Ask Tammy Your Health Insurance Questions

If you’re struggling to understand health insurance, we can help. Ask Tammy about how to navigate health insurance and maximize your benefits.


    What's your health insurance question?

    Note: Questions and answers may be published with your first name. Your email, phone, and location will remain confidential.


     

    The Latest Health Insurance Questions and Answers

    Health Insurance Affordability

    What is the most affordable type of health insurance? ― Mark

    Hi Mark,

    In many states, Medicaid is the most affordable option for health insurance, followed by Affordable Care Act (ACA) Health Insurance Marketplace plans. However, Medicaid eligibility varies by state and is not an option for everyone.

    ―Tammy

    How much is health insurance monthly? ― Sarah

    Hi Sarah,

    There’s no exact amount for health insurance. Many factors play a part in the cost of health insurance and are truly based on each individual circumstance. Plans can be as low as $0 if you qualify.

    ― Tammy

    What is the income limit for ACA insurance? ― Brandon

    Hi Brandon,

    Generally, to be eligible for a subsidy through the ACA, your household income should range from 100% to 400% of the federal poverty level. Income limits may be higher in Alaska and Hawaii because the federal poverty level is higher. Example of income as follows:

    Household of 1: $13,590 to $54,360
    Household of 2 $18,310 to $73,240
    Household of 3 $23,030 to $92,120
    Household of 4 $27,750 to $111,000
    Household of 5 $32,470 to $129,880
    Household of 6 $37,190 to $148,760

    Learn more about the federal poverty level.

    ― Tammy

    What can I do if I can't afford health insurance? ― Laura

    Hi Laura,

    If you are unable to qualify for Medicaid or ACA and can’t afford health insurance, there are a few options available:

    • A high-deductible, catastrophic, or short-term medical plan can be more affordable than major medical insurance, and can help put a cap on out-of-pocket expenses.
    • Telemedicine has become a cheap and easy alternative to getting prescription refills and treatment for non-emergencies.
    • Another option is Federal Qualified Health Centers (FQHCs) and rural clinics. These are clinics that receive grants to provide free to low-cost medical care even if you have no health insurance. To find one of these clinics in your area, visit the Health Resources Services Administration.

    ― Tammy

    How can I get free health care? ― John

    Hi John,

    FQHCs and rural clinics are available in every state. These are clinics that receive grants to provide free to low-cost medical care even if you have no health insurance.

    To find one in your area, visit https://findahealthcenter.hrsa.gov/

    ― Tammy

    My son who is 27 years old needs health insurance; he is autistic and cannot keep any jobs. It’s very hard for him. He needs to be seen and get therapy like he did before, but he cannot afford health insurance since he does not work. Can he get help? ― Shanti

    Shanti,

    There are several potential options depending on the state your son lives in.

    1. Applying for disability (if he hasn’t already) and Supplemental Security Income (SSI): I would start by checking with the Social Security Administration (SSA). I recommend going to your local office in your area. You can also apply online or call 1(800) 772-1213. If your son is declared disabled, this can open the door to several options like Medicaid or the Health Insurance Marketplace. Also, if your son is approved for disability, he would be eligible for Medicare 24 months after the date of approval.
    1. Medicaid: After you have checked with SSA, contact your local Medicaid office. Some states will approve an adult for Medicaid if they are 18 years or older, unable to work or disabled, and earn less than $1,000 a month. Every state is different. Here is some state-by-state Medicaid information:
    1. Health Insurance Marketplace (also known as Affordable Healthcare): If your son is denied for Medicaid, applying to Healthcare.gov would be the next step. Being denied by Medicaid can create a Special Enrollment Period (SEP) for marketplace plans. There is also an Open Enrollment each year from Nov. 1 to Dec. 15. In your son’s case, reaching out to a local agent certified in the marketplace plans would be his easiest option. The agents are licensed and certified to work with you on this particular plan. Search for local agents, and you may also call the hotline at 1(800) 318-2596.
    1. Parent group insurance: Occasionally, some group insurance through an employer will allow disabled children to remain on a parent plan past age 26. The best way to know is to contact the human resource for your company.
    1. Private insurance health policy: Anyone can purchase health insurance during Open Enrollment Periods (OEPs) each year. This can be done through the Health Insurance Marketplace or by contacting independent insurance companies or agents in the state your son lives. Most OEPs are Nov. 1 to Dec. 15.

