10 Health Insurance Facts Families Ought to Know

Got covered mom-girl
How’s this for a Mother’s Day gift: life-saving health care for a single mom of three who needs—but can’t afford—open-heart surgery. That’s what UT linebacker Dalton Santos made happen for his mom, after tweeting to fans last month about raising money for surgery for his uninsured mom.

The good news is it worked, and Dalton’s mom is on a path back to health. The bad news is others like her—many of them women—still don’t have health coverage and face equally dire situations. Nearly 1 in 3 working-age Texans are uninsured, and not all of them have a family fan base to raise $70,000 for a surgery if they need one. While it’s great that this family got help—and that hundreds of thousands of Texans recently signed up for health insurance under the Affordable Care Act—there’s still more be done, given that Texas has the nation’s highest rate of uninsured.

Odds are, we all know someone who doesn’t have health coverage, which puts their well-being, their family’s finances, and even their children’s health at risk. Insurance can be complex, so it’s good to stay on top of what’s available in terms of good, low-cost options and your rights as a health care consumer. Since health reform went into effect, a lot has changed quickly. Here are 10 things worth knowing.

1. Financial help is bringing down health insurance costs.

Most uninsured people want good health coverage but think they can’t afford it. But peace of mind may be more affordable than you thought: 84% of Texans who just enrolled in health insurance got financial assistance (tax subsidies, credits, and other breaks) that reduced their costs. I’ve met folks who pay as little as a few dollars—or even a few cents—per month for really good coverage. This calculator from Get Covered America shows what the price could be for you.

2. Remaining uninsured could lead to a fine.

People who have health insurance won’t notice a change, but uninsured families could face a fine when they go to pay their taxes in 2015. The size of the fine varies, but it’s as high as 1% of the family’s income (higher in future years). Getting insured sooner would reduce the fine, so it’s good to know that . . .

3. If something big just happened in your life, you may be able to get covered right now.

March 31 was the deadline to sign up in the Health Insurance Marketplace, but people experiencing big life events have another chance. For example, there is a 60-day window to enroll after you:

  • have a baby or adopt (not just for the child; everyone in the family can get insured);
  • get married or divorced;
  • lose your health insurance, for example, through your job (and the Health Insurance Marketplace is probably a better deal than COBRA); or
  • move to a new coverage area (a move within the neighborhood probably wouldn’t qualify; one to a new city might).

4. Many kids can get insured year-round.
Families whose kids qualify for CHIP and Medicaid can sign up any time of year here. Advertisement
5. Young adults have new coverage choices, too.

Through age 25, kids can stay on their parents’ health plans. Also, graduating students who had coverage through their school may be eligible to enroll in the Marketplace. About half of single young adults can find plans for $50 or less per month.

6. Turning 26 is now an insurance milestone.

If you were on your parent’s plan and lost coverage, turning 26 is a chance to get signed up in the Marketplace. (Tell friends born in ’88 the news.)

7. Today’s plans cover more.

Nowadays health plans have fewer loopholes. Preventive care—from well-child visits to mammograms—are covered, as are pre-existing conditions. From mental health to prescriptions to things like breastfeeding supports, things that may have been expensive add-ons in the past now typically come standard, sometimes with little or no out-of-pocket cost.

8. You can get help for free from experts.

Assistance to walk you through your options for enrolling can be found online at Healthcare.gov, by calling 2-1-1, and at sites such as clinics with in-person helpers.

9. Newly insured? To stay covered, you have to pay your premium every month.

This may sound obvious, but with many job-based plans, you don’t have to think about premiums since they just come out of your paycheck. If you’re among the 740,000 Texans who signed up for a Marketplace plan, though, you’ll need to treat health insurance like any other monthly bill, and submit payment every month to remain insured.

10. Already insured? Families who aren’t could use your help.

If you’ve read this far and you have health insurance yourself, I’m going to guess that you may be the type of person who cares about this issue and may be motivated to help the uninsured. Volunteers are needed to help spread the word about health care, to assist with enrollment, and more. Learn more here or drop me a line about how you’d like to get involved.


Christine Sinatra is with Enroll America and formerly worked for Texans Care for Children. She has written columns for the Austin American-Statesman and is a mom to a first-grader in South Austin.

Catherine Prystup
About Catherine Prystup 2157 Articles
Catherine Prystup founded LiveMom.com out of a desire to build a better community for Austin-area moms. She has three children, ages seventeen, eight and three years old.

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