Understanding the different kinds of health coverage that may be available to you
When you are looking for a plan to cover your health care needs, and perhaps those of your loved ones, it can be confusing to know what your options are and what you might be eligible for. And there could be a lot of factors that come into play, such as how old you are, where you live and your level of income.
But the good news is, no matter your circumstances, there’s a health plan that can work for you. Access to affordable health care coverage is more attainable than you might think. If you have questions about the different types of coverage being offered and who might be eligible, here’s a quick guide to help.
For the 170-180 million Americans with employer-provided coverage, many employers set aside a two- to three-week period between September and December when their employees can select health benefits for the following year. A lot can change in a year, so if you have employer-based coverage, consider whether your current benefits are still meeting you and your family’s needs and see what plan changes your employer has made in the options offered. If you are unsure about your options, check with your employer.
This is a federal program that provides health insurance for people 65 years and older, with certain exceptions for those younger than 65. There are several types, or “parts” of Medicare.
- Parts A (hospital insurance) and B (medical insurance) are considered Original Medicare.
- Part C is what’s also known as Medicare Advantage, and combines Parts A and B and usually includes prescription drug coverage. These plans often also offer additional benefits such as dental, vision and fitness.
- Part D plans are stand-alone plans that help pay for prescription drugs. Part D plans may be added with Original Medicare and/or a Medicare supplement insurance plan, as well as with certain Medicare Advantage plans that don't include prescription drug coverage.
- Medicare supplement insurance plans, also known as Medigap plans, help pay some of the out-of-pocket costs not paid by Original Medicare.
This is a federal health insurance program that is managed by each state, so the eligibility requirements (such as income level) may differ from state to state. Medicaid plans can also provide access to care for pregnant women, children, eligible low-income adults and people with disabilities. Medicaid plans cover things like hospital stays, doctor visits, and nursing home care. Often it includes things like prescription drug coverage, dental care and more. Check with your state plan to find out if you’re eligible and what that specific plan covers. Or learn more about Medicaid.
RELATED: Understanding Medicaid
Dual Special Needs Plans: Some people are eligible for both Medicare and Medicaid. In this case, they are also able to have what’s called a Dual Special Needs Plan, or D-SNP. It combines features of both programs, but also contains benefits that are exclusive to dual plans, such as credits to buy health-related products or groceries. In 2023, there can even be benefits to help with home utilities. These plans are administered by each state.
RELATED: DSNP 101
Other Special Needs Plans include:
- Chronic Special Needs Plans (C-SNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (I-SNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IE-SNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
More information can be found here: Medicare Special Needs Plans.
Individual and Family Plans
These plans are available on the Health Insurance Marketplace, also called the Exchange. This is where Affordable Care Act (ACA) health care plans are sold, offering affordable coverage, sometimes at low- to no-cost, for you and your family. These are health plans people can buy on their own. If you do not have health insurance through a job, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or another source, an Individual and Family Plan may be a good alternative for you. To find out more about UnitedHealthcare’s Individual and Family Plans or to see if they’re available in your state, visit uhc.com/marketplace.
This time of year is when many people are choosing their health care coverage for the coming year. For people with coverage from their employer, open enrollment typically happens for two weeks sometime between September and December. Medicare members can enroll or make changes to coverage from Oct. 15-Dec. 7. Most selections made will take effect on Jan. 1.