- Anyone can get health insurance coverage—there's an option for everyone
- Even if you have an illness or disability, coverage is available
- If you don't think you can afford health insurance, the government has options to help you if you qualify
Find out what health insurance might be right for you
- Your employer might offer Employer-Sponsored Insurance (ESI)
- The state or federal government has programs for some groups of people (American Indians and Native Alaskans, people with certain diseases or health conditions, pregnant mothers, etc.)
On your own
- Private insurance companies
- The Health Insurance Marketplace
Learn more about your options
There is a period of time called open enrollment. During this time, you can sign up for insurance for the upcoming year
- For employers, this is often in the fall
- For the Health Insurance Marketplace, you can enroll during the open enrollment period - see www.healthcare.gov for specific dates
- Some government programs like Medicaid allow you to sign up at any time
- Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events.
- You can also enroll in health insurance after going through certain changes in your life, called qualifying life events. These are opportunities to adjust your coverage to fit your needs
Examples of qualifying life events
- Birth or adoption of a child
- Death of a child or placement for adoption
- Change in marriage status (married, divorced, legal separation, annulment)
- Change in employment (hired for new full-time job, loss of job, retirement, etc)
- Loss of coverage from private insurer
Learn more about when to sign up
How much will my health insurance cost me?
How can I lower my health insurance costs?
How can I lower the costs of prescription medicines?
Can you give me an example of how a deductible works?
Can you give me an example of how a copay works?
Can you give me an example of how coinsurance works?
What costs contribute to my out-of-pocket maximum?
There are a number of factors to consider when choosing a health plan. To figure out what coverage you might need, you may want to first ask yourself questions, such as:
- Overall, how healthy have I been in the recent past?
- Do my family members or I have any health conditions?
- Am I beginning to experience any age-related health conditions?
- Am I active or do I have an active spouse or children playing sports? The risk of injury might be higher for people with active hobbies like rock climbing, recreational sports, or even running
- Do I see any specialists (like a podiatrist for foot problems or a neurologist for migraine headaches)?
Your answers will help you decide what features to look for in a plan.
Second, consider what options are available to you.
- Am I a US citizen, US national, or legal US resident?
- Am I 65 or older?
- What state do I live in?
- Can I get insurance through my job, spouse, parent/legal guardian?
- How much money do I make per year?
- Have I served in the US Armed Services?
- Am I pregnant?
- Do I have end-stage renal disease, Lou Gehrig's disease, a disability, or am I legally blind?
Your answers will help you decide where you can get coverage.
You will also want to consider the cost of your options. Think about each plan in terms of expected monthly and yearly costs based on your health care needs.
One way to balance out costs throughout the year might be to choose a plan with a higher monthly premium. These plans often have lower deductibles, allowing you to begin sharing the cost of care with the insurance company earlier in the year with copays and coinsurance.
If you can afford to pay more on your own each time you need care (and are generally healthy), a plan with a lower premium and higher deductible might be an option for you.
Think about what you can pay for care, and when you might want to pay these costs. When comparing plans, consider asking yourself:
- What can I afford to pay as a monthly premium, even if I don't need care?
How often do I think I may need to visit the doctor or a specialist?
- Are these doctors in my plan's network? If not, what will it cost me to see them?
- How often do I think I may need prescription medicines?
- How much can I afford to pay on my own before health insurance begins sharing the cost of care? (deductible)
- What will it cost me out of my own pocket each time I need care? (copay, coinsurance)
- What is the maximum I will have to pay out of my own pocket for covered services in a year?
Your answers will help you decide how much coverage you need. For additional information see www.healthcare.gov.