How can you get health insurance?
If you don’t have health insurance, you likely have multiple options for getting it.
If your employer offers group health insurance, you can get coverage through your job. It’s common for employers to pay a portion of your health insurance premiums as well. The Affordable Care Act requires large businesses with 50 or more full-time employees to provide health insurance to all full-time employees or pay a shared responsibility payment.
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The SHOP program
If you’re a small-business owner with at least one full-time employee (not including yourself), you can choose to get affordable health insurance for yourself and your employees through the Small Business Health Options Program. You may even qualify for the Small Business Health Care Tax Credit if you have fewer than 25 employees earning an average of $56,000 or less.
The ACA Marketplace
If your job doesn’t offer coverage and you’re self-employed, or unemployed, you can purchase an individual or family health insurance plan on Healthcare.gov or your state’s marketplace. You can use the marketplace to search for plans and apply for coverage. Make sure to compare ratings, including NCQA ratings, financial strength ratings, and Healthcare.gov star ratings, along with cost and benefits to help you choose the right plan.
You may also qualify for the Premium Tax Credit, which is designed to reduce your monthly cost if your income falls between 100% and 400% of the federal poverty level. If you qualify for cost-sharing reductions as well, you may get a lower out-of-pocket maximum. Though open enrollment runs from Nov. 1 through Jan. 15, you can also qualify for a special enrollment period in certain circumstances, such as if you lost your job.
Important Information: The Affordable Care Act has several important provisions besides the creation of the Health Insurance Marketplace. The ACA:
Allows young adults to remain on their parents’ health insurance plans until age 26
Prohibits insurance companies from denying someone coverage due to pre-existing conditions
Bars insurers from setting annual or lifetime spending limits for policyholders
Requires insurers to cover the cost of preventive services
Mandates that insurers cover maternity care
Expands Medicaid to cover more low-income Americans
Learn More: How to Get Health Insurance Without a Job
You can also use your health insurance marketplace to find out if you’re eligible for Medicaid, a joint state and federal program that provides no-cost and low-cost coverage to low-income Americans. Even if you don’t qualify, your children might be eligible for financial assistance through the Children’s Health Insurance Program (CHIP). Requirements vary by state.
Private health insurance
You can purchase an off-exchange plan from a private insurance provider. But bear in mind that these plans aren’t subject to ACA regulations, so they may not cover all ACA-mandated types of care, such as mental health coverage. If they don’t, they may not qualify as minimum essential coverage. You also can’t qualify for financial help if you go this route.
Medicare is a federal program that provides health insurance to people ages 65 and older in addition to younger people with certain disabilities and end-stage renal disease. Most people don’t pay a premium for Part A, which is hospital insurance, but everyone pays a premium for Part B, which is medical insurance. You also have the option of enrolling in Part D, which is prescription drug coverage.
Original Medicare and Medicare Advantage plans (Part C) can still leave you vulnerable to high out-of-pocket healthcare costs, so some people choose to purchase a Medicare Supplement plan for additional help with the copayments, co-insurance, and deductibles.
Learn More: Medigap vs. Medicare Advantage: Which Plan Is Best for You?