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Individuals / Families

Whether you’re living on your own or need health insurance for your family, you have several different options available to you. You’ll want to choose the health insurance plan that gives you the benefits you need at a price you can afford.

Group Coverage

Individual Coverage

Young Adult Coverage

Seniors or Disabled Coverage

Government Coverage

COBRA Coverage

Group Coverage

Group coverage is usually offered through your job. If your employer or union offers insurance or other health care coverage, you may want to consider enrolling. Group coverage may be less expensive than individual coverage.  

If you and your spouse both get health care coverage through work, look at the costs and benefit packages to see whether it makes more sense for each of you to have your own health care coverage, or for one of you to cover the other with family coverage, if you can. If so, you may want to enroll in both plans and carry one as primary coverage and the other as secondary coverage.

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Individual Coverage

If your employer doesn’t offer health care coverage, or if employer coverage is unaffordable, or you're self-employed, you can buy a plan on your own. This is generally called an "individual health insurance plan," even though it can cover your spouse and children too. You can buy insurance directly from an insurance company, through the federally-faciliated marketplace or through a licensed insurance agent. The individuals that often need to consider buying their own coverage include: seasonal workers, part-time employees, freelancers, early retirees, self-employed business owners and unemployed workers whose COBRA coverage is coming to an end.

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Young Adult Coverage

Young adults may purchase individual coverage. However, it may be more affordable to reamin on their parents' plan. Federal law requires adult children up to the age of 26 to be allowed to stay on their parents’ plan, with minor exceptions. And, in Pennsylvania, for group plansthis has been extended until the age of 30, under certain conditions. Download our guide to learn more about this law and its eligibility requirements.

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Seniors or Disabled Coverage

  • Long-Term Care Coverage - This is private insurance that covers Long-Term Care for an illness or disability, whether it’s provided in a residential facility or at home. This is not health care coverage, but instead provides care to assit with activities of daily living.
  • Medicare and Medigap -- If you are over 65 and have an illness or disability, you have the option of purchasing a Medigap plan, also called a Medicare Supplement plan. It is private insurance that fills in the gaps in traditional Medicare and pays for certain out-of-pocket expenses.  For more information, visit Medicare.gov or Download our guide to learn more about Medigap.

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Government Insurance

You can also get low-cost individual and family health insurance through government programs. CHIP (Children’s Health Insurance Program) covers uninsured children and teens up to age 19 in Pennsylvania. Or, look into Medical Assistance (also called Medicaid), which covers low-income adults and their families. You can apply for CHIP or MA at anytime, not just open enrollment. If you’re in the military or a veteran, you and your dependents may be eligible for benefits through Tricare or the Veterans Administration.

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COBRA Coverage

Did you recently resign from or lose your job? One option is to continue your coverage through your employer for a period of time.  Contact your employer’s Human Resources department to learn about your health coverage options, including COBRA.

COBRA health coverage is made available through state and federal laws that protect you from losing your employment-based health coverage if you lose your job, although you are not protected from high premium costs.

Other options to consider if you lose your job include buying your own individual insurance plan – either through the federally-facilitated marketplace (FFM) or in the private market – or getting government insurance. You may be eligible for subsidies if you purchase through the FFM (government insurance is already subsidized).

Whatever option you choose, don’t delay, since there are deadlines for signing up.

 

The Two Types of COBRA Explained

Federal COBRA protects you, your spouse and dependents from losing your health insurance when you are no longer employed by a company with more than 20 employees. It also provides for continuation of coverage when other significant life events occur, such as a reduction in hours, divorce or legal separation, your death, or eligibility for Medicare.

  • You can continue to be insured with your employer group plan for a certain time frame, generally 18 months.
  • Your benefits stay the same without any break in your coverage.
  • Your cost is much higher because your employer is no longer paying anything for the insurance - you are paying for all of it.

Pennsylvania’s Mini-COBRA law works like federal COBRA, but applies to Pennsylvania companies with 2-19 employees. You must contact your employer to receive instructions for enrolling in Mini-COBRA.

  • The benefits will continue for a set time frame, which is nine months.
  • Your benefits would stay the same without any break in your insurance.
  • Your cost is much higher because your employer is no longer paying anything for the insurance - you are paying for all of it.

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PAGE LAST UPDATED » 11/7/2014