Types of Health Insurance Uncovered

 

A guide to insurance coverage

If you have health insurance, do you know what type of coverage you have? The difference in health insurance coverage mainly comes down to the purchaser and what plan options are available to you. See our article, “Insurance Plans Spelled Out” for more information on plan types. 

Here’s a guide to the three main types of health insurance coverage. 

Group coverage

Group coverage is through a private plan purchased by employers to cover groups of people. Coverage is based on the benefits package selected by your employer. Employers may offer various plan options to employees. 

Group coverage may also be sponsored by a union. Union-sponsored plans may follow different annual enrollment timelines. 

It’s possible for people to have coverage under more than one group policy. In this situation, it’s important to understand how those plans will coordinate your benefits.  

 

Individual/non-group coverage

Individual/non-group coverage is through a private plan purchased by individuals for themselves and/or their families. It can be purchased through the Health Insurance Marketplace, also known as the Health Insurance Exchange (HIX), or directly from an insurance company. Some states have established their own health insurance exchanges while others use the federal HIX. 

The HIX offers various benefit options to fit all budgets, and plans may provide access to premium subsidies for qualified individuals. Plans can change annually and typically require annual re-enrollment. Some states offer extended open enrollment periods and special enrollment periods after a qualifying life event. 

Individuals may also apply for Catastrophic Health Insurance, an option for people who cannot afford health insurance coverage. To qualify, you must be under 30 years of age or get a hardship exemption, which you can apply for at www.healthcare.gov.  

 

Government-sponsored coverage

Government-sponsored coverage is health insurance funded by federal and/or state dollars. There are two types of government-sponsored coverage: Medicare and Medicaid. 

Medicare is health insurance funded by the federal government for people over age 65 and some people younger than 65 with disabilities or end-stage renal disease. Some people may choose to purchase a supplemental plan to Medicare (a Medigap policy) or enroll in a Medicare Advantage managed care plan. Medicare-eligible recipients are typically not able to purchase individual or health insurance exchange plans. You can learn more about Medicare at www.medicare.gov.  

Medicaid is health insurance funded by both the federal and state government for people with disabilities or low income. State Medicaid programs can vary in terms of coverage and benefits depending on how the individual state has expanded (or not expanded) their program. Many states require Medicaid recipients to enroll in a Medicaid managed care plan. State health insurance exchanges will screen applicants for Medicaid eligibility as well. Medicaid-eligible recipients are typically required to re-certify their coverage annually. You can learn more about Medicaid at www.medicaid.gov. 

 

For any questions you may have about health insurance coverage or navigating the healthcare system, your CareConnect team is just a phone call or email away. Call 1-800-745-4447, option 3, or email info@CareConnectPSS.com.