Many people get health insurance through their employers. Employers will often offer group health plans, with some even contributing to the cost of your premium. If your employer provides insurance, you may be eligible to enroll during the annual open enrollment period or when you start a new job. Healthcare can be a major perk of a job to explore and while it shouldn’t be a reason to stay in a workplace you are unhappy in, it can be a great thing to check out in a new job role you are interested in.
Health Insurance Essentials
Hormonally can give you an overview of the basics to think about when choosing a suitable insurance plan.
Health Insurance Essentials
Hormonally can give you an overview of the basics to think about when choosing a suitable insurance plan.
Health Insurance Essentials
Managing your hormone health is stressful enough without the worry of having to think about insurance coverage too.
While Hormonally cannot tell you whether your insurance covers your coil, or helps to prevent pregnancy, we can give you a little overview of the basics to think about when it comes to choosing a suitable insurance plan.
The main ways people access health insurance coverage are:
Health Insurance Marketplace (Healthcare.gov)
The Health Insurance Marketplace, established by the Affordable Care Act (ACA), provides a platform for you and your family to compare and purchase health insurance plans. Open enrollment typically happens annually, but you may qualify for a Special Enrollment Period if you have experienced a certain life event, such as a marriage, the birth of a child, or the loss of other health insurance coverage.
Medicaid
Medicaid is a joint federal and state program that provides free or low-cost health coverage to individuals and families that have a lower than average income. Eligibility for the program can vary by state. You can apply for Medicaid through your state’s Medicaid office or through the Health Insurance Marketplace.
Children's Health Insurance Program (CHIP)
CHIP provides health coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. Again, eligibility and application processes can vary by state. Applications can be made through the Health Insurance Marketplace.
COBRA Coverage
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to continue receiving your employer-sponsored health coverage for a limited time after leaving your job, experiencing a reduction in your work hours, or experiencing other qualifying events. Typically, you are likely to have to pay the full premium cost without support.
Individual Health Insurance Plans
If you don’t qualify for Medicaid or CHIP and are not eligible for employer-sponsored insurance, you can purchase an individual health insurance plan directly from insurance companies or through the Health Insurance Marketplace. These plans vary in coverage and cost, and you can compare options to find one that suits your needs. Remember to ask any specific coverage questions you have before taking out a plan. This helps to make sure you are aware of the costs your coverage will cover and the costs that are likely to have to come out of your own earnings.
Health Insurance Agents and Brokers
Insurance agents and brokers can help you navigate the process of finding and enrolling in a health insurance plan. They can provide personalized guidance based on your budget and your healthcare needs. Think of a health insurance broker a bit like a real estate agent that helps you to buy or rent a property, they look for the best option you can afford given your budget.
Remember though, just like a real estate agent, a broker may try to sell you things you don’t need, so go into these conversations with your eyes and ears open!
Special Enrollment Periods (SEPs)
In addition to open enrollment, SEPs allow you to enroll in or make changes to health insurance plans outside of the regular enrollment periods. SEP’s can be triggered by things like getting married, having a baby, adopting a child, or losing your existing health coverage.
Things to remember
Review any changes to your plan carefully, including the coverage, costs, and the network providers, this is to make sure your health insurance plan still meets your needs.
Staying informed about changes in healthcare policies and open enrollment periods is crucial for obtaining and maintaining coverage so make sure to read any correspondence you receive from your insurance provider – we know those envelopes can be stressful but it’s better to open them and find out than leave things to chance.
If you don’t have health insurance, here are some resources and key points to consider:
Healthcare.gov
Healthcare.gov is the official website for the Health Insurance Marketplace in the United States. It provides information about health insurance options, including Medicaid and the Children’s Health Insurance Program (CHIP).
Medicaid and CHIP
If you make less than the average US citizen, you may qualify for Medicaid or CHIP. These programs provide free or low-cost health coverage to eligible people and families. You can check your eligibility and apply through Healthcare.gov.
Community Health Centers
Federally Qualified Health Centers (FQHCs) and local community health centers provide affordable healthcare services on a sliding fee scale, based on your income. You can find a nearby health center using the HRSA Find a Health Center tool.
Free and Low-Cost Clinics
Some communities have free or low-cost clinics that provide basic healthcare services. You can search for local clinics through resources like FreeClinics.com or by contacting your local health department.
Prescription Assistance Programs
If you need assistance with prescription medications, various pharmaceutical companies offer patient assistance programs. NeedyMeds is a resource that provides information on such programs.
Local Health Departments
Your local health department may offer public health services and information on where to access affordable healthcare in your community.
Charity Care Programs
Some hospitals and healthcare providers have charity care programs that offer financial assistance to individuals without insurance. Contact the hospital’s financial assistance office for more information.
Free Preventive Services
The Affordable Care Act mandates that certain preventive services must be covered without cost-sharing, even if you don’t have insurance. These services include vaccinations, screenings, and counselling. You can find a list of these services on the Healthcare.gov Preventive Services page.
Local Nonprofit Organizations
Nonprofit organizations often work to connect individuals with healthcare resources. Local nonprofits may have information about clinics, programs, and assistance available in your area.
Emergency Rooms and Urgent Care
In emergencies, you can seek care at the emergency room, regardless of insurance status. Urgent care centers are also an option for non-life-threatening issues.
Further reading
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Things to think about…
It’s really important not to delay seeing a clinician in person if you have a medical concern that requires physical examination. For example, if you are entering perimenopause or menopause and experiencing changes down below (such as pain, itching, dryness or other discomfort) you should seek care from a provider before purchasing anything online.
A lot of companies now look to bypass insurance or trips to see your provider entirely. While for certain issues (such as antibiotics for a urinary tract infection (UTI)) an online consultation may be fairly straightforward, for other concerns, it’s essential to see a doctor for an exam. Check out our resource comparing in person and telehealth appointments for more information on this.
If you don’t have coverage, paying out of pocket to see a clinician is an option and some clinics will work with you to find a financial solution. For this reason it’s always a good idea to consider calling a clinic to talk to them about your financial situation. An appointment may be more affordable than you think.
Remember, it’s crucial to explore your options, seek assistance, and communicate with healthcare providers about your financial situation.
Hormonally recognizes that the costs of healthcare can be high and we would encourage you to do your research and look at where you can save money.
It can take some committed search engine browsing, but there are options out there. Equally, healthcare policies and resources may change, so staying informed and seeking local assistance can be beneficial.
