If you’ve ever worked as an employee for a company that offers health benefits to employees, you know what it’s like to get health insurance coverage. Often, all you have to do is make a few basic decisions, sign the paperwork, and your health insurance card arrives in the mail.
Being a gig worker is a very different story. As you know, if you’re an independent contractor, sometimes called a 1099 worker, the companies you drive for may not offer health insurance to 1099s. Your health needs, though, are still the same.
Checkups, medications, and other treatments are forms of routine medical care that almost everybody needs from time to time. With the price of care being what it is these days, it’s virtually impossible to pull together the cash to pay for these services, let alone for the cost of a more catastrophic health crisis. What can you do?
In this article, we’ll show you key information you need to know about getting health insurance, including new information that makes getting coverage even easier. Here are topics to be covered:
- How the American Rescue Plan Act (ARP) and Inflation Reduction Act have made coverage more affordable
- ACA-compliant coverage: What it is and how you can get it
- Paperwork, regulations, and enrollment periods: What could stand between you and a plan
- How to get knowledgeable help in choosing, and securing, the right plan
- No more fear—walk into the right health plan for you with a guide
The American Rescue Plan Act (ARP) and Inflation Reduction Act
Before going into the basics of getting health insurance, it’s important to understand that the American Rescue Plan made some important improvements to how Affordable Care Act (“ACA”) premium subsidies were calculated. Those changes were temporary, and were set to expire at the end of 2022. But the Inflation Reduction Act extended them through 2025, ensuring that people who buy their own health insurance can continue to access more affordable coverage.
Here’s an overview of the improvements:
- The income cap (previously 400% of the federal poverty level) for subsidy eligibility has been removed. So, depending on where you live and how old you are, you might find that you’re eligible for subsidies even with an income well above that level.
- Premium subsidies are larger than they used to be. They’re still income-based and on a sliding scale, but the percentage of income that people have to pay (after the subsidy) is lower than it was pre-ARP. Some people qualify for premium-free plans and, even on the high end of the income scale, eligible applicants don’t have to pay more than 8.5% of their household income for the second-lowest-cost Silver plan.
- There’s a year-round special enrollment opportunity for people who are subsidy-eligible and whose household income isn’t more than 150% of the poverty level. This was created after the ARP was enacted, and the government specified that it would only be available as long as the ARP-style subsidy enhancements were in effect. Since the Inflation Reduction Act extended the ARP subsidy enhancements through 2025, this ongoing enrollment opportunity will also continue to be available through 2025.
Now, let’s get into the ABCs of health coverage, and how you can get it.
ACA-compliant coverage: What it is and how you can get it
For those who purchase their own health coverage, ACA-compliant coverage is available through the exchange/marketplace and also outside the exchange. Before we get into the specifics of this, a few definitions might be useful, since ACA terminology can sometimes be confusing:
- ACA-compliant coverage: Health insurance that complies with the ACA’s rules for major medical health insurance. This is straightforward enough, but it’s important to understand that the ACA’s rules aren’t the same for all types of coverage. Individual and small-group health plans have one set of rules, while large-group and self-insured health plans have different rules. (Some rules apply across the board, such as the cap on out-of-pocket costs.)
- Essential health benefits (EHB): Under the ACA, all individual and small-group health plans with effective dates of 2014 or later are required to include coverage for ten general categories of coverage, which are known as essential health benefits. The specific services that must be covered under each EHB are defined by each state, so they vary depending on where you reside.
- Minimum essential coverage (MEC): When the Affordable Care Act (ACA) was signed into law in March 2010, it stipulated that most Americans would have to maintain health insurance, and there was a penalty for non-compliance from 2014 through 2018. (The requirement to maintain coverage still exists, but the federal penalty was eliminated in 2019.) In order to be compliant with this requirement, a person must have a health plan that’s considered minimum essential coverage (MEC). To be clear, minimum essential coverage does not necessarily mean that a plan is ACA-compliant, or that it includes the ACA’s essential health benefits. For example, any employer-sponsored health plan is considered MEC – even “skinny” employer-sponsored plans that cover very little.
- Minimum value (MV): Under the ACA’s employer mandate, large employers (50+ employees) are required to offer their full-time workers health coverage that’s affordable and that provides minimum value. This just means the plan covers at least 60% of medical costs across a standard population, and provides “substantial” coverage for physician and inpatient care. But a plan does not have to include coverage for EHBs in order to provide minimum value. And even if an employer-sponsored plan doesn’t provide minimum value, it’s still considered MEC.