    Some other resources to contact:

    I hope you find this helpful. I appreciate you reaching out.

    Thank you,
    ― Tammy

    I have been on Medicaid for the last two years and I am up for renewal. I was told last year that I was only on that plan due to the COVID-19 pandemic. I just turned 21 and I am looking for health insurance, which is required for me to be in college. Please help me find an affordable plan. I only have a part-time job on campus. I make $336/month but have other expenses. ― Gabrielle

    Hello Gabrielle,

    Every state has different guidelines regarding Medicaid. Go ahead and see if Medicaid will let you renew. If you are no longer eligible the next option is the Health Insurance Marketplace. Based on the income you have listed you potentially do not make enough to qualify for it. However, since you are a student you may be eligible to enroll in the Health Insurance Marketplace through your parents or be added to a parent’s work coverage. They would need to work with you on the information you need to provide. You can go to a local agent or here to enroll. There is also a tab there to “find local help.”

    Another option is to contact your College Admissions office to see if they have an insurance program available. Many colleges offer student health insurance that you can purchase through the university. Some of the plans can even be covered by scholarships or financial aid money. Many of these can be affordable. If the university does not have this type of plan available then short-term medical is a good option. It can be purchased online or from a local agent, which is always good to start with because they have a lot of resources to help you in the right direction. You would need to look for an agent that specializes in selling health insurance products. This link will give more detailed information.

    I hope that you are able to find something that meets your needs and is affordable. Thank you for reaching out.

    ― Tammy

    Health Insurance Eligibility

    I currently have no health insurance since moving to the U.S. from Europe. I am pregnant and am looking for an affordable health insurance plan; who can I contact for more information? Thank you. ― Tohar

    Hello Tohar,

    Immigrants are eligible for insurance through the Health Insurance Marketplace if any of these apply to your situation:

    • Your immigrant status is “qualified non-citizen” and you have no waiting period.
    • You have a valid non-immigrant visa.
    • You are here on a Temporary Protected Status, humanitarian status, as an asylum applicant, or something similar.
    • You are a lawful temporary resident.

    These are simply a few of the reasons you would be eligible. For a full list, please refer to this link.

    Another option is Medicaid. It has similar eligibility status. I would suggest you start with the local Medicaid office in your area and if you do not qualify the staff can direct you to more options. The Public Health Department in your county may also have some resources for you. This link tells you the states that provide Medicaid services to immigrants.

    Even if you don’t see your state, contact your local Medicaid office first. If you have no luck there, HealthCare.gov would be the next option. If you look for a local insurance agent for assistance, make sure they are certified with the Health Insurance Marketplace to sell it. In your situation, short-term medical insurance would not be a good option because none of the companies will cover pregnancy since you are already pregnant. Here is more information about some of the things I have mentioned.

    Thank you so much for reaching out to me! I am glad to be of assistance. Good luck with your health care endeavors.

    ― Tammy

    Health Insurance Plan Choice

    What's the best health insurance? ― Emily

    Hi Emily,

    This question can be answered in many ways. To put it simply, “the best” is what meets your specific needs and checks the most boxes for you. Consider affordability, network size, deductible, copays, coinsurance, and max out-of-pocket cost. It is always good to check a company’s ratings and financial stability, too.

    ― Tammy

    Is health insurance mandatory? ― Betsy

    Hi Betsy,

    In January 2019, the tax penalty mandate for health insurance was eliminated. While it is no longer mandatory on a federal level, some states have mandates that include tax penalties. Some of those states include Massachusetts, New Jersey, Vermont, California, Rhode Island, and Washington, D.C.

