Updated on 04.20.16

The Complete Guide to Health Insurance

Jennifer McCarthy

The state of health insurance today is one of America’s most heated debates. The Affordable Care Act, widely referred to as Obamacare, aims to revamp the American health care industry, and some provisions of the Act are already kicking in. In this rapidly changing environment, it pays to be aware of the fundamentals, and to compare rates to ensure you are getting the best health insurance plan for your needs.

As an informed consumer, understanding the building blocks of health insurance can help you avoid confusing, even misleading, lingo, which will ultimately end up saving you money. Regardless of the particulars of any plan, some concepts are applicable to all of them.

This guide will take you through the health insurance essentials, teaching you how to go about making the stressful financial and medical decisions without compromising your coverage.

understanding the building blocks of health insurance can help you avoid confusing, even misleading, lingo, which will ultimately end up saving you money

I. Health Insurance Fundamentals

A. Coverage Options

Currently, insurance plans fall into two categories: group coverage and individual coverage. Group plans are provided by an employer, government agency or worker’s union while individual plans are negotiated between an individual policyholder and their insurer. Generally, group coverage is less expensive because the provider pays most of the premium for the user.

Group Plans

If a group insurance plan is available to you, it will probably provide more comprehensive coverage than an individual plan. This is because group plans pool policies within an organization and ultimately reduce costs for insurers. Under these plans, you’re more likely to be covered for maternity care, well-baby services, preventive care, vision and dental care.

Keep in mind that the way your group plan is set up can make a difference. Group plans are either self-funded or fully insured. What this boils down to is who makes decisions regarding your coverage.

Self-Funded vs. Fully Insured Group Plans

In a self-funded plan, your employer pays all medical costs and assumes all risk for its employees. Instead of paying a fat premium to a partner insurance company, self-funded plans are allowed to calculate a maximum annual risk and then keep that amount in reserve until it might be needed. For instance, if it’s anticipated that a company’s maximum risk is $1.5 million per year, the company is allowed to keep that money and even invest it. At the end of the year, anything that wasn’t spent out of these funds goes back into the company coffers.

In what’s called a fully insured plan, an employer partners with an insurance company and pays it a premium to manage its employees’ health care claims. The premium amount is based on the company’s maximum annual risk, and the insurer assumes all administrative and legal responsibilities related to claims management. If we use the same example as above, the $1.5 million potential risk is paid directly to the insurer, where it remains regardless of what is spent.

A key difference is that self-funded plans are exempt from state laws, which govern fully insured plans. This leaves your employer with considerable leeway in deciding what kind of coverage you get and whether an expensive surgery or procedure will be approved. If, for example, a benefit included in the plan ends up costing your employer more than they bargained for, they are freely allowed to rescind that benefit if they so choose. State mandates that dictate the breadth of coverage do not apply to these plans.

Self-funded plans are cheaper for employers and are often promoted to employees, but they operate in the company’s best interest, not yours

If you appeal, you are appealing to an employer, not an insurance company. Your only access to legal action is in Federal Court, should it come to that. If your group health insurance plan is self-funded, be sure to carefully inspect the details of your coverage. Self-funded plans are cheaper for employers and are often promoted to employees, but they operate in the company’s best interest, not yours.

Individual Plans

Individual plans are sometimes referred to as single-payer plans. You purchase an insurance plan independently from the open market and your employer is not involved. Single-payer plans are generally much more expensive than group coverage and provide limited coverage.

Expanding Your Individual Plan

For a fee, single-payer insurers offer additional riders to cover specialized expenses like pregnancy and labor and delivery. This excess cost is charged to you because you are not part of a large pool of insureds and the insurance company’s risk is higher.

Example: Scott and Zelda, a married couple, both have group coverage through their employers. Scott’s plan is fully insured and meets all requirements of New York state, including pregnancy/labor and delivery coverage. Zelda’s plan is self-funded and doesn’t answer to New York state mandates. Scott and Zelda would like to have a baby, but due to a company-wide outbreak of pregnancies last year that cost Zelda’s company a fortune, her employer no longer provides pregnancy coverage.

