Finding Health Insurance

Learn About the Affordable Care Act  

The Affordable Care Act (ACA) was designed to give individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that they may not have been able to get on their own or through an employer. Under the ACA:

• You may be able to purchase health care through a state or federal marketplace that offers a choice of plans.

• Insurers can't refuse coverage based on gender or a pre-existing condition.

• Lifetime and annual limits on coverage are eliminated.

• Young adults can stay on their family’s insurance plan until age 26.

• Seniors who hit the Medicare Prescription Drug Plan coverage gap or "donut hole" can get a discount on medications.

Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.

When to Enroll

Open enrollment is the part of each year that citizens can freely make changes to their health care coverage purchased through the ACA's Health Insurance Marketplace.

The next open enrollment period is expected to begin on Thursday, November 1, 2018, and end on Saturday, December 15, 2018. During the open enrollment period, you will be able to:

• Re-enroll in your current plan

• Choose a plan for the first time

• Choose a new plan to replace your current plan

• Make changes to your existing insurance plan

You can enroll or change your plan year-round if you have certain life changes:

• Getting married or divorced

• Having a baby or adding a dependent to your family

• Losing other coverage

• Moving to a new state

• Qualifying for Medicaid or CHIP

Check to see if your life event qualifies you to change your coverage under a Special Enrollment Period.

How to Enroll and Get Answers to Your Questions

You can learn more about and apply for ACA health care coverage in several ways.

• Go to HealthCare.gov. Depending on where you live, you'll apply for benefits there through the ACA Health Insurance Marketplace or you'll be directed to your state's health insurance marketplace website.  Marketplaces, prices, subsidies, programs, and plans vary by state. 

• Contact the Marketplace Call Center at 1-800-318-2596 or TTY at 1-855-889-4325.

• Find a local center to apply or ask questions in person.

• Download an application form to apply by mail

Find the answers to common ACA questions about submitting documents, getting and changing coverage, your total costs for health care, tax options, and more.

Using Your Coverage

If you have questions about specific parts of your insurance plan, you must contact your insurance company to get answers. Only your insurance company can answer specific questions about doctors, medications, treatments, medical equipment, and what is and is not covered under your plan.

• Find contact information for your insurance company on your insurance card or bill.

• If you can't find out how to contact your insurance company, contact the Marketplace Call Center.

• If you need help appealing a dispute with your insurance company, contact the Marketplace Call Center.

Small Businesses

Businesses with 50 employees or fewer can offer Small Business Health Options Program (SHOP) plans to employees, starting any month of the year. Learn about small business tax credits to help companies with the equivalent of fewer than 25 full-time employees provide insurance coverage to their workers.

Learn  About Health Coverage

Health insurance helps you pay for medical services and sometimes prescription drugs. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses--usually a certain dollar amount or percentage of the expenses.

How to get Health Coverage

You can get health care coverage through:

• A group coverage plan at your job or your spouse or partner's job
• Your parents' insurance plan, if you are under 26 years old
• A plan you purchase on your own directly from a health insurance company or through the Health Insurance Marketplace
• Government programs such as Medicare, Medicaid, or Children's Health Insurance Program (CHIP)
• The Veterans Administration or TRICARE for military personnel
• Your state, if it provides a health insurance plan
• Continuing employer coverage from your former employer, on a temporary basis under the Consolidated Omnibus Budget Reconciliation Act (COBRA)

Types of Health Insurance Plans

When purchasing health insurance, your choices typically fall into one of three categories:

• Traditional fee-for-service health insurance plans are usually the most expensive choice, but they offer you the most flexibility in choosing health care providers.
• Health maintenance organizations (HMOs) offer lower co-payments and cover the costs of more preventive care, but your choice of health care providers is limited to those who are part of the plan.
• Preferred provider organizations (PPOs) offer lower co-payments like HMOs but give you more flexibility in selecting a provider.

Choosing a Health Insurance Plan

Read the fine print when choosing among different health care plans. Also ask a lot of questions, such as:

• Do I have the right to go to any doctor, hospital, clinic, or pharmacy I choose?
• Are specialists, such as eye doctors and dentists, covered?
• Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
• Does the plan cover home care or nursing home care?
• Will the plan cover all medications my physician may prescribe?
• What are the deductibles? Are there any co-payments? Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from co-payments, which are the amount of money you pay when you receive medical services or a prescription.
• What is the most I will have to pay out of my own pocket to cover expenses?
• If there is a dispute about a bill or service, how is it handled?

Learn About COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families the right to choose to continue group health coverage provided by their group health plan for limited periods of time.

Eligibility

There are three basic requirements that must be met for you to be entitled to elect COBRA continuation coverage:

• Your group health plan must be covered by COBRA
• A qualifying event must occur (for example, voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, or divorce)
• You must be a qualified beneficiary for that event

If you are entitled to elect COBRA continuation coverage, you must be given an election period of at least 60 days to choose whether or not to elect continuation coverage.

How to Get COBRA

Under COBRA, group health plans must provide covered employees and their families with a notice explaining their COBRA rights. Plans must also have rules for how COBRA continuation coverage is offered, how qualified beneficiaries may elect continuation coverage, and when it can be terminated.

For more COBRA information, see An Employee's Guide to Health Benefits under COBRA.

Get More Information or File a Complaint

If you have questions or complaints about your COBRA coverage, contact your plan administrator or the Employee Benefits Security Administration (EBSA).

Note: In some cases, you can change from COBRA coverage to Marketplace health insurance coverage.

Learn About Long-Term Care (LTC)

Long-term care (LTC) is a variety of services that include medical and non-medical care for people who have chronic illnesses or disabilities.

If you are thinking about long-term care needs for yourself or your loved one, these resources can help:

• Learn what LTC means - start with the basics
• Find local long-term care services
• Assess the cost of care
• Learn about legal issues to consider

Long-Term Care Insurance

Most health insurance plans and Medicare severely limit or exclude long-term care. If you want coverage, you may need a separate long-term care insurance policy. Learn more about the long-term care insurance. You should consider the cost of long-term care insurance as you plan for retirement.

These questions can help you evaluate long-term care insurance policies.

• What qualifies you for benefits? Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet, and remaining continent.
• What type of care is covered? Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
• What will the benefits amount be? Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing-home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
• What is the benefits period? It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
• Is the benefit adjusted for inflation? If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
• Is there a waiting period before benefits begin? A 20 to 100 day period is not unusual.

Complaints about Long-Term Care

To report an emergency where there is immediate danger, call 911 or contact your local authorities.

If you have a complaint about a long-term-care facility, reach out to the National Long-Term Care Resource Center to find a state's long-term care ombudsman program. 

If you have an elder abuse complaint, contact your long-term ombudsman or local elder abuse resources.

Health Coverage for People With Disabilities

If you have a disability, you have a number of options for health coverage through the government. 

• Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply. 

• Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Learn about eligibility, how to apply and coverage.

• Affordable Care Act Marketplace offers options to people who have a disability, don’t qualify for disability benefits, and need health coverage. Learn about the Marketplace, how to enroll, and use your coverage.

Health Resources for People With Disabilities

Federal, state, and local government agencies and programs can help with your health needs if you have a disability. 

• Explore the Disability and Health section of CDC.gov for articles, programs, tips for healthy living and more.

• Learn more about assistance and benefits for people with disabilities from the Social Security Administration.

• Contact your local city or county government to find out what medical and health services are available locally for people with disabilities.

• Your state social service agency can help you locate medical and health programs. 

Visit USA.gov’s Government Benefits page to learn more about government programs and services that can help you and your family.