Applying for Government-Sponsored Health Coverage
It doesn’t matter if you’re in your twenties or on the verge of retirement—having access to affordable health care can be vital to your happiness and well-being. Outside of employer-sponsored health insurance, there are two common avenues people typically take: the Health Insurance Marketplace or Medicare. If you’re planning to enroll in either option in 2025, follow these tips to help ensure that you’re fully prepared for what’s ahead.
Health Insurance Marketplace
If your employer doesn’t provide health insurance and you aren’t yet eligible for Medicare, you may be able to find affordable plans through the Health Insurance Marketplace at HealthCare.gov. (Note that some states have their own marketplace for enrolling in health care, which Healthcare.gov can direct you to as applicable.) As you follow the steps below, consider reaching out to your insurance broker, who can help you sort through the options to find the plan that suits you best.
Assess your medical situation
Evaluate your household’s medical needs, weighing factors like how often you go to the doctor and whether you may potentially require hospitalization or a specialist’s care. Also note which doctors you see and what prescribed drugs you take. These considerations can help you refine your search to health-care plans that provide your ideal coverage and include your preferred providers and prescriptions.
Determine your budget
Review your finances to determine how much you’ll be capable of spending on monthly health-care costs like copays and premiums. If your budget seems tight, look into ways you could potentially save, such as with the advance premium tax credit; this is an up-front credit based on your total estimated income for the year that can help reduce your monthly payments. (Keep in mind, though, that if you underestimate your income, you may have to pay back some of the credit come tax season.) Armed with a clear budget, you can better pinpoint a plan you’ll likely be able to afford.
Know your deadline
In general, the Open Enrollment Period is November 1, 2024, to January 15, 2025, though some states extend the deadline. To have your coverage begin January 1, you must enroll by December 15 of this year and pay your premium beforehand; if you sign up later than that, your coverage won’t be in effect until February 1. And if you miss the enrollment window entirely, you may have to wait a whole year to join. There are exceptions, however, such as if you’re eligible for a Special Enrollment Period due to a loss of health coverage, birth of a baby, or other qualifying circumstance.
Understand the plan types
There are four tiers of Marketplace plans: Bronze, Silver, Gold, and Platinum. Each level covers the same health benefits but has its own deductibles, premiums, and copays. For instance, Bronze plans have the lowest monthly premiums and the highest deductibles and copays, while Platinum plans are the opposite. Additionally, Silver plans are the only ones eligible for cost-sharing subsidies that may reduce what you’ll have to pay before your insurance takes over.
Beyond the tiers, you should also become familiar with the various types of health networks: HMOs, PPOs, POSs, and EPOs. The one you select may impact your costs and where you can get covered care. For example, HMOs tend to be budget friendly but require you to stay in network; conversely, PPOs offer the most freedom but tend to have more expensive premiums.
Final steps
As open enrollment nears, create an account at Healthcare.gov or your state’s health insurance marketplace. Doing so will give you access to comparison and filter tools to weigh the pros and cons of various plans, allowing you to be fully prepared once the sign-up process begins.
Medicare
The Medicare program provides nearly universal health coverage for eligible individuals over sixty-five as well as those with certain qualifying health conditions. Like with Marketplace insurance, there are a lot of moving parts, so consider connecting with an insurance specialist for any questions or concerns you may have ahead of enrollment.
Identify when to enroll
Generally, you’ll be eligible to sign up for Medicare during your Initial Enrollment Period (IEP), a seven-month window beginning three months before your sixty-fifth birthday and ending three months after. Note that if your birthday lands on the first of the month, your IEP will kick off four months before you turn sixty-five and conclude two months after.
There are a few exceptions to these requirements. For instance, if you begin receiving Social Security benefits four months ahead of turning sixty-five, you will be automatically enrolled in Original Medicare (Parts A and B) on your birthday. Likewise, those who receive Social Security Disability Insurance will be automatically enrolled in Original Medicare after two years, even if they are not yet sixty-five. Use this online tool from Medicare.gov to determine when you may be eligible for Medicare.
You should start familiarizing yourself with the enrollment process and your options at least a year before your IEP to allow ample time to consider your choices so you don’t risk missing your window. It is possible to sign up after your IEP, but you may be stuck with higher premiums for the duration of your Medicare coverage. You can potentially avoid this if you qualify for a Special Enrollment Period, such as if you retire after sixty-five and need to enroll in Medicare once you are no longer covered by an employer insurance plan.
Know your coverage options
The most common way to receive Medicare is through Original Medicare. This includes Part A, encompassing inpatient/hospital coverage, and Part B, which covers doctor’s visits, preventative care, and other outpatient services. Most hospitals and doctors in the United States accept Medicare, and Part A is usually free for most policyholders.
Original Medicare enrollees can add a Part D plan as well, typically at an additional monthly cost, for assistance in paying for prescription drugs. Just be sure to sign up for it during your IEP, or you may be charged higher premiums.
The other main way to receive Medicare is with Medicare Advantage, also called Part C. You must enroll in Parts A and B to be eligible for this option and may have to pay an extra monthly premium. In return, though, you can get additional coverage for prescription drugs along with vision, dental, and hearing care, depending on your needs.
Beyond Parts A and B, there are other coverage options you can add, such as Medigap, which is designed to provide reimbursement for various out-of-pocket costs. You can explore these by typing your zip code into this Medicare plan-compare tool.
Final steps
The easiest and quickest way to launch your Medicare enrollment process is by creating an online My Social Security account at SSA.gov, where you’ll sign up for Original Medicare during your IEP. You could then enroll in a Part D or Medicare Advantage plan, if desired, at Medicare.gov.
Applying for health insurance can be a complicated process, so reach out to a specialist for guidance. Armed with their expert knowledge and your thorough preparation, you can head into the enrollment period with confidence, ready to get the coverage you need.
