Where to Look for Health Insurance
Health insurance comes from three main sources: your employer, the government, or the private market. Most people under 65 get coverage through a job — your employer picks a plan, you pay a share of the premium from your paycheck, and the insurance company covers medical costs above what you pay out of pocket. If you don't have employer coverage, you can buy directly from private insurers, or you can look at government programs like Medicaid (for lower income) or Medicare (at 65). The fastest way to find what's available to you is to start with your situation: employed, self-employed, unemployed, retired, or a student.
If you're employed, contact your HR or benefits department and ask for the plan options, the premium amounts, and the deductibles — that's the amount you pay before insurance kicks in. If you're not employed, go to Healthcare.gov (the federal marketplace) or your state's health insurance marketplace. These sites let you enter your income and household size, then show you plans ranked by price. Medicaid is separate — you check that through your state health department or by calling 211, a free referral line that connects you to local programs.
Key Takeaways
- Employer plans, private marketplace plans, Medicaid, and Medicare are the four main routes, and which one is available to you depends on your employment status and age.
- Healthcare.gov and state marketplaces show you private plans side by side with their monthly cost, deductible, and what doctors are in the network.
- Medicaid is a state-run program for lower-income households, and income limits vary widely — you may may have access to even if you work full-time.
- Open enrollment (usually November through January) is when you can sign up for private plans; outside that window, you need a may have access to event like job loss or a new baby.
- The monthly premium is what you pay to have insurance; the deductible is what you pay out of pocket before the insurance company starts paying.
Understanding Premiums, Deductibles, and Out-of-Pocket Costs
Every health insurance plan has three costs you need to understand. The premium is what you pay monthly to have the insurance — this is the bill that comes due whether you use the insurance or not. The deductible is the amount you have to pay out of your own pocket for medical care before the insurance company starts paying. The out-of-pocket maximum is the most you'll pay in a year; once you hit it, the insurance covers 100 percent of covered services for the rest of that year.
A plan with a low premium usually has a high deductible — you pay less monthly but more when you actually need care. A plan with a high premium usually has a low deductible — you pay more monthly but less when you need care. There's no "right" answer; it depends on whether you expect to use medical care this year. If you're young and healthy, a high-deductible plan might save you money overall. If you take regular medications or see doctors often, a low-deductible plan might cost less in total.
When you compare plans on Healthcare.gov, the site shows you the premium, deductible, and out-of-pocket maximum side by side. It also shows you the copay — a fixed amount you pay for a doctor visit or prescription — and coinsurance, which is a percentage of the cost you pay after you hit your deductible. Write these numbers down for each plan you're considering so you can do the math for your own situation.
How to Use Healthcare.gov or Your State Marketplace
Go to Healthcare.gov and click "Find Local Help" or "See Plans." You'll be asked for your zip code, household size, and income. The site uses income to calculate whether you may have access to for a tax credit — a discount on your monthly premium. It also shows you whether you might may have access to for Medicaid in your state. Once you enter this information, the site shows you all available plans ranked by price.
Each plan listing shows the monthly premium, the deductible, the out-of-pocket maximum, and which doctors and hospitals are "in network" — meaning the insurance company has negotiated rates with them and you'll pay less. Click on a plan to see the full details: what prescriptions it covers, what the copay is for a specialist visit, whether it covers mental health care. Some plans are labeled "Bronze," "Silver," "Gold," or "Platinum" — these are standardized categories that tell you roughly how much the insurance company pays versus how much you pay. Bronze plans pay 60 percent; Silver pay 70 percent; Gold pay 80 percent; Platinum pay 90 percent.
Once you've chosen a plan, you'll enter your Social Security number and other personal information to complete the enrollment. The insurance company will send you a member ID card in the mail, usually within two weeks. You can use that number to find in-network doctors, check your deductible balance, and submit claims.
Medicaid: Income-Based Coverage
Medicaid is a joint federal and state program that covers people with lower incomes. Unlike private insurance, there's no monthly premium — the government pays the insurance company directly. The income limit varies by state; some states cover people making up to 138 percent of the federal poverty line, while others have lower limits. A single person might may have access to with an income under $1,500 per month in one state and over $2,000 in another. The only way to know is to check your state's Medicaid program.
To learn about you may have access to, call 211 (a free referral service) or go to your state health department website and search for "Medicaid." You'll enter your income and household size, and the program will tell you whether you may have access to. If you do, you can enroll when ready — there's no waiting period like there is with private insurance. Medicaid covers doctor visits, hospital stays, prescriptions, and preventive care, though the exact coverage varies by state. Some states also cover dental and vision; others don't.