The couple has three options:

  1. Modify Zelda’s plan with an added rider that covers pregnancy and pay a higher premium
  2. Pay out of pocket for all pregnancy-related expenses
  3. Delay pregnancy until the next open enrollment period at Scott’s company, when Zelda can be added to Scott’s plan and receive the same comprehensive benefits at a reasonable cost
Massachusetts vs Minnesota Health Insurance

Consider how widely coverage options can vary by state. This is a comparison of health insurance in two states, Massachusetts and Minnesota. Click image to enlarge.

If you cannot afford an individual plan that covers your needs, there are other options. Public insurance refers to Medicare, Medicaid and other state-based coverage programs. Currently, the qualifications for these programs are determined by age, disability status and income, and they can vary by state.

But if you haven’t qualified for these programs in the past, you may soon–one of the major features of Obamacare is the expansion of public insurance eligibility. By the start of 2014, for example, new provisions from the Affordable Care Act will come into effect and an additional fifteen million low-income Americans will qualify for Medicaid.

If you cannot afford an individual plan that covers your needs, there are other options

B. Cost Terminology

Regardless of where your insurance plan comes from or how it works, all of them have cost-sharing methods in place. A premium is simply a monthly bill that keeps your insurance policy active; sometimes this may be partially or wholly paid by an employer.

While they structure them differently, all insurance companies use three specific cost-sharing mechanisms: co-pays, deductibles and coinsurance.

Co-pays are flat fees that consumers must pay when receiving a medical service. These are fixed amounts and specified for things like emergency room visits, primary care physician visits or specialist visits.

  • Your co-pay is the amount you pay for each prescription refill or doctor’s visit. (Usually this is around $15-30, respectively.)

Deductibles refer to an out-of-pocket expense ceiling that you must meet before some facets of your plan begin to pay. Deductibles apply to a given benefit period, usually of one year at a time.

  • For instance, you may be expected to pay the first $1000 toward any hospital visits before your plan begins to cover expenses.

Coinsurance stipulates that the insured pay a certain percentage of the total cost for services; this feature commonly kicks in after deductibles are met.

  • Many coinsurance plans involve an 80/20 split in which you assume 20% of costs and your insurance plan covers the remaining 80%.

Flexible Spending Accounts, or FSAs, are pre-tax deductions from your wages that can be applied toward health care in a given benefit period. If an FSA is part of your insurance coverage, you can use these funds for co-pays, coinsurance bills, over-the-counter products and other out-of-pocket spending. This savings tool has been tweaked by the Affordable Care Act. As of 2010, FSA contributions are capped at $1,200 per plan year for individuals, a considerably smaller amount than many users once opted to save. The IRS is reviewing acceptable expenditures and whether unused funds may be rolled over or refunded at year’s end; new details about FSA use will be reported here as they emerge.

  • If you are offered an FSA and anticipate any out-of-pocket expenditures, opt for the FSA; the tax savings are considerable.

II. The Current State of U.S. Health Insurance

It’s been two years since the Affordable Care Act passed Congress, but it will be years before public officials can truly evaluate its success. This is because many of the bill’s provisions are not yet legally effective and those that are are still quite new.

Of course, publicly funded U.S. health care has its fair share of skeptics. For many of the 64.2% of Americans that are already privately insured, these changes can seem unsettling or confusing. And those of us who do have private group insurance may not want to miss out on the advantages.

