How do I health insurance?

April 6, 2022 8:10 AM

I need to purchase medical and dental insurance on the private market (i.e., not through my employer). I am in the United States. I have no idea where to begin.

I've always had medical, dental, and vision insurance included in my compensation package at work.

However, I just accepted a job with a startup company, and they don't yet offer such things. So, I need to figure out how to insure myself.

(I'm mainly interested in medical and dental. I can forgo vision for a while.)

I don't even know what I don't know – so I welcome any advice you can offer. But, maybe some of these questions are relevant:

Are there any specific insurers I should look at? (Or, failing that – what terms should I be Googling to find them?)

Are there different types of self-paid insurance that I should be aware of? What are the differences between them?

Does medical insurance typically cover serious medical issues with the eyes? Or would I need vision insurance for that? (In the past, I've only used vision insurance for eye exams and glasses/contacts. But if I developed a more urgent issue, I'd hate to discover that medical insurance doesn't cover it.)

Are there tax considerations?

Is there anything else I should be aware of?

Basically: where do I begin with this?

For reference, I'm a reasonably healthy 45-year-old cis male, with no notable health issues. I am single, so I'd only be insuring myself.

Thanks!

posted by escape from the potato planet to Health & Fitness (10 answers total)

If you changed jobs, you can go to Healthcare.gov to purchase insurance on the exchange that meets your financial needs - this works because you have had a change in insurance status (e.g., you had insurance and you changed jobs and now you don't have insurance). Look for something that has a middle ground of premiums vs. deductible. When I had to choose insurance, I looked for higher premium plans with lower deductibles, for example, because I knew that I would always be able to budget the set monthly payment for the premium, but I couldn't count on having several thousand dollars to pay a maximum deductible if I had a huge expense (which is always a consideration when you have female parts).

Generally speaking, I have found that insurance will cover eye things like trauma and injury, glaucoma, etc., but will not cover optometrist stuff (like glasses and contacts). That requires vision insurance.
posted by honeybee413 at 8:15 AM on April 6, 2022 [2 favorites]

This varies by state. In Washington state where I am, you can go to https://www.wahealthplanfinder.org/ and get guided through.

You can also go directly to an insurer. For example, if you have a preexisting relationship with a doctor you like, you can ask what insurance they accept, and then use that to constrain your options.

Since you’ve started a new job you qualify for special enrollment, so you shouldn’t run into too many roadblocks.
posted by Mizu at 8:22 AM on April 6, 2022

As you research you might also check out Healthcare.gov's Find Local Help, which will connect you with an insurance agent/broker/assister in your area who can answer questions and help you apply.
posted by jameaterblues at 8:32 AM on April 6, 2022

As a heads up, without an employer subsidy, vision and dental insurance may or may not be "worth it." You will probably want to check the numbers with your expected use case.
posted by oceano at 8:34 AM on April 6, 2022 [3 favorites]

Seriously, talk to a health insurance broker. They cost you nothing and are the best at sorting things out and explaining them to you.
posted by SLC Mom at 8:48 AM on April 6, 2022 [2 favorites]

OK so private dental insurance has a 6 month waiting period before they'll cover anything at all, so don't go in for a cleaning or whatever right away if you can wait til it's covered.

I wear glasses and just order new ones online through Firmoo or one of the other inexpensive options. I get eye tests at Costco (you don't have to be a member), they are not expensive at all. I spent more replacing lenses in my old glasses through my vision plan than I've ever spent on new ones online.

If your prescription coverage isn't great, Costco almost always has the cheapest prices (again, you don't have to be a member) and GoodRX, website or app, has coupons and will also let you compare prices between all the pharmacies.

If you have a high deductible and don't have a lot going on health-wise, it's almost always cheaper to pay in cash instead of with insurance if you don't think you'll meet your deductible that year.

Also you only have 30 days from your qualifying event to register for new insurance, i.e. that your previous insurance is no longer active because you changed jobs.
posted by ananci at 8:51 AM on April 6, 2022

When shopping for a plan, you will essentially be choosing whether you want to pay more in your monthly cost (premium) to have better coverage during appointments/emergencies, or whether you want a lower montly premium in exchange for a higher cost should anything happen (higher deductible, co-pay, etc). It's a bit of an exercise in how much risk you want/are willing to take!
posted by reksb at 9:08 AM on April 6, 2022

Individual dental plans are tricky. Only a very narrow subset of patients will get a true benefit from them. You might want to have your current dentist review what they would anticipate your costs to be over the next year, and weight that against what the insurance will cost+ out-of-pocket charges even with the insurance. It would not surprise me (a Dentist) to learn that you will spend less without the insurance.
posted by OHenryPacey at 1:32 PM on April 6, 2022 [1 favorite]

Dental insurance is often not worth purchasing for yourself. If you look at what is covered, and what the maximum amount the insurer will pay out in a year, it is often about the same as what you've paid in premiums. If you have no major dental emergencies, you will have lost money. if you do have a major emergency, you will have paid about the same either way. So dental is fine if your employer pays for it, but not necessarily worth it if you have to pay for it.
posted by mrgoldenbrown at 1:35 PM on April 6, 2022 [1 favorite]

I had lunch the other day with some one who told me about health insurance through my school's alumni association. It sounded like a decent price. If you went to a large enough school, maybe check out your alumni association.
posted by BooneTheCowboyToy at 4:15 PM on April 6, 2022 [1 favorite]