Health Insurance Marketplaces Now Open: New Health Insurance Marketplaces are now available in every state that provide one-stop shopping for health insurance for individuals and families needing coverage. Financial assistance is available to help make the premiums affordable. To find the Health Insurance Marketplace for your state, visit www.healthcare.gov(link opens in new window) 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(link opens in new window).
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(link opens in new window) or the Children’s Health Insurance Program(link opens in new window).
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(link opens in new window). 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(link opens in new window) or visit www.healthcare.gov(link opens in new window).
The next open enrollment period will begin on November 1st and end on January 31st. However, if you have lost your health insurance because you lost your job, you may qualify for a special enrollment period to buy coverage outside of the regular open enrollment period(link opens in new window). Check with your state’s Marketplace to see if you qualify for a special enrollment period.
Additionally, those who qualify can apply for the Children’s Health Insurance Program (CHIP) or Medicaid at any point during the year. There is no open enrollment period for these programs. Also, if you own or operate a small business, you can begin offering coverage to your employees at any time.
COBRA Coverage: You may be eligible to continue receiving coverage through your former employer’s health plan if you take over paying the full premium under a law called COBRA. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, and it gives employees and their family members the right to pay premiums to keep their group health insurance if they lose their job. In most states, COBRA applies to employers with 20 or more employees and allows people to keep the insurance for up to 18 months. In a few states, employers with less than 20 employees may be required to offer COBRA. Check with your Human Resources department to see whether you are eligible for COBRA. However, COBRA coverage can be expensive since the former employer isn’t required to pay any part of the premium. Those who have lost employer-based health insurance may find it more beneficial to apply for coverage through the Health Insurance Marketplace, particularly if they are eligible for financial assistance through the Health Insurance Premium Tax Credit.
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(link opens in new window) to find your state Marketplace. Meanwhile, if you need coverage immediately and would like to search for and compare plans available now, go to finder.healthcare.gov(link opens in new window) to start your search. The Foundation for Health Coverage Education’s website(link opens in new window), also includes state-by-state information on different coverage options or sources of financial assistance that may be available to you.Learn more:
- Options for Children
- Options for the Disabled
- Options for the Uninsured
- FAQs About Health Insurance
- Cut the Cost of Health Insurance - English(link opens in new window)
- Cut the Cost of Health Insurance - Spanish(link opens in new window)