Whether you’re a freelance instructor or a studio owner, it can be a headache to think about getting health insurance for yourself and your family. Fortunately, the Affordable Care Act has made buying your own insurance a whole lot easier. Not sure where to start? Here’s a guide to health insurance for fitness professionals, including some smart ways to save money.
Do I really need health insurance?
Part of being healthy and staying that way is preventive care. Any individual health plan you buy will cover the cost your annual physical, a well-woman exam, preventive screenings, a flu shot, and more. Plus, as you may know, an unexpected illness or injury can cost tens of thousands of dollars without health insurance coverage. Get covered to protect your body, your finances, and your business’s finances, too!
What if I decide not to get health insurance?
The Affordable Care Act’s penalty for not getting minimum essential health insurance applies to anyone who goes without health insurance for more than three consecutive months. In 2019, it’s whichever of the following is greater:
- $695 per adult and $347.50 per child OR
- 2.5% of your household income, up to the total yearly premium of the national average for a Bronze plan sold on the Marketplace
The good news is Obamacare also ensures that insurers can’t deny you insurance or make you pay a premium for having pre-existing conditions, and it offers many people subsidies that can make health insurance for fitness professionals cheaper.
Where do I start looking for coverage?
If you’re just looking for a plan for yourself and your family, you can purchase a plan through the individual marketplace (a.k.a. Obamacare) by visiting HealthCare.gov. You can also get a quote and sign up directly with an insurance company like Oscar, which offers health plans in New York, Los Angeles, Orange County, San Francisco, and San Antonio. Most plans are available for purchase directly from the insurance company or through the marketplace.
If you are eligible for financial assistance, which many individuals and families are, you’ll want to enroll in the plan you choose through the marketplace to claim your financial aid. Otherwise, it’s usually faster to enroll directly with the insurance company.
If you are looking for a plan for yourself and your employees, you’re most likely looking for a small group policy. Learn more about health insurance if you’re a small business owner.
How to pick a plan
Plans are named after metal tiers to make it easy to compare options between different companies. Healthy people generally choose Bronze or Silver plans, which are less expensive but have higher deductibles, so you pay less every month and pay more if you need care.
If you go to the doctor regularly or have an upcoming procedure, you may want a Gold or Platinum plan, which is more expensive but covers more of the cost when you get care during the year.
Under 30 and healthy? You might opt for a Catastrophic plan, which is similar to a Bronze plan but with a lower monthly premium. But you can’t apply financial aid to a Catastrophic plan. So if you qualify for financial assistance, you may find a Bronze plan with a lower premium or a Silver plan with a reduced deductible.
Still not sure? Read more about how to pick the perfect plan.
When you’re deciding on a health plan, take the following into consideration. Does the plan:
- Cover the doctors you want to see? Either call your insurer or your doctor to find out if they participate with the plan you’re considering. At Oscar, you can search to see the doctors, hospitals and drugs that are covered. Just choose your state and filter by specialty.
- Cover your prescriptions? Again, search online or call the insurance company to confirm they cover your medication and to find out which “tier” it belongs to. This can impact how your health plan covers the cost. If you need help and are looking at Oscar plans, you can speak to a plan guide (1-855-OSCAR-88) and they can help you figure it out.
- Offer any extra perks? Low copays, free access to telemedicine, and rewards programs can make a big difference in how much you spend on health care next year. Oscar offers Simple Plans which have all three!
How do I find out if I’m eligible for financial assistance?
Depending on your household income, you may qualify for one or more forms of financial assistance to make your health insurance more affordable:
- Premium tax credits: If you earn less than 400 percent of the federal poverty level for your household size ($47,520 for individuals and $97,200 for a family of four as of 2016), you might qualify for a credit that lowers your monthly insurance premium.
- Cost-sharing reductions: Depending on your income, you may also qualify for lower deductibles, copays, and coinsurance, as long as you sign up for a Silver plan.
- Medicaid or the Children’s Health Program (CHIP): When you sign up for the healthcare Marketplace, you may find you’re able to apply for these low- or no-cost health insurance programs if your income falls below a certain level.
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