medical expenses and you’re married to someone who’s not covered through his or her employer, your partner’s insurer may cover some of the costs.
After you get married, the two of you probably have to work together to make sure that your health insurance is still usable. Some married couples decide to get separate coverage, but it’s often cheaper for them to get married first and then get separate insurance later.
If you and your spouse are still working at the same place, then it’s easy to combine your coverage. You can do this by creating a family plan with your spouse or partner, but be aware that you’ll probably have to pay more for your premiums than if you had just gotten single coverage on your own.
If you’re married, your insurance company must provide you with coverage for your spouse. If you are a widow or widower, your insurance company must provide you with coverage for your spouse.
If you are divorced, separated, or have never been married, and have or had dependent children living with you at the time of divorce or legal separation, your insurance company must provide you with coverage for these dependents.
If there is no longer a legal obligation to provide coverage for dependents because they are no longer living in the same household as the employee at the time of cancellation, then the employee may purchase health insurance from any insurer.
After a divorce or legal separation
If you are divorced or legally separated, you will have to pay for your health insurance for the rest of the year. If you have a job that provides health insurance coverage, you can continue to use it until your divorce is finalized and your ex-spouse no longer has access to it.
If your ex-spouse has health insurance coverage through work and you don’t, you can still purchase your own plan and it will be available when the divorce decree is finalized.
The short answer is that you don’t have to pay anything for health insurance until you’re covered under your new spouse’s plan. The longer answer is that the rules are a little more complicated than they seem. There are two things to keep in mind:
When you get married, you’re automatically covered by your spouse’s plan. Your new spouse will pay their share of the premiums, and you’ll pay yours.
If you get divorced or legally separate from your spouse before being covered by their plan, then you’ll be covered by COBRA (the Consolidated Omnibus Budget Reconciliation Act). You’ll have to pay the full premium for this coverage, but it will end when your new spouse joins their spouse’s plan.
So while it seems like there’s no point in waiting until after the wedding, there actually isn’t any reason not to wait until after the divorce or legal separation date (which can be up to nine months post-divorce).
If you’re unemployed
If you’re unemployed, you have to pay for health insurance for at least three months before you can get unemployment benefits.
If you’re self-employed and not working for someone else, your employer must provide health insurance coverage that would be available to an employee. If you’re employed by someone else and not making enough money to buy your own health insurance, your employer must provide health insurance coverage that would be available to an employee.
If you work at a small business with fewer than two employees and are self-employed, the company may offer its employees health benefits as part of the company’s plan. Or if it doesn’t offer health benefits and you want them, you should ask your employer to let you enroll in its plan.
If you’re unemployed and not eligible for COBRA coverage, then your employer will provide health insurance through COBRA continuation coverage. If you are covered under a group plan, your group’s insurer may pay your COBRA premiums or bill them to the company that pays your salary.
You have 30 days after leaving employment to enroll in COBRA continuation coverage. This allows time to look for a new job so that you can become covered again.
If you are on Medicare
If you are on Medicare, your premium will be deducted from your monthly checks. If you have other health insurance, check with your provider to see if they participate in Medicare and if so, what the cost is. If you are not on Medicare, the cost of health insurance depends on the type of plan you choose and whether or not it covers prescription drugs.
If you are on Medicare, you have the option of paying for your health insurance with a monthly premium and a co-payment. Medicare Part B covers various medical services. If you use Medicare Part B, you will need to pay a monthly premium for it. The premium covers the cost of your medical care.
There are two different types of premiums:
The initial premium is the first month’s premium, plus a monthly maintenance fee that is paid every month for as long as you have coverage under Part B. The maintenance fee is the only amount you pay each year.
The annual deductible is the amount that you must pay before your plan starts providing benefits. The deductible is usually between $1,000 and $2,500 per year depending on your age and other factors. This amount may include both inpatient and outpatient costs as well as prescription drugs.
If you are on Medicare, the answer is “as long as you want to be.” Medicare Advantage plans, which cover an additional layer of benefits, can cost up to 15 percent less than traditional Medicare. But they also have a higher deductible and out-of-pocket maximum.
In general, if Medicare is available through your employer or through a plan purchased through the Marketplace, you can keep it.
If not, but your employer offers retiree coverage or other supplemental plans that pay for some or all of your health care expenses, consider enrolling in one of these plans if it offers better value for your money than traditional Medicare would provide with its higher premiums and deductibles.
Conclusion:
If you purchased a plan through the Health Insurance Marketplace, the answer is easy: the one-year requirement (at least) remains in place. If you’re not sure whether or not you bought a Marketplace plan, then take a look at your insurance card. If it says “Obamacare” or “ACA,” then you have Marketplace.
In truth, the length of your COBRA coverage is dependent on whether you competed in a qualifying event after March 30, 2010, and if you satisfied other eligibility requirements. We’ll explain more about these eligibility requirements below. If you’re offered coverage by your employer, then the answer to this question is likely “as long as you work there.”
In other words, if your employer offers health insurance coverage, then it’s expected that you’ll avail yourself of that benefit for as long as you are working for them. On the one hand, this isn’t surprising — after all, health insurance is designed for people with ongoing healthcare needs, which means that it isn’t some one-time expense.
