How to get health insurance
Six routes exist, and for most people only one or two are actually available. Which is yours is decided by how you work, what you earn and how old you are.
There are six ways to get health coverage in the United States, and for most people only one or two are actually available. Which applies to you is decided by how you work, how much you earn and how old you are — not by preference. Work down the list; the first one that fits is usually the answer.
1. Through an employer
If a job offers coverage, it is nearly always the cheapest route, because the employer pays a large share of the premium and you cannot get a premium tax credit while an affordable offer is on the table. Worth taking even when the plan is mediocre. The exception is when the offer is not affordable by the legal test, which has a specific definition and a specific consequence.
2. Through the marketplace
The route for people who work for themselves, whose employer offers nothing, or who are between jobs. Plans cannot refuse you or price you on your medical history, and the premium tax credit pays part of the premium if you earn under $63,840 as a single person or $132,000 as a household of four. How the marketplace works.
3. Medicaid
If your income is at or below 138% of the poverty guideline — 22,025 dollars a year for one person — you may qualify for Medicaid rather than a marketplace plan, and it enrolls all year round rather than only during Open Enrollment. There is no premium in most cases.
This depends heavily on your state. In the states that did not expand Medicaid, adults below the poverty line can fall into a coverage gap: too little income for a subsidy, too much for Medicaid as their state defines it. Nationally 7,958,134 uninsured people under 65 are in that income range. Check your state.
4. Staying on a parent's plan
Anyone under 26 can stay on a parent's plan, whether or not they live at home, are married, or are financially independent. What happens when that ends is one of the more common reasons people first buy their own coverage.
5. Continuing coverage after a job ends
COBRA lets you keep an employer plan for a period after leaving, at the full unsubsidised price plus an administrative fee — which is usually a great deal more than the payroll deduction was. Losing job coverage also opens a 60-day window to buy on the marketplace instead, and that comparison is worth doing carefully. Between jobs.
6. Medicare
At 65, or earlier with certain disabilities. Different program, different rules, different enrollment calendar. This site covers the under-65 market and does not advise on Medicare. Retiring before 65 is the gap that catches people out.
What you will need
Whichever route applies, an application asks for the same things: everyone in your household, your expected income for the coverage year, and details of any coverage available to you through work. The full list, and the steps.
Enrollment dates · Guidance by situation · Coverage where you live