    ― Tammy

    Where can I get affordable health insurance? ― Steve

    Hi Steve,

    The primary option for affordable health insurance is the Health Insurance Marketplace. This option proves to be one of the most affordable. Licensed insurance agents or brokers can also help guide you to what best suits your needs. Many times they can do the shopping for you. If you work for a company that provides health insurance and your employer assumes some of the cost, always consider this as a top choice.

    -Tammy

    Can you get affordable health insurance without a job? ― Kristen

    Hi Kristen,

    Yes, you can get affordable health insurance without a job. Some health insurance is based on household income. Even if you do not have a job, if someone in your household, such as a spouse or parent has income, you can still qualify or even be eligible for coverage under their plan. In some states, Medicaid may be an option.

    ― Tammy

    I’m waiting for Medicaid but I need insurance now for my daughter to enroll in school. How long does it take for them to get back to me? What insurance can I apply for while I wait for the call from the Health Insurance Marketplace? ― Eric

    Eric,

    Thank you for reaching out! If you are waiting on Medicaid for your daughter it can take up to six weeks sometimes. It varies by state. I suggest you go to the local Medicaid office if there is one. Usually, the staff can give you an idea if she will qualify. If Medicaid says she is not going to qualify, you can get a letter from the agency and apply through the marketplace with the reason “denied by Medicaid.” If it seems like she will be approved and it is just a matter of the process, tell Medicaid you need proof for school and you may be able to get a letter that will be sufficient until you get the actual approval.

    If these are not options, many people will purchase a short-term medical plan, which can give coverage from a month up to three years in some states. This type of plan does have health questions and preexisting condition look-backs. You can purchase this type of plan through a local health insurance agent. This would at least give some coverage until you get approval or denial from Medicaid.

    Here are some more resources and information that could help:

    If she doesn’t qualify for Medicaid she could qualify for a program above that called CHIP. Medicaid will automatically transfer her to that division if the agency thinks it is better suited. If CHIP declines her, the Health Insurance Marketplace would be the next step.

    Best of luck! I do hope this has been helpful.

    ― Tammy

    Looking for health insurance for my parents, as they will be staying with me for six months. ― Vineet

    Hello Vineet,

    Thank you for reaching out to me. Coverage for your parents will mostly depend on the state they will be in and their age. If under 65 years of age, your parents may qualify for a Special Enrollment Period (SEP) for a change of residence. They may also qualify if they lost creditable health insurance in the last 60 days or will be losing it in the next 60 days. This could make them eligible for a plan through the Health Insurance Marketplace. These plans are based on income and can be very affordable.

    If they are over 65 years of age, you would need to see what coverage they have had up to the point of staying with you. If they have Medicare with a Supplement and Prescription Drug Plan (PDP) that can continue as long as they are there short-term (six months, as you explained). If they are on a Medicare Advantage Plan (MA Plan) and outside their service area for more than six months, they would definitely need to look at one that covers the area they are staying.

    Short-term medical plans or travel insurance would be other options to consider. An agent in your area can assist you in finding a good fit. It is important to find coverage in the first 60 days of the relocation. You may also refer here for a detailed summary. For state-specific resources please refer to this webpage.

    I do hope that you find this helpful. Thank you again.

    ― Tammy

    I am a new resident of Rhode Island! And I am also pregnant. How should I go about finding the best option for me? ― Angel

    Hello Angel,

    Here is an article that is specific to Rhode Island and health insurance.

    I would start with HealthSource RI. This is the State health insurance exchange. You would be eligible for a Special Enrollment Period if you recently moved to the state. HealthSource RI has tools to get insurance quotes and has the income guidelines available. There are also phone numbers and links to many resources that can help. It doesn’t matter if you meet the income guidelines; you can still get regular quotes and plan options.