It’s important to remember that while initial cost is definitely a primary concern, insurance policies should be evaluated with more than cost in mind

A. The Advantages of a Private Policy

  • Choice: Most sponsors of insurance, whether an employer, union or association, offer several group coverage options from recognizable brands like Aetna, Humana or Blue Cross & Blue Shield. Users have the luxury of choosing the plan that best suits their needs from a number of options. This also creates a competitive marketplace for the insurance companies and drives them to create better products.
  • Affordability: Group plans by definition have a large pool of users that spreads risk out among the group so costs are lowered for everyone in the plan. This also has the added benefit of attracting more users to participate; ultimately, fewer Americans may forgo insurance entirely. That means your tax dollars won’t be spent on medical care for the uninsured.
  • Risk Management: Large groups of insured in a private plan all pay the same premium, so an employee with a chronically ill spouse pays the same as her healthier co-workers for a family plan. Mitigating the risk of cost over a large group allows insurers to charge lower premiums to the everyone, meaning less money out of your pocket.
  • Effective Payment: Premium payments made by a large private entity are more reliably paid, as are claims for medical services. Individuals responsible for premium payments may pay erratically or late, or may even skip payments in lieu of other expenses. Under-insured and uninsured citizens’ health care is paid by your tax dollars.
  • Enhanced Job Market: Companies strive to be attractive places to work, and offering comprehensive health insurance is considered a major benefit. Additionally, promoting an attitude of wellness and health maintenance not only makes the workplace more pleasant, but it reduces company losses from paid sick days and loss of productivity.

While on the surface group policies appear to be the least financially restrictive, in some cases they may not be the best option for you and your family. It’s important to remember that while initial cost is definitely a primary concern, insurance policies should be evaluated with more than cost in mind.

B. Limitations of Private Policies

  • Restricted Options: While we may be given a handful of insurance options, it’s not the same as we would find on the open market. Many companies push their self-funded plans to employees, sometimes offering bonuses or other incentives to choose a plan that best serves the company. In smaller companies there may be no choice at all. Choosing something as important as health insurance should give us the same autonomy we have choosing auto insurance, for instance, but it doesn’t.
  • Insurance Networks: You must operate within your plan’s framework and see only plan-approved doctors if you want your expenses covered. If you have a tricky medical condition, this can be problematic. Some plans will cover out-of-network medical services at a lower rate, but in the end, this means more out of your pocket. If you travel frequently and find yourself ill and away from home, you may end up paying the full price for your health care. Single-payer insurance, while expensive, offers more flexibility.
  • Tax Implications: Many users of group insurance are able to have premiums deducted from their pay prior to taxes. Single-payer insureds have no choice but to pay premiums with after-tax dollars, and health insurance for the self-employed is only partially deductible.

C. What is Public Insurance?

As our economy has struggled and unemployment has soared, the number of privately insured Americans is dropping. In their place is a rising percentage of the population using public health insurance; 15.9% of us are recipients of public health programs. While Obamacare will change the face of public health insurance in America, as it stands now there are three types available.

  • Medicaid is a state-managed program that provides health insurance to those who cannot afford it, to children in lower-income families and sometimes to the disabled. Eligibility is based on income; while each state has its own rules, income requirements are usually tied to the federal poverty line. Disabled adults who don’t meet Social Security guidelines for Medicare assistance may also qualify.
  • Medicare is also state-managed and is eligible to seniors over age 65, disabled adults who receive Social Security benefits and to citizens with end-stage renal disease. Medicare uses a combination of government funds and premium payments for its programs, and works much like a group insurance plan. You’ll find a more extensive breakdown of Medicare plans in Part V of this guide.
  • Each state also offers coverage for high-risk individuals who are uninsured. Since having a pre-existing condition can currently prevent you from acquiring health insurance, the Pre-Existing Condition Insurance Plan (PCIP) was developed to extend coverage to high-risk individuals who have gone without insurance for 6 months. PCIP coverage is relatively expensive (about $650 a month in Illinois) but is available for individuals who meet eligibility requirements.

The type of insurance plan that best meets your needs may very well be driven by the stage of life you’re in. As you’ll see in the Parts III and IV to follow, your coverage needs will change substantially from when you are a college student to when you start a young family.

