Nobody wants to pay a high rate for their health insurance. Do you? Often, most benefits are not utilized, and policies cost thousands of dollars each year. Sometimes, every month! So what’s the solution to getting free or very cheap benefits, but at the same time, maintaining high-quality coverage? Simply find a way to pay less (or nothing at all!) for comprehensive medical coverage and save your money.
Our recommendations aren’t ideal for everyone, but they might be the best option for you. We help you understand how to get federal and state subsidies, or find private coverage from major companies that offer low-cost options. Rates and/or benefits will vary from state to state. Open Enrollment periods are often different for states that run their own Exchanges. Typically, the OE period (under age 65) begins November 1st, and ends January 15th.
Corporate Plans. Although hard to find, there are still employers that will pay 70%-100% of your healthcare premium. Several companies that pay 100% of the cost, include Kimley-Horn And Associates, ZocDoc, Ultimate Software, Twitter, Boston Consulting Group, GoDaddy, Gates Foundation, Arthrex, and FactSet. There are many other employers that will pay more than 50% of the premiums. Depending upon the company, often several options are available, including cheaper high-deductible plans, and HMO options with a large network. PPO options may not be offered.
Many companies feature FSA (Flexible Spending Account) options, and will contribute a fixed dollar amount (perhaps $1,000-$3,000 per person) that can be deposited into a separate fund for your personal medical expenses. If you avoid major claims, you will have very little or no out-of-pocket costs. And since preventive benefits are covered at 100%, all of your funds can be directed towards symptomatic medical expenses. Additional items, including allergy testing and dental checkups can also be payed for out of the account.
These plans are often HSA-eligible, which will provide specific tax benefits when you spend pre-tax dollars on qualified expenses. Dental and vision expenses are also typically eligible. It’s possible that future legislative changes will allow over-the-counter medications and prescriptions to be tax-deductible, with additional preventative credits provided by the carrier. More flexibility with withdraws could be proposed. These changes could be implemented in 2024, although bipartisan support is never guaranteed.
Depending upon the company, occasionally, upon retirement, most of the employee’s healthcare benefit costs will be paid by the employer, especially with 25 or more years of service. Typically, the retiree must have reached age 55, and retired in “good standing.” For example, if the retail monthly cost is $1,200, the retiree may be offered coverage for approximately $300, with the option to continue the plan until each covered adult reached age 65. High-deductible plans are always the cheapest option, with low out-of-pocket cost HMO and PPO plans the most expensive. The annual election period to choose or change group coverage occurs in November or December.
Medicare. If you’re 65 and live in the US, there’s a great chance you are eligible for benefits. This may not be new information to most consumers, but there are quite a few people that aren’t familiar with Medicare eligibility requirements. If you can qualify, the benefits are fairly comprehensive, and you’ll like the price! Although it’s true that you have been paying for many years for the right to receive these benefits, they will continue as long as you live. Medical underwriting is not needed, and pre-existing conditions are covered. Nearly all major hospitals have a contract with Medicare so finding a network facility is not a concern.
Younger disabled applicants may qualify for benefits, along with persons with ESRD (End-Stage Renal Disease). Prescription drug coverage is also available (Part D), and is added to your original coverage. Many major and smaller carriers offer plans with different deductibles and copays. Generic, non-generic, and specialty drugs are covered. An MA-PD contract is an Advantage plan that includes prescription drug benefits. Many additional benefits are often provided, including, dental, hearing, vision, and fitness club memberships.
You can also purchase supplemental benefits to Medicare (Medigap and Advantage Plans). The “Advantage” policies have very little or no premium and provide coverage for many of the expenses Medicare misses. However, it is possible that these types of plans may not be offered in the future due to changes and updates in legislation. Medicare-Supplement contracts are widely available and can be easily tailored to fit your specific situation. Note: Part D (HD) Supplement plans have a $2,700 deductible and are typically the least expensive option of all Supplement contracts. The out-of-pocket maximum must be reached before benefits are paid.
Medicaid. Medicaid is quite different than Medicare. In recent years, many states have been considering the expansion of their Medicaid programs. The minimum eligibility standard for parents is 133% of the Federal Poverty Level. Adults without children can qualify if they are disabled or if their state has a separate established program. More than 70 million persons currently utilize benefits, including CHIP coverage for children. Seniors can also qualify for benefits while also qualifying for Medicare benefits (Dual).
Several states have recently expanded their eligibility requirements, so if you have been previously denied, you may approved if you apply now. The Modified Adjusted Gross Income (MAGI) is utilized to determine single and family subsidy eligibility for many programs, including Marketplace healthcare plans. The old AFDC program (Aid To Families Of Dependent Children) program terminated more than 20 years ago. Once approved, the effective date is typically at the time the application was submitted or the first day of the month of submission.
You must be a legal resident of the state where you are applying for coverage. In certain situations, non-citizens may be able to get coverage, if they are permanent legal residents. Applicants with major medical issues may be eligible for benefits through a “medically needy program.” Although not available in all states, this program helps persons that may not financially qualify. Also, a 209(b) “spend down” may be offered for disability, blindness, or meeting an age requirement (age 65).
