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How To Get Health Insurance

If you need to buy health insurance, you’re in good company. For the fourth year in a row, the number of uninsured people in the United States increased in to approximately 30 million individuals in 2020. We’ll explain each option for buying your own health insurance so you can decide which path might be best for you.

KEY TAKEAWAYS

  • Your best chance to buy affordable, comprehensive health insurance is during the annual open enrollment window.
  • If you want to qualify for subsidies, you should apply through Healthcare.gov or your state exchange rather than buying directly from an insurer.
  • You can also work with an agent or broker to get health insurance. Working with a broker means you won’t be charged a fee.
  • If you purchase health insurance through an online health insurance brokerage, aka a private exchange, you may not be shown all of the plans that meet your requirements.
  • Buying through an association or membership organization may allow you to get a group rate on health insurance.

Option 1: Use the Government’s Health Insurance Marketplace

The Health Insurance Marketplace is often referred to as the health insurance “exchange.” Depending on your income and your eligibility for other health insurance coverage, you may qualify for subsidies—also called premium tax credits—when you buy health insurance through the marketplace.

You can buy a marketplace policy even if you are eligible for insurance through your employer, and it doesn’t hurt to see if you can find a better plan for your situation. You probably won’t be eligible for subsidies if you have access to job-based coverage, though.

Open enrollment for 2022 coverage began Nov. 1, 2021. You must enroll by Dec. 15 for coverage that begins Jan. 1, 2022. In 2021, amid the ongoing COVID-19 pandemic, the open enrollment period was extended from Feb. 15 to May 15.

State exchanges may have slightly different enrollment dates. It’s important to buy a policy during this annual enrollment period because you won’t be able to buy a policy for the rest of the year unless you have a qualifying life event like moving, getting married, or having a child.

You can apply online, by phone, or in person. If you need help applying, you can work with a marketplace navigator in some states, a certified application counselor, or in-person assistance personnel. You must be a U.S. citizen or lawfully present in the country to buy a marketplace plan.

Start your search for a marketplace policy at Healthcare.gov. Enter your zip code and you’ll be directed to buy a policy through the federal marketplace. If your state has its own marketplace, you’ll be redirected to your state’s website. You can also find direct links to state exchanges at Healthcare.gov’s The Marketplace in your state site.

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If you aren’t sure whether you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you can find out by visiting your state’s Medicaid website or by filling out an application at Healthcare.gov.

In 2021 and 2022, all taxpayers with insurance bought on the Marketplace are eligible for the Affordable Care Act (ACA) Premium Tax Credit; previously, filers were ineligible if their income exceeded 400% of the federal poverty line.5

Option 2: Work With an Agent or Broker

An agent or broker can help you find a good policy for you because they have experience evaluating health insurance plans. The federal government’s Find Local Help tool can help you locate a marketplace-trained private insurance broker. To learn about the greatest number of options and get the least biased advice, you may want to work with a broker that sells both marketplace and non-marketplace plans.

Health insurance companies pay brokers when they sell policies. Consumers don’t pay a fee to brokers, nor do they pay higher premiums to work with them. “Agent” usually means someone who only sells policies from one insurance company, while “broker” means someone who sells policies from multiple insurance companies.

Private insurance brokers may also show you options on private enrollment sites from insurance companies and web brokers. If you want to qualify for subsidies, however, you should apply through Healthcare.gov or your state exchange.

The government’s health insurance navigators will only show you marketplace plans available through Healthcare.gov. All of these plans are eligible for subsidies, and a navigator’s help is free.

Option 3: Buy Directly From an Insurer

The Health Insurance Marketplace does not include every health insurance plan available. Some people might be able to find a plan that better meets their coverage needs or their budget outside the marketplace. When you’re shopping for a policy on a single insurer’s website, you will, of course, only see options available from one insurer. You’ll need to visit several insurer’s websites to see all your options if you want to buy direct.

ACA-compliant plans sold outside federal and state exchanges must meet the minimum essential coverage standards of the Affordable Care Act (ACA), such as covering preexisting conditions, providing essential benefits, and offering preventive care at no cost before you meet your deductible.

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You can also buy non-ACA-compliant short-term plans (up to 12 months) outside the exchanges that may have more exclusions and fewer benefits. People who are between insurance carriers might think that having some insurance is better than having none at all. Short-term health insurance plans market their perceived coverage as an excellent alternative to ACA-compliant insurance that comes with lower premium costs.

But those lower costs do not mean equal coverage for the consumer. Most short-term plans deny coverage to patients with preexisting conditions and sharply limit mandated ACA vital essential health benefits (prescription drugs, mental health services, prescription drugs, and maternal care). leaving many with the costly remaining balance. These strategic policy limitations on applicants and the coverage plan are the real reasons behind this alleged affordability. Proceed with caution concerning short-term health insurance because the financial risk may outweigh the financial gains in cost savings.

In short, pay close attention to what you’re signing up for if you apply through a private exchange and when considering any so-called alternative to traditional health plans. If you don’t apply through the federal marketplace, keep in mind that you won’t be eligible for subsidies. If your state operates its own health insurance marketplace, you should buy your health insurance plan through your state marketplace to make sure your plan is eligible for subsidies.

If your income is too high to qualify for subsidies, you might not care. But if you end up earning less than expected in the coming year, you could end up unexpectedly qualifying for subsidies, so you might want to keep your options open. Subsidies are based on how much you earn in the year you’re buying coverage for. When you enroll, you’ll only be getting an estimate of your subsidies based on your estimated income.

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