The type of insurance plan that best meets your needs may very well be driven by the stage of life you’re in

Making an informed choice about your health insurance should be based on an understanding of your specific needs.

III. Health Insurance for Young Adults

A. College Students

Thanks to the Affordable Care Act, college students may now be covered under their parent’s insurance policy up to their 26th birthday. The ACA also instituted new mandates for what campus insurance will cover. Previously designed for healthy young adults who likely only needed coverage for catastrophic events, campus insurance plans now function as full-service plans with comprehensive coverage. Plan benefits can be extensive, often including maternity coverage, substance abuse treatment, vision and dental care.

Usually, universities collaborate with a third-party insurance provider and bill premiums to student accounts. While the expansion of coverage mandated by the ACA has driven up the cost of premiums at many schools, campus insurance is still generally cheaper than purchasing an individual policy. Premiums for an academic year range from a few hundred bucks to a few thousand.

Some students can’t stay on their parents’ insurance plan, such as in my personal experience. My oldest daughter attends an out-of-state university and our family policy doesn’t extend to every state, notably not to the one where she goes to school. We purchased campus health insurance for her; she has a pre-existing condition so we were relieved she could get comprehensive coverage.

However, campus insurance plans frequently have high deductibles and relatively low caps on plan payouts to service providers. For example, some plans cap covered expenses at $50,000 to $100,000. In cases of catastrophic injury or illness, that cap can be reached in a matter of hours. And it’s not uncommon to see deductibles as high as $3,000 and co-pays for office visits at $75. The potential out-of-pocket costs lead some families to carry dual plans for their student; often a family plan can make up some of the gaps in campus insurance, but you still bear the expense of paying two premiums.

Most students must use the campus health center as a primary source of treatment; when necessary, universities will refer students to specialists. Pre-existing condition restrictions are not uncommon, and some schools do not insure students over the summer or pay claims made at a distance from the university. Coverage may mimic either an HMO where in-network claims are covered at 100% or a PPO with the standard 80/20 cost split.

B. Single Young Adults

Newly minted college graduates face a health insurance choice. No longer covered by campus insurance or on the family plan, some young adults reason that since they’re young and in good health, insurance isn’t a worthy expense. But we can’t predict illness or injury, no matter how many good health habits we practice. The costs of a sudden hospitalization or the need for urgent tests have driven 62% of all bankruptcy filings in the U.S.; it’s much wiser to spend your money on premiums now than face staggering debt for years to come.

Consumer Price Indices for Insurance

Young people who are considering foregoing coverage to save on monthly expenses should consider the recent and rapid inflation of emergency medical care costs. This graph demonstrates that the costs of medical supplies and treatments rise much faster than other U.S. consumer expenses–even famously inflationary expenses like auto insurance. (Notice that hospital care costs rose at three times the rate of general consumer products since 2003.) Click image to enlarge.

If you’ve previously been covered under a family insurance plan, you can opt for Continuation of Coverage (COBRA) to extend the policy’s coverage for up to 36 months. COBRA is expensive; you pay 100% of the premium your parents may have only paid a small percentage of. But if you’re still looking for a job with health care benefits, COBRA can be a good short-term option for you. COBRA does not apply to campus insurance policies.

If you’re employed, your choices are to purchase an individual plan or opt in to your employer’s health plan. Employers often pay part (sometimes most) of the premium, which offers a financial advantage over buying your own plan. Today’s job market is unstable, though, and some feel that the risk of losing a job and the insurance that goes with it outweighs the price. If you’re confident in your health, you may be comfortable with this risk.

If you have ongoing health problems, you may experience more peace of mind knowing that your medical care isn’t going to be disrupted if you lose your job.