    Medicaid could also be an option. There are Medicaid plans specific to pregnancy. HealthSource RI also has info regarding Medicaid or you can refer to this link.

    I believe this will get you going in the right direction! I hope you have a safe and happy pregnancy.

    Thanks for reaching out!

    ― Tammy

    I recently became a travel nurse and I am in need of individual health insurance. I read about the premiums that are available, but I need further information about each one. Please feel free to contact me at my phone number or email address listed. ― Tara

    Hello Tara!

    A lot of information you are seeking depends on where you are going to be located. Each state has different options for individual health insurance. I would start with the Health Insurance Marketplace.

    At this link you can search for local help in the area you will be in. A local agent who does health insurance and is certified to work with the Health Insurance Marketplace can guide you.

    A short-term medical plan could also be a good fit for you. If you are fairly healthy and don’t have any pre-existing conditions, these plans are affordable and convenient when in places for short periods of time. Short-term medical can be purchased online or from a local agent. This link has helpful information about these plans.

    I hope this information helps. Thank you!

    ― Tammy

    I need a month's worth of gap health insurance due to work insurance being cancelled. ― Susan

    Hello Susan,

    A great option for you would be short-term medical, which can be purchased online or from a local health insurance agent. It is convenient because you can choose to have it for as little as a month or in some cases up to three years.

    Short-term medical does have some health questions and lookbacks on pre-existing conditions. This link can provide a lot of helpful information.

    If for some reason you can not pass the health questions and be approved for the short-term medical, you might want to try the Health Insurance Marketplace which can offer full major medical coverage with no health questions or pre-existing conditions.

    You can use it until you get insurance coverage through your job. You would be eligible for a Special Enrollment Period if you involuntarily lost your work insurance. Contact a local health insurance agent for this, refer to this website to self-enroll, or call 1 (800) 318-2596.

    Best of luck. Thanks for reaching out!

    ― Tammy

    Hi Tammy, I am at present staying with a friend Montana. I am looking for a Medicare Advantage plan. Humana Gold Plus looks good to start. Please email me that and other plans you recommend. ― Eric

    Hello Eric,

    Could you please give me your zip code? Plan options can be different depending on where you are in Montana. That will help me give you more detailed information.

    Thanks so much!

    ― Tammy

    Retirement

    I will be 65 on Jan. 1, 2023. I am recently retired and am looking for insurance that won't break the bank. I will start to receive Social Security in July 2022. I am also enrolled in Medicare A and B.

    I need help with Rx coverage. I have some Tier 1 medicines, one Tier 3 medicine, and one Tier 5 medicine (Enbrel) for which I am finding it extremely hard to find coverage at a decent cost. I just won't be able to afford all of these medicines when I have to pay copays and deductibles. I have some time yet, as I can carry my former employer's coverage through December 2022. I am trying to get an idea of how much all of this will cost at this earlier stage so it won't be such a shock when I actually need to sign up. I am at a loss of who to contact. Suggestions and advice are certainly welcomed and appreciated. ― Mary

    Hello Mary,

    Thank you for reaching out to me. When you do elect to drop your employer coverage and go to full Medicare, here are some things to consider:

    • Do you want Medicare with a Medicare Supplement and an individual Prescription Drug Plan (PDP)?
    • Do you want a Medicare Advantage (MA) Plan that has all-in-one coverage, including the drug plan?

    Depending on the state you live in, the most economical options can vary. Please refer to this webpage for detailed info on the difference between these options.

    A local insurance agent that works with Medicare clients is a good place to start. They will know all the plans available in your area and you can check back with them over time if you have questions or problems. If you choose to go with a MA Plan, those can start at zero premium and include extra benefits of dental, vision, and PDP, to name a few. With this type of plan, you will have copayments for medical care. Medicare with a supplement is the opposite of a PDP. You will pay more out-of-pocket for the plans but will have fewer out-of-pocket expenses when you go for medical care.

