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Navigating Healthcare Without Employer-Sponsored Health Insurance

Millions of Americans go without health insurance every year. High costs, a lack of transparency and a lack of clarity in the healthcare system keep many from finding and getting the care they need.

For those who go without because they don't have access to employer-sponsored health insurance, navigating healthcare alone in this way can feel almost impossible.

Having the right information and a better understanding of the system empowers people to find healthcare solutions when they aren't able to access them through their workplace.

There are different options for insurance plans and prices and also alternative healthcare solutions outside the insurance marketplace that can complement your plan. The more information and options you get to know, the easier it will be for you to find the best way to manage your healthcare.

It's important to understand that there is no "one fit for all" in healthcare. You have to take into account your specific healthcare needs to find what could work best for you and your budget.

The ACA Health Insurance Marketplace
If your employer does not offer health insurance, you can still enroll in an individual health insurance plan through the health insurance marketplace under the Affordable Care Act. If you're considering the health insurance marketplace, there are several options to choose from based on your needs. But first, there are a few key things to know.

For starters, you might wonder, "What is the marketplace, and what are my health insurance options through it?" The ACA health insurance marketplace, or exchange, was created by the government in 2013 to regulate competition among private insurers for people who don't have health insurance through their employers.

Insurance companies in the marketplace must meet certain cost and benefit standards. Currently, is the largest health insurance exchange and is run by the federal government. If a state doesn't have its own exchange, residents will use the federal exchange. As of 2021, 14 states have their own exchanges, and if you're a resident of one of these states, you will be directed to the state plan. All companies in an exchange must cover the ACA's 10 essential benefits, and individuals must apply for coverage during the open enrollment period. This is the only period of time each year when you can sign up for health insurance in the health insurance marketplace. For 2022, open enrollment ends on January 15. If you miss the deadline, you’ll have limited opportunities to enroll later in the year.

Who Can Use the Exchanges?

All United States citizens and legally present residents who aren't enrolled in Medicare and aren't imprisoned are eligible to purchase a health plan in the exchange in the state where they live.

Tips to Choose the Right Plan for Your Needs

If you're thinking about enrolling in the exchange, there are a few steps to complete.

  • First, you need to create an account online and finish a short application.
  • Then, estimate your household income for 2022 and make sure you do not qualify for government subsidies, such as Medicaid. These may actually help you save more money on healthcare, so you want to research the most affordable option possible. You can also check this through the marketplace.
  • Next, evaluate your medical expenses from the current year and think about anticipated medical expenses for next year. Typically low-cost options have higher deductibles, copayment, or coinsurance. If you are healthy and don't expect to go frequently to the doctor, this could be an option for you to save money, but be aware that you could end up paying more in out-of-pocket costs if you need major medical assistance during the plan year.
  • Make sure you understand the clause of your policy by understanding the terminology.
  • Review the network of providers in your potential plan. There are four different types of plans regarding the network of providers. If you don't want to change your current providers, make sure they work with your plan.
  • Review the prescription policy of your plan to avoid surprises.
  • Finally, decide who must be covered under your plan and determine whether your spouse or children qualify for coverage under any other source (school, work, etc.).

Alternative Healthcare Solutions

In recent years, new healthcare solutions have arisen to provide patients with immediate, simplified, and affordable healthcare services without the barriers and additional fees that are common in health insurance plans.

These solutions are not health insurance and won't cover your medical expenses in case of major health accidents or illness but can provide routine or common medical services in a much more affordable way. They help people who cannot afford health insurance access basic healthcare services and are a perfect complement to emergency-only or high-deductible insurance plans, where patients might normally be paying out of pocket for primary care services that aren't considered preventive.

For example, virtual care plans are available at a very low cost and provide access to doctor appointments for urgent care, primary care, and even behavioral health. Patients can enjoy high-quality, affordable care for the most common medical and behavioral health issues — without the need of leaving their house. Another option is the direct primary care model in which patients pay their physicians directly — a flat fee periodically for a defined set of primary care services.

While it's easy to think that you're unable to navigate healthcare without an employer-sponsored health insurance plan, you have more options than you think. The health insurance marketplace, virtual care, and other care alternatives enable you to find the best possible care for you and your family.

At Health Karma, we believe that good healthcare starts with understanding it. For more information and tips about navigating healthcare, visit Health Karma's website.