Glossary

How to Get Health Insurance

There are three main ways to get health insurance: through an employer, on your own, or from the government. Let’s look at the ways to get health insurance, and then how to sign up for coverage. It all depends on your personal situation.

Through an Employer (or your Spouse's Employer)

Group Plans

If you have health insurance through your job, you don’t have to worry about much – your employer will choose an insurer and plan for you. Some employers may have several insurer and plan options that you can choose from.

Sign Me Up

If you get married or have a baby, there's usually a short window of time (usually 30 days) to add your spouse or child to your plan. Don't miss that deadline and leave your loved one uninsured! Check with your employer to see when and how to change your plan benefits.

COBRA

If you’ve lost your job, COBRA lets you stay on your employer's health plan for a while. You may be eligible for COBRA if any of the following has happened:

  • Loss of job for reasons other than gross misconduct.
  • Reduced work hours below the minimum required for coverage.
  • The employee covered under the plan dies.
  • Divorce or legal separation from the covered employee.
  • A child no longer meets the plan's eligibility rules.

COBRA lets you (and your dependents) stay insured, temporarily and at your own expense. It’s available only at companies with 20 or more full-time employees. Contact your employer to find out how to enroll in COBRA.

 

Interview Questions About Benefits

You got a job offer – congratulations! One of the first things you'll want to know about your potential employer is the kind of health care coverage they provide. It's an important part of your compensation package, so consider these questions before you accept the job:

  • When does coverage begin?
  • Who pays for coverage? If the employer and employee share costs, how is it split up?
  • Are family plans available? Do they cover domestic partners? Who pays for family or dependent coverage?
  • What health plans are offered?
  • Can you review the health plan options and premium costs? Are there any deductibles, restrictions, or limitations? Are dental, vision, or other supplemental insurance options available?
  • Is there coverage to treat the medical conditions you have?
  • Are FSA, HRA, or HSA benefits available?

Through the Government

Medicare

Medicare is a federal program that provides basic health benefits to people 65 years or older and to certain disabled individuals. Medicare has four parts:

  • Medicare Part A covers hospital stays and emergency care.
  • Medicare Part B covers doctor's office visits. Together, Part A and Part B are often referred to as Original Medicare.
  • Medicare Part C, or Medicare Advantage, provides all the benefits of Part A and Part B and may include Part D prescription drug coverage. Medicare Advantage plans are offered by private health insurance companies.
  • Medicare Part D covers prescription drugs.

Medicare

Keep in mind that Medicare doesn’t cover all your medical costs. You’ll still have to pay a portion of expenses out of your own pocket, such as premiums, copayments, coinsurance, and deductibles.

Fight Medicare Fraud!

Fraud costs us all. Learn how to detect, prevent, and report Medicare fraud, abuse, and waste from the Department of Health.

Medicaid/QUEST

Medicaid is a joint federal-state program that provides health coverage to people with low incomes or resources. Medicaid covers a wide range of health care services.

On Your Own

Individual Plans

Not everyone has health insurance through their job or the government. Many people buy health insurance on their own.

Because an employer isn’t sharing the cost of your monthly premiums, an individual health plan may cost more in the short term, but you’ll save in the long term. If you have to go to the hospital for any reason, you’ll save more with an individual plan than no insurance. Services like X-rays, pain medication, and follow-up visits can cost thousands of dollars. But with a health plan, you’ll pay hundreds, not thousands. That’s big savings.

Through the Online Health Insurance Marketplace

Individuals

Individuals can get insurance through their state’s online health insurance marketplace, which allows you to shop around and compare the health plans of different health insurance companies. Some states currently don’t have a state online health insurance marketplace, in which case individuals can use the federal online insurance marketplace instead. Depending on your financial situation, you may be eligible for financial help, which is only available through the online marketplace.

Hawaii’s online health insurance marketplace is called the Hawai‘i Health Connector. You can apply for insurance at www.hawaiihealthconnector.com.

Employees

Employees can get insurance through their state online marketplace if the company they work at went through the marketplace to buy a group plan. Check with your employer to see how you’re getting covered and what next steps to take to choose your health plan.

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