Let’s break down some basic costs. Using the Kaiser Foundation’s Employer Health Benefits 2012 Annual Survey, we can estimate your out-of-pocket cost for health insurance as follows:

Average cost of employer-sponsored group coverage for a single adult: $472 per month
Average premium percentage paid by employees: – 12%

$84.96 per month

it’s much wiser to spend your money on premiums now than face staggering debt for years to come

In our alternative example, to purchase comprehensive insurance from Blue Cross, with riders added for critical care, maternity, vision and dental coverage, your cost would be $723.67 per month before deductibles and co-pays. Obviously, cost is considerably higher than for similar group coverage, but the policy would never be dependent on your employment status.

IV. Young Families and Their Health Insurance Needs

When you marry and consider starting a family, the big picture changes when it comes to insurance needs. This is a time to investigate every option you have so that you make the best choice for your growing family. You may both be employed and have two different employer plans to choose from, or you may consider it wiser to pre-empt employer-sponsored plans and purchase your own.

A. How Do I Choose?

Costs are the primary consideration when most people choose an insurance plan. In a recent study by Kaiser Health Tracking, half of Americans tried to reduce their healthcare costs by skipping preventive care and delaying a doctor’s visit when they began to experience symptoms of illness. This is unwise; much better to select a policy that’s both affordable and understandable.

Three U.S. governmental departments – Health and Human Services, Labor and the Treasury – teamed up to create a document called a Summary of Benefits and Coverage, or SBC. This document is designed to help you compare policies, using standardized language to break down exactly what coverage you are being offered. You have the legal right to request an SBC when evaluating plans; a glossary of terms should also be available to you.

half of Americans tried to reduce their healthcare costs by skipping preventive care and delaying a doctor’s visit when they began to experience symptoms of illness. This is unwise

There are several variations of health insurance plans that you may encounter in your search.

  • PPOs: Preferred Provider Organization plans, or PPOs, cover participants within a specific hospital and physician network. PPOs will cover out-of-network costs at a reduced rate. Typically, PPOs split the cost with you after the deductible is met. 80/20 plans, which take 20% of costs out of your pocket in addition to the premium, are common.
  • EPOs: Exclusive Provider Organization plans are much like PPOs, with the exception that no out-of-network charges will be covered by the plan. In some cases, the plan may cover out-of-network costs for emergency room visits.
  • HMOs: Health Maintenance Organizations (HMOs) are built around a strict arrangement with participating providers in a network. If you stay within this network, usually based on where you live, coverage is often 100%. Because the providers in an HMO are under contract, premiums are usually lower.
  • POS: Point of Service plans are a hybrid of PPOs and HMOs, and allow reduced coverage of out-of-network medical services. Three tiers of services are available: use a contracted HMO provider and pay no co-pay; use an in-network PPO provider and pay a co-pay; or see a provider outside of the network and, after your deductible is met, split the cost by a percentage rate.
  • HDHPs: High Deductible Health Plans are structured to provide you with tax savings. The plans themselves may be associated with an HMO or PPO and are tied to Flexible Spending Accounts (FSAs). An FSA provides you more flexibility in spending your healthcare dollars, allowing you to set aside pre-tax funds to use toward future medical expenses. Typically, HDHPs have higher deductible than other plans and preventive care does not count toward the deductible. Since FSAs are currently under IRS scrutiny, the future of HDHPs in the healthcare market remains unclear.

Premiums are generally the first thing we consider, since this is often a paycheck deduction. However, there is much more to cost than a premium. Questions to ask when evaluating your potential out-of-pocket costs could be:

  • Do I want a safety net for catastrophic events or do I want comprehensive coverage?
  • Is my family typically healthy with few needs for medical services, or does a family member have chronic illness that requires monitoring?
  • Do I or any family members have jobs or hobbies that are risky?
  • How much of the premium will my employer pay?
  • What are the deductibles for each type of service?
  • What coinsurance is offered after my deductible is met?
  • Do I want prescription coverage?
  • Do I require brand name drugs or can I get by with generics?
  • What are the specific co-pays for each kind of service?
  • Is there an annual or lifetime limit to what the insurer will pay?
  • What policy provisions increase or decrease my deductibles?
  • Is there a maximum out-of-pocket expense where my plan begins to cover everything?
  • How restricted is my provider network?

