Beginning in 2014, the Affordable Care Act requires all Americans to carry health insurance or to pay a fine. If you’re under 65, you have several options for buying insurance, including your employer, government health insurance marketplaces, private insurance companies and insurance brokers. Low-income families may be covered under Medicaid or the Children's Health Insurance Program, and adults under age 26 may be covered under their parents' plans.
Start with your employer. Many companies subsidize insurance costs, so job-based group coverage may be the best option if you’re eligible. If you are married, you may qualify for coverage through your spouse’s job. And, if you’re 26 or younger, you may obtain coverage under your parents’ plans. Note that if you waive job-based coverage, you are not eligible for premium tax credits through the ACA marketplace.
Shop for insurance at healthcare.gov. This is the portal for the state and federal health insurance marketplace, also known as exchanges, set up by the ACA. Using the marketplace, you can get coverage online, over the phone or in person. You can shop for coverage during open enrollment periods, or at any time if you have special qualifying circumstances such as getting married or losing a job. If you meet income guidelines, you may qualify for premium tax credits and out-of-pocket cost reductions that help offset the cost of care. You also can apply for Medicaid or CHIP via the marketplace.
Consult the Plan Finder website offered through healthcare.gov. Developed by the federal government, this website can help you find and compare private health plans available outside the government marketplace.
Compare plans from an online insurance seller that offers health plans from a number of insurance companies. After you compare prices and features, you usually can enroll with the insurance company through the seller's website.
Contact an insurance company directly to see plans available in your area. Many companies have websites that let you compare all of the plans they offer.
Work with an insurance agent or broker to compare plans and enroll. Agents typically work for a single health insurance company, while brokers represent several companies. You generally won't pay more for a policy from an agent or broker because they are paid by the insurance companies.
After considering all your options, choose the plan that best meets your healthcare needs and budget. If you're young and generally healthy, you might go with a plan that offers higher co-payments and coinsurance amounts along with lower monthly premiums. If you're older or have conditions that require ongoing care, you might prefer a more expensive policy with better coverage.
The ACA set new minimum standards for insurance plans. To comply, insurance companies cannot deny coverage or charge higher premiums if you have a pre-existing condition. They can't drop your coverage if you get sick, and they can't set a lifetime policy limit on how much they will pay for your care. Most insurance plans must cover preventive services like shots and screening tests without charging a co-payment or co-insurance.
When evaluating plans, check to see if your current doctors are covered. A lower-cost plan that requires you to switch doctors might not be worth the savings. If you choose to switch, start looking for a new primary care physician as soon as the new policy is in effect. You'll want to schedule preventive screenings and get to know your new doctor before you become ill.
If you buy an individual insurance plan outside the healthcare.gov marketplace, you won't qualify for premium tax credits or lower out-of-pocket costs based on your income.
If you can afford health insurance but choose not to buy it, you must pay a fee, which increases every year. You may avoid paying the fee if you qualify for an exemption.
Even if you purchase health insurance, you may still have to pay a fee if you choose a plan that does not meet minimum requirements set by the ACA.
- Healthcare.gov: Health Coverage Rights and Protections
- Healthcare.gov: How to Apply for Health Coverage
- Healthcare.gov: Exemptions From the Fee for Not Having Health Coverage
- Healthcare.gov: Getting Coverage Outside the Marketplace -- Plan Finder
- Healthcare.gov: Health Insurance Options If Your Income is Too High for Tax Credits
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