The concepts of MEC, EHB, and MV are often conflated. But if you’re buying your own health coverage, the only real concept you need to understand is ACA-compliant. Any ACA-compliant plan you buy on your own will include the EHBs, and it will count as MEC.
(Even though there’s no longer a federal penalty for not having MEC, this is still important in some states that have their own penalties for not having coverage. And it’s also important if you later experience a qualifying event and want to switch to a different plan, as most special enrollment periods only apply if you already had MEC prior to the qualifying event.)
Any ACA-compliant individual (self-purchased) health plan will include:
- Coverage of the EHBs, including testing, treatment and vaccination for COVID-19;
- Coverage of pre-existing conditions. For instance, if you have diabetes or a heart condition, a plan that is ACA-compliant cannot reject your application. Your premium will not be based on your medical history. (Premiums can only vary based on age, location, and tobacco use; your premiums will be higher if you add additional family members to the plan).
- No annual or lifetime limits on essential health benefits. That means if you need expensive tests or extensive treatment, the insurance company isn’t permitted to stop paying even after your expenses reach a certain level.
When you’re ready to purchase your insurance plan, you can visit the Health Insurance Marketplace and review all the options. You can also purchase ACA-compliant coverage directly from a health insurance company, but you won’t qualify for financial assistance if you shop outside the Marketplace. In general, the Marketplace will be your best bet, since most enrollees do qualify for income-based financial assistance in the form of subsidies.
There are also other types of plans you can enroll in rather than going through the Marketplace, such as a parent’s group health plan (if you’re under the age of 26), student and/or veterans’ health plans (if you qualify), and Medicaid (if you meet certain criteria). If you have any of these plans, or if you need to find out if you qualify, you’ll have some homework to do.
If you purchase your own plan, you may qualify for reductions in your insurance costs, particularly if you’ve recently had a reduction in hours and/or income from your job. This can be handy for drivers who’ve experienced downturns in business. Before you reach that point, however, you’ll have to clear a few hurdles.
Paperwork, regulations, and enrollment periods: What could stand between you and a plan
When you don’t know how to do something, it can seem impossible. How do you know, for instance, if you qualify for a veterans’ program or Medicaid? Should you sign up for community college and get a student plan? And, if you decide to purchase a plan, how do you know what kind is best for you?
As a driver, you’re may be among the self-employed. This page on the HealthCare.gov website is specifically for self-employed individuals, and gives you an idea of what to expect if you apply directly for an ACA health plan.
While the ACA is the government’s attempt to supply consumers with easy ways to get affordable health care, the website can be confusing to navigate. Even with the convenience of the web-based application process, filling out a lengthy form can be cumbersome. Then there are the enrollment periods. When will they take your application for a plan?
Even if you get your timing right and start to enroll on the ACA site, you’ll have to answer a number of questions, figure out if you’re asking the right questions, and hope the person on the other end can help you get the plan you need.
And then what happens? At what point do you have to sign up, and what if you’re not sure you want to sign up yet? What if they sign you up anyway? Finding the answers to all these questions can be tiring and time-consuming. Wouldn’t it be great if there was an easier way?
There is.
How to get knowledgeable help in choosing, and securing, the right plan
When you’re on an arduous journey like the one you must take toward securing a healthcare plan, you need a guide. That’s why IHC Specialty Benefits has a program for drivers like you. IHC helps you find the fastest, easiest pathways to securing health coverage under the ACA, and there’s a program just for drivers who use Gridwise.
As for the enrollment periods, they are windows of time through which HealthCare.gov accepts applications for health plans. There is the Marketplace Open Enrollment Period (OEP), which runs from November 1 through January 15 (some states have different deadlines); and Special Enrollment Periods (SEPs), during which people have a chance to enroll if they experience a qualifying life event.
Individuals who have a certain life events, such as the loss of job-based health benefits, having a baby, losing a spouse’s coverage, and other life-changing circumstances may qualify for SEPs. People can apply under this kind of SEP up to 60 days before or after the event takes place.
No more fear—walk into the right health plan with a guide
Anyone could easily feel intimidated by the thought of applying for health coverage without help, but it doesn’t have to be that way for you. Now that you know about IHC’s partnership with Gridwise, you can see that health coverage for drivers is definitely within reach.
Enter your information, then find out if you qualify for a subsidy or payment reduction, and get a wide selection of plans that will work for you. And – if you still have difficulty deciding, or need help finding your way – IHC will guide you.
Isn’t it a relief to know there’s a great company like IHC to help drivers get health coverage? Yeah, we think so too.
