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Health insurance upheaval

Without health insurance, you're more likely than insured people to skip medical treatment, or face financial trouble if you get seriously sick or injured and have to pay for care out of your own pocket.

That's why health insurance remains the top-ranked job benefit among employees. In a recent Ask.com survey, in fact, 60 percent of Americans said they'd rather spend a night in jail than lose job-based health insurance and other benefits.

But what if you don't have coverage through an employer? Then join the club -- you're among the growing number of folks who have to buy health insurance on their own. The percentage of Americans under age 65 without employer-sponsored health insurance has fallen steadily in the last decade. In 2011, the portion hit 58 percent, down from 69 percent in 2000, according to the Economic Policy Institute.

One thing holds true, though, regardless of how you buy coverage. You need to understand how health insurance works, what it covers and doesn't cover and how the health insurance market soon will change.

You must buy health insurance in 2014

Since Congress passed the Patient Protection and Affordable Care Act in 2010, many new rules already have gone into effect and even bigger ones lie ahead.

Starting in 2014:

  • Almost everyone will be required to have health insurance. You could pay a tax penalty if you don't have coverage.
  • More people will qualify for Medicaid, the federal and state health insurance program for low-income people.
  • Many lower- to moderate-income people who don't qualify for Medicaid will get tax credits to help them afford health insurance.
  • Health insurers will no longer be able to charge higher premiums or deny coverage for people who are sick or have health conditions, including pregnancy.
  • State health insurance marketplaces, called exchanges, will open. The landscape of exchanges is complex. Some states plan to run their own exchanges; others are doing so in a federal-state partnership. And states that make no plans will default to federally run exchanges. The National Conference of State Legislatures has information about implementation in each state.
  • You'll be able to buy health plans through the exchanges, or directly from insurers, through health insurance agents or through insurance-comparison websites.
  • All individual health plans will have to provide certain benefits, such as maternity and newborn care, preventive services, hospitalization and emergency services. Plans will be standardized, so it's easier to compare them.

Buying health insurance right now

Until 2014, if you aren't lucky enough to have group health insurance through work, you shouldn't wait until you get sick or pregnant to shop for an individual health plan.

When shopping for an individual health plan or choosing a plan among those offered by an employer, you should think about your health care needs and then compare plans according to their benefits and costs.

Employer-sponsored group plans can't exclude coverage for pre-existing conditions if you've maintained health insurance coverage for the last 12 months, with no gaps of 63 days or more. Read more about HIPAA: Your rights to health insurance portability.

Premiums depend on how a plan is designed. Generally the higher your out-of-pocket costs, such as deductibles, copayments and co-insurance, the lower the annual premium is.

For individual health plans, premiums vary according to your age, health condition and whether you smoke. See these 12 ways to lower your health insurance premiums. Group health plans can't charge a particular person more based on his or her health conditions or age, but the overall health and age of your "group" at work will influence premiums for everyone.

Understand how the plans work before you choose one. What services are covered? Does the plan include a network of providers? If so, make sure your doctors are in the network and that the network includes a healthy array of hospitals, primary care doctors and specialists. You will pay more for care outside than inside the plan's provider network. For more on the different types of plans, see health insurance basics.

Finding the right health insurance plan means weighing costs and benefits of each plan and then choosing the most suitable one. Only you can decide which mix of flexibility, services and costs fit your needs.

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