Health insurance is no longer an option. Men, women and children across the U.S. are mandated to maintain health coverage throughout the year or the head of household will suffer the consequences – the Obamacare (or Affordable Care Act) penalty. Each year, this penalty raises higher and higher, in an effort to get people to voluntarily obtain health insurance each year.
Some men aren’t used to worrying about health insurance. This is because they either get it through their employers or go through life without it. However, now that it is mandatory to be insured, men throughout America have to find coverage that suits their needs. The good news is that there are a number of plans out there to choose from, especially in the federal and state health insurance marketplaces.
If you’re a male, it’s very important to start looking for insurance ASAP – not just to avoid the penalty, but to keep your body in tip top condition; healthcare statistics show that the health of men in America is greatly failing.
Alarming Stats About Men’s Health
We can all agree that women are more proactive about their health when it comes to visiting the doctor. Most men won’t go to a hospital unless it was an absolute emergency. This way of thinking is likely why a lot of American men are living with health conditions that could have been easily prevented if only they were diagnosed sooner. Here is a quick peek at the various stats regarding men’s health:
- Men between 25 and 64 are more likely to die from a drug overdose than an auto accident
- One 20-ounce bottle of soda has between 15 and 18 tsp of sugar, increasing your risk of diabetes by 26 percent and heart attack by 20 percent
- On average, men spend three hours daily watching television
- A quarter of men between 25 and 44 smoke cigarettes
- Twenty-five percent of men don’t eat breakfast, which likely accounts for the growing prevalence of male obesity
- Men spend an average of approximately 101 minutes daily driving their car
Lifestyle changes are in order to avoid contributing to these statistics. For instance, walking and biking is healthier than driving all the time, especially if you have a short commute to work. The same goes with eating a healthy breakfast to curve your appetite throughout the day so you don’t end up overeating sugary snacks.
Health Insurance Options for Men
The good news is that the Affordable Care Act has made it easier for Americans to obtain coverage. Federal and state marketplaces are available during open enrollment where you can find various types of plans that suit your needs and lifestyle. Now, if you have a pre-existing health condition you can still obtain health insurance.
If you’re looking for the best options, then you need to check with your state’s marketplace. The costs vary depending on the region you live in. There are four types of coverage options to select from, including bronze, silver, gold and platinum.
In the bronze package, 60 percent of medical expenses are covered, silver covers 70 percent of health costs, gold covers 80 percent of medical costs and platinum covers 90 percent of health care expenses. These plans are available in the health insurance exchange, which is the marketplace where you can shop for health plans. The higher the metal, the more your premium will cost. However, your deductible, coinsurance and co-pay will decrease.
Whichever plan you opt for, there is a cap for out-of-pocket costs, which is at $6,350 for single people and $12,700 for families. This cap doesn’t include out-of-network expenses or cost for premiums.
Health Insurance Costs by Package
So what are the costs for these packages? This varies based on your age, health and income. But to give you an idea, a 27-year-old man with a $25,000 income would pay around $215 monthly for silver ($145 monthly after tax credits) and about $93 monthly after tax credits for the cheapest plan. For families earning $50,000 annually, the silver plan would be $774 monthly ($282 after tax credits) and $95 monthly for the cheapest plan, after tax credits have been deducted.
On average, monthly premiums from the federal exchange was $346 per person. After tax credits, this dropped down to $82. The good news is that you can still save on your health plan if you earn a decent salary. Tax credits can be obtained if you earn between 100 and 400 percent of the federal poverty level. In 2014, single men had to make between $11,670 and $46,680 to qualify for the tax credits.
In-Network vs. Out-of-Network
When you enroll into a health plan, you normally have to choose doctors and specialists that are within the network of your insurance provider. If not, you won’t receive coverage for the expenses incurred, or only some of the cost is covered. For instance, you might be responsible for paying 21 percent of the medical expenses for in-network treatments, while 38 percent of out-of-network expenses would have to be paid out of your pocket.
Then for deductibles, the price difference would be something like $1,046 for in-network and $2,071 for out-of-network. The out-of-pocket annual max for in-network health care would be $3,046 and $6,045 for out-of-network care. Finally, the coinsurance for emergency room visits would be 26 percent for in-network visits and 40 percent for out-of-network.
You can pretty much expect to pay double for out-of-network health care than you would for in-network care.
Employer Health Plans
If you are employed, it’s very likely that you will be able to obtain health coverage through your place of business. The Affordable Care Act has made it mandatory for qualifying businesses to provide insurance to qualifying employees (full-time, etc).
The Penalty for Being Uninsured
It’s time to take your health coverage seriously, because if you don’t, you’ll literally have to pay. The penalty for not having proper coverage for yourself and your family will continue to rise each year:
- $95/adult or 1 percent of income (2014)
- $325/adult or 2 percent of income (2015)
- $695/adult or 2.5 percent of income (2016)
If you have uninsured children, you can expect to pay 50 percent of the adult penalty per child. This money is taken directly from your tax refund.