Choosing an insurance plan can be mind-boggling, and it’s often difficult to distinguish the particulars of one plan from another. Even if you are fortunate enough to have several employer-sponsored plans to choose from, it is probably worthwhile to price-compare against single-payer plans on the open market.

B. Young Families

Couples who are both employed may face a decision on which employer-sponsored plan to choose a lucky problem to have. Whatever the source of your health insurance, there are certain particulars about this stage of life that should be taken into consideration. If you’re planning on having children, the list of requirements increases.

Some questions you could ask yourself when choosing an insurance plan for a young family might be:

Will we both continue to work indefinitely?

If one of you decides to stay home when children arrive, consider all of the changes going from a single policyholder to a family policy. Evaluate potential costs and investigate coverage for children before they arrive. If the two of you are covered on one employer-sponsored policy, does it still make sense to use that policy when you have children?

Is a Flexible Spending Account an option?

FSAs allow you to deduct funds from your paycheck prior to tax deductions; these funds are designated for medical expenses and can cover many over-the-counter expenses and co-pays. Using pre-tax dollars to meet these expenses can add up to considerable savings, especially when little ones are so prone to the sniffles.

How is pregnancy and childbirth covered?

Examine your policy for details about prenatal vitamins, prenatal testing and screening, emergency procedure and delivery options. If you are considering an alternative birth, such as a home birth or use of a midwife, ensure that those options are covered or set aside funds for the out-of-pocket expense. Otherwise, consider the costs and advantages of purchasing additional coverage with a rider.

Is well-baby coverage offered?

Within their first two years of life, children need frequent visits to the pediatrician for vaccinations and examinations, regardless of any illness or injury concerns. Well-baby coverage can make the expenses of managing a newborn’s or toddler’s health much more manageable.

Do I have a choice in my child’s pediatrician?

Choosing your child’s doctor is an important decision. Make sure that you have enough options to adequately research potential candidates, and ask for background information on medical school, residency and other training in pediatrics. Many new parents like to interview pediatricians before the baby’s arrival; inquire whether your plan will cover these visits if you are charged fees for them.

When must I register my newborn or newly adopted child?

All insurance companies have a window within which you can add a dependent outside of the normal open enrollment period. While it is generally around 30 days, don’t make that assumption without first checking with your plan. If you miss the registration window, you may have to wait until the next open enrollment period for your child to have health insurance.

Using pre-tax dollars to meet [over-the-counter expenses and co-pays] can add up to considerable savings, especially when little ones are so prone to the sniffles

Starting a family is an experience that will use up every ounce of your strength, your courage and your ability to function without sleep. Health insurance is not something you need to hassle with during this time, so make your choice wisely.

V. Health Insurance Concerns When Approaching Retirement

Regardless of your insurance status as a working or retired adult, you qualify for Medicare coverage on your 65th birthday. Medicare is a complex system designed to provide public insurance to workers in retirement age, and is at this point guaranteed to every American.

For many seniors, joining Medicare is a seamless transition from employer-sponsored health care or more expensive single-payer plans. Unfortunately, the U.S. is foundering in debt and the Medicare program is strained for funding. While details have yet to be hammered out, the Affordable Care Act hopes to address these funding issues.

The Nation's Health Care Dollar Visualized

Historically and today, Medicare ranks as one of the country’s highest health expenses. Above is a breakdown of how each U.S. health care dollar was spent in 2011. Notice that Medicare is the second highest expenditure, costing 21 cents on every dollar spent. One of the primary aims of Obamacare is to reconfigure the budget so that high-cost, high-value programs like these can be retained. Click image to enlarge.

Functioning as a group plan backed by the government, Medicare is funded partially by tax dollars that you contribute your entire working life. Low-cost premiums and deeply discounted prescription pricing make this an affordable and attractive option for many people, including disabled citizens on Social Security and end-stage renal disease patients. There are numerous plan structures available, all with nationally recognized insurers who partner with the government to provide medical care to this patient population.