Medicaid is also the program that covers people who lose employer insurance due to job loss. If you're laid off, you may may have access to for Medicaid even if your income was higher when you were employed — the program looks at your current income, not your recent income. This is one of the fastest ways to get coverage if you're between jobs.
Medicare: Coverage at 65 and Beyond
Medicare is federal health insurance for people 65 and older, regardless of income. You become may be able to access automatically at 65 if you've worked and paid into Social Security for at least 10 years. You don't have to do anything — Medicare Part A (hospital insurance) and Part B (doctor and outpatient care) start automatically three months after you turn 65.
However, you do need to sign up for Part B if you want it, and you should do this during your initial enrollment period — the three months before you turn 65, the month you turn 65, and the three months after. If you miss this window, you'll pay a penalty for the rest of your life. Part B has a monthly premium (the amount changes each year) and a deductible. You can also buy Part D (prescription drug coverage) and a Medigap plan (supplemental insurance that covers costs Medicare doesn't). These are optional but often worth the cost if you take medications or see doctors regularly.
If you're already on Medicare and want to change plans, you can do so during the annual open enrollment period, which runs from October 15 to December 7 each year. Changes take effect January 1.
Employer Coverage: What to Ask Your HR Department
If your employer offers health insurance, you'll usually be asked to choose a plan during an open enrollment period — often in the fall, with coverage starting January 1. Your HR department will give you a summary of each plan showing the premium you pay, the deductible, and the out-of-pocket maximum. They should also tell you which doctors and hospitals are in the network.
Ask your HR department these specific questions: What is my monthly premium? What is the deductible? What is the out-of-pocket maximum? Are my current doctors in the network? Does the plan cover my current medications? Is there a waiting period before coverage starts? When does open enrollment end, and what happens if I miss the important date? Some employers allow you to enroll when ready when you're hired; others make you wait until the next open enrollment period.
If you're offered coverage through your job, you generally can't switch to a private marketplace plan unless you have a may have access to event — you lose your job, you get married, you have a baby, or your employer's plan becomes significantly more expensive. Outside of those events, you're locked into your employer's plan until the next open enrollment period.
may have access to Events and Special Enrollment Periods
Open enrollment for private marketplace plans runs from November 1 through January 15 each year (the exact dates can shift slightly). If you miss this window, you can't sign up for a private plan unless you have a may have access to event — a life change that lets you enroll outside the normal period. may have access to events include losing your job, getting married, having a baby, moving to a new state, or losing coverage through an employer or Medicaid.
When a may have access to event happens, you have 60 days to enroll in a new plan. You'll need to provide proof of the event — a termination letter from your employer, a marriage certificate, a birth certificate, or a notice that your coverage ended. Contact Healthcare.gov or your state marketplace when ready after the event; don't wait until day 59. The sooner you enroll, the sooner your coverage starts.
If you're unemployed and lost coverage through your job, you may also may have access to for COBRA, which lets you keep your employer's plan for up to 18 months — but you pay the full premium yourself, which is usually expensive. COBRA is rarely the cheapest option, but it can be useful if you have ongoing medical care and want to stay with the same doctors.
Frequently Asked Questions
What if I can't afford the monthly premium?
If your income is below 400 percent of the federal poverty line, you may may have access to for a tax credit that lowers your monthly premium. Healthcare.gov calculates this automatically when you enter your income. Some states also offer additional help for people with very low incomes. Medicaid is another option if your income is low enough — it has no monthly premium.
Can I change plans if I'm unhappy with mine?
If you're on a private marketplace plan, you can only change during open enrollment (November through January) unless you have a may have access to event. If you're on Medicaid, you can change plans at any time. If you're on an employer plan, you can only change during your employer's open enrollment period, which is usually once a year.
What happens if I don't have health insurance?
There is no federal penalty for being uninsured, but you'll pay the full cost of any medical care out of pocket. If you can't pay, hospitals will still treat you in emergencies, but you may face debt collection. Many people without insurance delay care until problems become serious and expensive.
Do I need to enroll in Medicare at 65 even if I'm still working?
You should enroll in Medicare Part A (hospital insurance) at 65 even if you're still working and have employer coverage. However, you can delay Part B if your employer has 20 or more employees and you're covered under their plan. If you delay, you won't pay a penalty. Talk to your HR department about the timing.
What's the difference between in-network and out-of-network doctors?
In-network doctors have negotiated rates with your insurance company, so you pay less. Out-of-network doctors haven't negotiated rates, so you pay more — sometimes much more. Before choosing a plan, check whether your current doctors are in the network. If they're not, you may want to choose a different plan or find new doctors.