    Any type of Medicare PDP will have the tier system and deductibles that apply to Tiers 3, 4, and 5. There are a couple of things that may help with the cost.

    • Medicaid: Check with your local Medicaid office to see if you qualify for assistance with prescription drugs.
    • 340B program: Many states have this program through rural clinics and hospitals. The program helps cover the cost of expensive drugs that are often unaffordable. Read here for more info.
    • Check with the manufacturer of the expensive drug. Sometimes there are patient assistance programs. If you continue on your work insurance, the companies often have a discount card to get the medicine at a very low cost. If you have a Medicare PDP there are separate assistance programs specifically for this. Usually, you and your doctor will complete some forms, send them to the company, and if approved, you pay a lot less ― in some cases zero. For Enbrel, here is the patient support.

    Hopefully, this will get you started in the right direction.

    ― Tammy

    Affordable Care Act

    Earlier this year, I purchased short-term insurance to bridge between jobs but the new job fell through. So now I am shopping for Affordable Care Act (ACA) Marketplace Insurance. My ex-wife claims our children (15 and 17 years old, respectively) but I am responsible for providing their health care insurance. Is there a way for me to get the tax credit associated with ACA insurance even though I don’t claim the kids as dependents on my income tax?― Michael

    Hello Michael,

    If you don’t claim them on the income taxes it isn’t possible for you to get the credit.  The rule is: if you won’t claim them as a tax dependent, don’t include them.

    There is one option that some ex-couples do that will help you with the cost of your children. Get a plan specifically for the children through the ACA or Children’s Health Insurance Program (CHIP) program in your state. To do this your ex-wife would have to be willing to apply using her household income with just policies for the children and then you pay the insurance premium every month to the company. I do have many parents that are willing to do this for the sake of the children.

    It won’t help you get any extra credit toward your personal insurance, but you can still apply for a tax credit based on just your household.

    If your ex-wife is not willing to work with you on this then you could just buy plans outright for the children and turn in your cost for insurance on your taxes and you may get some credit back there. If your ex-wife is concerned about the process of the insurance you could meet with a local insurance agent certified in ACA Marketplace plans and let them do the enrollment so that it is neutral ground and not dependent on one of you doing the enrollment. I understand that some exes don’t want to share income info with each other. She could confidentially give that info to the agent and you could confidently give your payment information to the agent.

    This link has some helpful information about insurance for students that may help you find something affordable for your children.

    Best of luck in your search!

    ― Tammy

    I am a college student (age 21) and need to have insurance that satisfies the Affordable Care Act (ACA) requirements. I am in excellent health, and want to find the least expensive policy (perhaps catastrophic). ― Katelyn

    Hello Katelyn,

    There are a couple of options:

    Since you are in college, to qualify for the ACA plan you can enroll if you meet the minimum income requirements and file taxes. Even if you do not qualify for a subsidy you can purchase individual health insurance through the Marketplace, but it is more expensive without the subsidy. If you do not make enough income to qualify alone you may use your parents’ income if they still claim you on their taxes and household. Because you are a student, this applies even if you do not live with them. They would not have to enroll; you only need their information (Social Security number, date of birth, income, and so on).

    If you can’t get the ACA plan many college students have a short-term medical plan.  These plans can cover you for one month up to three years depending on the state you live in. Usually the colleges will deem them acceptable. My daughter is your age and I have used both types of plans for her with no problems. Short-term medical plans can be very affordable and you can choose how much coverage you want to fit your budget. You can purchase these types of plans directly through the companies that sell them or through a local insurance agent that sells health insurance.

    I also recommend that you check with your university to see if they offer insurance for college students. Many universities have policies you can purchase through a specific vendor they use or have their own plan for on campus that can be purchased and used at the student health center.

    These links will give you info on companies that provide short-term medical and can give you a little more direction.

    1. https://www.affordablehealthinsurance.com/best-student-health-insurance/
    2. https://www.affordablehealthinsurance.com/best-short-term-health-insurance/

    Thanks so much!

