Getting health insurance
Health insurance (also called health coverage or a health plan) helps you pay for medical care. Health insurance is really important for you and your family.
You may have several choices for health insurance depending on things like where you live and how much money you make. For example, you may get your health insurance from your employer (where you work) or your partner’s employer. Or you may get it from the government or buy it on your own.
You may want to choose a health plan based on what’s happening in your life. If you’re pregnant or planning to get pregnant, you want to make sure your plan covers prenatal care and care for your baby after he’s born. You may have to plan ahead to make the best choice for you and your growing family.
Where can you get health insurance?
Depending on the amount of money you make each year (also called your annual income), you may be able to get your insurance from:
- Your employer or your partner’s employer
- A private insurance company
- Government programs like Medicaid and the Children’s Health Insurance Program (also called CHIP). Medicaid provides free or low-cost health insurance to people with low income. CHIP provides health insurance to some children and pregnant women in families that earn too much to get Medicaid but can’t afford private insurance.
You can find out about different kinds of insurance from your state’s Health Insurance Marketplace (also called the Health Insurance Exchange). This is an online resource that helps you find, compare and buy health plans in your state. You answer some basic questions, and the Marketplace shows you insurance options and the cost for each. It also tells you if you can get a tax credit to help you pay for insurance. Then you can pick the plan that works for you and fill out an application.
To help you choose a plan, you can talk to a Navigator. This is a person who’s trained to help you understand your insurance choices. She can tell you about the plans you’re looking at and what each one offers. She also can help you fill out forms and find out if you can get help to pay for your plan. Navigators are available 24/7 (every day, all day and all night) at www.healthcare.gov/contact-us or (800) 318-2596.
If you or your partner work, do you have to get insurance through your employer?
It depends. Many people get health insurance through employers. In fact, this may be your best option for insurance if it’s affordable. According to the Affordable Care Act (also called ACA or Obamacare), affordable means it costs less than 9.5 percent of your household income. Household income is the total income from everyone who lives with you, including anyone who files a tax return.
If your employer’s health plan is affordable, you can choose to buy insurance from the Marketplace, but you can’t get a tax credit (a discount) to help you pay for it. For example: If your household income is $40,000 a year and the health plan offered by your employer costs less than $3,800 a year, this may be the best insurance plan for you. If you choose not to take this plan, you can still buy a plan offered in the Marketplace, but you can’t get a tax credit to help pay for it.
If your household income is $40,000 a year and your employer’s health plan costs more than $3,800 a year, you may be able to get a tax credit for plans offered in the Marketplace. You can decide which plan is best for you—your employer’s or one from the Marketplace.
To help you figure out how much your employer health plan costs, you can:
- Look at the plan information you get from your employer.
- Talk to someone from the human resources department at your workplace.
If you get your health insurance through your employer, it may be limited if you work part time. And not all employers offer coverage for your family. If your employer doesn’t have coverage for family members, you can look for coverage for them in the Marketplace. The U.S. Department of Labor has more information on getting health insurance through your employer or your partner’s employer.
If an employer’s health insurance is too expensive, or if you’re unemployed or self-employed, what choices do you have for health insurance?
When you use the online Marketplace to get your insurance, it tells you the amount of financial help you can get. Many Americans can get help to pay for health insurance. The amount of help depends on a few things like:
- How much money do you earn each year (your annual income)?
- How many people are in your household (live with you)?
- Does your employer offer an affordable health plan?
The Marketplace uses your answers to these questions to figure out how much help you can get to pay for health insurance. For example:
- If you’re younger than 65 and earn less than about $15,000 a year, you may qualify for (be able to get) Medicaid. Medicaid is health coverage offered by your state government. The income amount for Medicaid is different for each state.
- If you earn more than about $15,000 a year, you may be able to get help paying for health care costs, including premiums, deductibles and co-pays. But if your income reaches a certain level, you don’t qualify for this kind of help. For example, if you’re a family of 3 and your annual income is at least $73,000, you can’t get a tax credit to help pay for insurance. Check out this calculator to see how much of a tax credit you may be able to get for health insurance.
You can use the information you get in the Marketplace to help you choose a health plan that you can afford and that meets the needs of you and your family.
Last reviewed: August, 2014