Many free resources are provided, including SPA and 1915 waiver processing, MAC learning collaboratives, CHIP and Medicaid program portals, disaster response toolkit, state technical assistance, and school based services. Additional data is also offered regarding drug pricing and payment, enrollment, quality, and eligibility.
The Children’s Health Insurance Program (CHIP) will typically provide benefits for a family of four with income under $45,000. Coverage is very comprehensive and can often be customized to meet specific needs. For ages of five and under, the income requirement (family of four) is reduced to about $30,000. For ages 6-18, the income amount reduces to $36,000. NOTE: Guidelines vary in different states, although most states provide coverage to kids in households up to 200% of the FPL. About half of all states use a 250% limit.
Benefits are very comprehensive and contain complete preventive coverage including office visit, prescription and hospital coverage. Depending on the state, you may also be eligible to receive dental and vision help. More than 9 million persons are currently enrolled. Required services include immunizations, well-child and well-baby care, inpatient and outpatient surgical and hospital treatment, doctor’s office visits, and x-rays and lab tests. The “benchmark” plan is based on the standard BCBS PPO option offered to federal government employees.
Dental benefits are also provided, including preventative and emergency treatment. Plans can vary, depending upon your state of residence. A benchmark dental package is also provided in several states. This coverage must meet several guidelines, including matching the most popular private plan available in the state.
CHIP covers more than 9 million persons, and is completely run by each state, although funding for the program comes from both the state and federal government. Typically, it is administered by Medicaid expansion, a separate program or a hybrid of both. The Affordable Care Act provides more financial assistance to CHIP, so there’s no immediate danger of it suddenly ending. If your household income reduces, it is possible to be ineligible one year, and eligible for coverage the following year. Also, the waiting period is very small (typically three months or less).
Comprehensive benefits are included with each state provided the flexibility to adjust coverage. Benchmark-equivalent coverage includes labs and x-rays, doctor’s surgical and medical services, and outpatient and inpatient services. Marketplace plans can also be purchased without a subsidy, but the rate will be the full retail cost. Each state much provide a listing of all available providers of benefits. States with a separate program are required to offer an approved package that contains all CHIP benefits, or a benchmark dental package.
State Health Insurance Exchange Open Enrollment. Each November, you can apply for a policy without providing any medical information. The premium you pay will be based on your age, zip code, smoking status and household income. The earliest effective date is typically January 1 of the following year. But without a qualified exception, later effective dates are generally not available. Family members that are Medicare-eligible typically can not get coverage. Their income must also be included in the subsidy calculation.
The “Patent Protection And Affordable Care Act” (signed into law in 2010) awards a subsidy to help reduce the amount you pay for your healthcare. The less money you make, the more assistance you receive. For example, a 35-year old single mother of two children residing in Columbus (Ohio) that earns $55,000 per year will receive more than $8,000 per year in annual subsidies.
Many plans are available with a monthly rate of less than $25. In most other states, multiple options are offered with low premiums. The four popular available plan options for Open Enrollment are Bronze, Silver, Gold and Platinum. The Platinum plan is the most expensive since you pay the least out of pocket money. Catastrophic plans are available for persons under age 30.
But ALL four plans have 100% preventive coverage along with office visit, specialist, prescription and hospital benefits. Each year, you can change from one policy to another, if it is better-suited to your needs, or if the makeup of your family changes. You may also qualify for a Special Enrollment Period that allows you to obtain subsidized policies during any time of the year. Most areas have multiple companies available with either HMO or PPO options.
Move to another country. Seriously, we don’t really advocate moving to another country to take advantage of free healthcare. Although your medical treatment may be free, the quality is likely to suffer. But in case you’re interested, some of the major countries that offer free healthcare include: Canada, Australia, Israel, Japan, Greece, Italy, Finland, Sweden, Denmark, Portugal, Ireland, United Kingdom and Hungary. Wait times for certain procedures are often very long.
The countries that offer the worst type of medical coverage include: Sierra Leone, Myanmar, Nigeria, Liberia, Mozambique, and Zambia. However, of Westernized countries that you are more likely to visit, the following are known to have very inefficient systems: Russia, Brazil, Algeria, Columbia, Bulgaria, and Belgium.
Get Temporary medical coverage. Often referred to as “short-term” policies, although not free, they are the cheapest form of legitimate health insurance you can buy without any type of government assistance. Prices are low (about 50%-70% less than unsubsidized Marketplace plans), approvals often take less than a day, and you can complete an application online in about 15 minutes. Several carrier use national networks, including Allstate (formerly National General), who utilizes the Aetna Open Choice PPO Network. Blue Cross Blue Shield was previously a major underwriter of short-term plans, but has exited the market in most states. In Ohio and Indiana, however, they offer temporary policies that cover pre-existing conditions.
Depending on where you live, you can keep benefits for as long as 6-12 months, and usually the policy can be renewed once before you have to shop for a different company to write another policy. They also are not Obamacare-approved, which means that any current conditions you are being treated for will probably not be covered. Often, an emergency-room visit will be subject to a special copay. Depending upon the carrier, the extra charge may be $250-$500. Maternity and mental-illness are generally not included, although network repricing may be available.
Seven great ways to obtain free or very cheap healthcare. You can compare prices on our website and quickly determine which type of individual or family medical coverage is best for you.