    ― Tammy

    Relocating to the U.S.

    My wife and I are both 76 years old, British, and live in the U.K. We plan to join our only daughter in Iowa. We shall shortly be applying to become permanent residents in the U.S. We will both need medical and dental coverage. Can you assist us? ― Gerry

    Hello Gerry, Legal immigrants who are over age 65 and do not have a work history in the U.S. can purchase Medicare Part A after residing legally in the U.S. for five consecutive years. New immigrants are not eligible for Medicare until that requirement is met. Medicare Part A will only help cover hospital, home health, hospice, and skilled nursing care.

    The best option to start would be the Health Insurance Marketplace. I am attaching a link that has a significant amount of information about if you qualify and what you need to qualify.

    Please check out this link.

    To find local representatives in the area your daughter lives look here. You can put in her zip code and get a list of local insurance agents that can assist you.

    Many will be local so you can make contact in person. If you aren’t eligible for health insurance through the Marketplace you could be eligible for Medicaid in that state. Every state has different guidelines. That information is also covered in the link I provided above. Dental insurance is fairly easy to obtain; the local agent will also have several options for you.

    To help you have time to navigate once you come to the U.S. I would contact an insurance provider in your country and look into travel insurance, which can cover you for extended lengths of time. It would need to be purchased where you are before you actually travel.

    It covers some medical, emergencies, emergency evacuation, and will pay to have your body shipped back if something happens to you. You can usually choose the amount of time you want coverage. This link has some helpful info to get you started in the U.K.

    Thank you for reaching out and best of luck on your travels! May you have a safe journey.

    ― Tammy

    Coverage Outside the U.S.

    I want to get health insurance for my fiance who currently lives in the U.K. Is that possible and/or allowable?

    ― Timothy

    Hi, Timothy! To answer your question requires more specific information. Are they a current U.S. citizen? Are you trying to get them coverage while they are still out of the country or when actually located in the U.S.?

    If your fiance is a U.S. citizen then they would be eligible for some major medical plans, but the problem would be finding someone in the network while in the U.K. Sometimes travel insurance is a good option for people going to other countries from the U.S. However, if your fiance is not a U.S. citizen, eligibility would be very limited until officially in the U.S. or you are married. If not a U.S. citizen and they are going to be living in the U.K. for a while then getting insurance in the country they are currently in is better until they are officially in the U.S.

    I hope this information is helpful. Thank you for reaching out to me.

    ― Tammy

    Tax Credits

    I don't understand Advanced Premium Tax Credit (APTC). ― Tandy

    Hello Tandy,

    APTC is a tax credit you could be eligible for that helps cover the cost of your health insurance. To get this credit you must meet certain requirements. You are also required to file a tax return with a form 8962. For full details on eligibility, I’m attaching a helpful link.

    To see if you qualify you need to know your household income and the number of people you claim on your taxes. An easy way to check eligibility can be found here. Just answer the questions on that page.

    If you find you are eligible you have the option to take the amount you are deemed eligible for and apply it toward health insurance through the Health Insurance Marketplace. That is where the term “Advanced” Premium Tax Credit comes from. You can choose to apply the whole credit or some of the credit. If you don’t apply all of the credit you will often get the remainder of the credit when you file your tax return.

    Most people elect to take the whole amount so that the cost of health insurance is less throughout the year. APTC applies only to Health Insurance Marketplace plans. You have to enroll for the plans through Healthcare.gov or a local agent that is certified to enroll you in the Health Insurance Marketplace plans.

    An example: you put in the requested household information and it determines the Premium tax credit available for this household: $992/month. If the health plan you are interested in costs $1100 and you apply all of the APTC of $992/month then your health insurance will cost you $108/month ($1100 minus $992).

    I hope this is helpful for you. Thank you for reaching out!

    ― Tammy

    author-img
    Insurance and health care consultant

    Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

    Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

    Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.