Health Insurance Marketplaces Now Open: New Health Insurance Marketplaces are open in every state. They provide one-stop shopping for health insurance for individuals and families needing coverage. Financial assistance is available to help make the premiums affordable. Insurance companies are not allowed to deny coverage to individuals with pre-existing medical conditions or charge higher premiums because of your health status. To find the Health Insurance Marketplace for your state, visit www.healthcare.gov or call toll-free at 1-800-318-2596.
Eligibility: Individuals who need coverage who are legally residing in the U.S. and who are not incarcerated are eligible to purchase coverage through their state’s Marketplace. Small employers with fewer than 50 full-time employers can also purchase coverage through the Marketplace. Insurance companies will not be allowed to deny coverage to individuals with pre-existing medical conditions nor will they be allowed to charge higher premiums to people because of their health status.
Financial Assistance Available: Most uninsured individuals qualify for financial assistance called a Health Insurance Premium Tax Credit to help make their insurance premiums affordable. The amount of financial assistance depends on your income and family size. Individuals with low incomes may qualify for free or very low premiums. To find out how much financial assistance you may qualify for, check out the Kaiser Family Foundation’s subsidy calculator .
Types of Coverage: All of the health plans sold through the Marketplace are offered by private insurance companies and are required to meet minimum requirements. All of the plans are required to cover a comprehensive set of benefits that includes hospital care, doctors’ visits, emergency care, prescription drugs, lab services, preventive care, and rehabilitative services. Before choosing a plan, individuals will be able to see whether their healthcare practitioner participates in the plan’s network (if choosing a network plan). Individuals will be able to choose the plan that best meets their needs and budget. Individuals with low-incomes may instead qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program.
How to Enroll: Individuals who need coverage can fill out a single application to find out what financial assistance they are eligible for and to apply for coverage. To find your state’s Marketplace and to apply online go to www.healthcare.gov. Individuals can also call toll-free 1-800-318-2596 to apply. Those needing assistance with filling out the application can get help from trained, certified counselors; to find in-person assistance near you, contact your state’s Marketplace or visit www.healthcare.gov.
The next open enrollment period will begin on November 15th, 2014 and end on February 15th, 2015. However, in certain circumstances, you may be able to buy coverage outside of the regular open enrollment period, such as if you:
- Have or adopt a baby, or
- Get married, or
- Move to a new state, or
- Lose your other health insurance coverage.
High-risk Pools: About 35 states have high-risk pools that provide coverage to people with medical conditions who are not able to get other coverage. Find out if your state has risk pools. Many states may be phasing out their high-risk pools starting January 1, 2014 when insurance companies will be prohibited from denying coverage or charging higher premiums to people with medical conditions. Many people currently being covered through a high-risk pool will qualify for the Health Insurance Premium Tax Credit to help make coverage more affordable for them through their state’s Health Insurance Marketplace.
Individual Coverage: In most states, health insurance coverage will still be available outside the Health Insurance Marketplace. However, if consumers want to take advantage of the Health Insurance Premium Tax Credit to help pay for their coverage, they must buy their coverage through the Health Insurance Marketplace. Visit www.healthcare.gov to find your state Marketplace.
Medicaid: Depending on your income and the state in which you live, Medicaid may also be an option. Medicaid is a partnership between state and federal governments that provides coverage for medical services to certain individuals and families who have low incomes. Find your state’s Medicaid program. Individuals can find out whether they are eligible for Medicaid by submitting a short application through their state’s Health Insurance Marketplace.
Community Health Centers: Some hospitals, health centers and clinics provide medical care, prescription drugs, dental care and other services regardless of your ability to pay. Anyone may use a community health center, whether you have health insurance or not. How much you pay will depend on your income. Find a community health center near you.
Medication Assistance: There are public and private programs that offer discounted or free medicines. To learn more, check out these Medicine Assistance Programs.
Foundation for Health Coverage: The Foundation for Health Coverage Education’s website, also includes state-by-state information on different coverage options or sources of financial assistance that may be available to you.Learn more:
- Why is health insurance important?
- Options for Children
- Options for the Disabled
- Options If You Lose Your Job
- FAQs About Health Insurance
- Cut the Cost of Health Insurance - English
- Cut the Cost of Health Insurance - Spanish