A. The Ultra-Basics of Medicare

Part A: Medicare Part A essentially covers any billable charge related to a service received at a medical facility, such as hospital admissions, nursing home care, home health services, skilled nursing services and hospice. There is no premium for Part A coverage. If your doctor has accepted Medicare assignment, you will be responsible for reduced co-pays and deductibles as per Medicare guidelines.

Part B: Medicare Part B covers any medically necessary expenses to manage your health, including preventive services. This covers doctor’s office visits, ambulance service, mental health expenses, medical equipment and the cost of a second opinion before surgery. Part B requires a premium, and most people who paid taxes into the system pay a little over $100 per month.

Drug Coverage: Plans strictly related to prescriptions operate independently of Parts A and B. Drug coverage is purchased from a private insurer or a Medicare-approved private company. Each insurer maintains a formulary, a list of covered medications, that usually breaks drug products into tiers. Your out-of-pocket costs include a monthly premium, an annual deductible, prescription co-pays according to tier and extra costs if you exceed the plan’s annual spending cap. You may not purchase drug coverage from Medicare if you do not have Parts A and B.

Medigap Coverage: Since Parts A, B and D can still leave you with substantial out-of-pocket costs that could be burdensome on a fixed income, Medicare has allowed the purchase of supplemental insurance plans. These plans are purchased independently from an approved insurer and require an additional premium, but can go a long way toward meeting the expenses that Medicare doesn’t cover. Medigap plans do not cover prescriptions and can only cover one individual.

This information barely scratches the surface of the complexities of the Medicare system. In later articles I will discuss Medicare Advantage (Part C), tips and tricks on navigating the system, and delve into how to research and choose the right plans for you each step of the way.

VI. The Changing Face of Health Insurance in America

It’s more important than ever to understand the ins and outs of health insurance. The hotly disputed Affordable Care Act was deemed constitutional by the U.S. Supreme Court in June 2012, and now it’s here to stay. While the scope of the legislation’s impact is somewhat murky, its provisions will affect every American at every stage of life, impacting college students and small business owners alike.

  • For college students and their parents, one of the first changes was a boon. Previously, students were limited to either campus insurance (see Part III) or single-payer plans (see Part I). Campus insurance, while low-cost, was not intended to serve as a comprehensive health plan. Single-payer plans that provide better coverage have always been pricey, and up to one-fifth of U.S. college students simply gambled on their youth and went without health insurance. This risk is no longer necessary.
  • Young adults beginning their career have also already benefited from Obamacare. New graduates can take advantage of ACA legislation that allows them to remain on a family plan until age 26; a survey by the Centers for Disease Control (CDC) attributed the subsequent 6% drop in uninsureds in that age group directly to the new legislation. The act’s prohibition of discrimination due to pre-existing conditions, effective Jan. 2014, also makes transitioning out of campus or family insurance plans easy for young adults with chronic illness.
  • Young families have already experienced some positive changes and can expect more in the near future. As of Jan. 2014, health plans are no longer able to impose lifetime benefit caps; if your child is sick, you can rest assured that your health plan can never suspend coverage. Employer-based group plans are also required to cover birth control, which may assist to your family planning efforts.
  • American seniors (and other citizens who are eligible) perhaps stand to benefit most from the ACA’s changes to Medicare. The much-reviled donut hole that can cost thousands of your out-of-pocket dollars will be phased out. Preventive services that once fell under co-pay and deductible restrictions will also be offered free of charge, making it possible for you to proactively maintain your health at less cost.

Most of the details have yet to play out, leaving many of us with a questionable understanding of the new laws. We’ll focus on individual provisions of the Act, explain what they mean for your wallet and when new changes take effect. Be a part of the national discussion on health insurance reform here on The Simple Dollar.

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