Finding coverage

Coverage options

You can get health insurance:

  • through your job, if your employer offers it.
  • by buying a plan from a membership association, union, or church.
  • by buying it from an insurance company or agent.
  • by buying it through the federal health insurance marketplace.
  • by staying on your parent's plan until you turn 26.
  • through your college or university if they have a student health plan.
  • through government programs like:
    * Children's Medicaid or CHIP for children and pregnant women.
    * Medicaid for some people who can't afford private coverage.
    * Medicare for most adults over age 65 and people with disabilities.

    * TRICARE and other options for military service members and their families.

Where can I buy individual coverage?

Insurance you buy directly from a company or the marketplace is called individual insurance because it’s sold to individuals, not to members of a particular group.

You can buy individual coverage through:

If your family earns between 100 and 400 percent of the federal poverty level (FPL), you may qualify for a premium tax credit to reduce the cost of coverage. This tax credit is only available when you buy a plan through the federal Marketplace.
Learn more about premium tax credits

Note: It's important to know what type of insurance you're buying.
Learn more about major medical plans and other types of health insurance

When can I enroll in individual coverage?

You can enroll for individual coverage during open enrollment, which runs from November 1 to December 15. If you miss open enrollment, you might not be able to enroll until the next year's open enrollment period unless you have a qualifying life event.
Learn more about open enrollment | Learn more about qualifying life events and special enrollment

Shopping for health insurance

  • Know what you’ll have to pay. Plans with higher deductibles, copayments, and coinsurance have lower premiums. But you'll have to pay more out of pocket when you get care.
  • Consider things other than cost. To learn a company’s financial rating and complaints history, call our Consumer Help Line or visit our website.
  • Get help. If you buy health insurance from the federal marketplace, you can get free help choosing a plan. Call the marketplace for more information.
  • Buy only from licensed companies and agents. If you buy from an unlicensed insurance company, your claim could go unpaid if the company goes broke. Call our Consumer Help Line or visit our website to check whether a company or agent has a license.
  • Get several quotes and compare coverages. Know what each plan covers. If you have doctors you want to keep, make sure they’re in the plan’s network. If they’re not, you might have to change doctors. Also make sure your medications are on the plan’s list of approved drugs. A plan won’t pay for drugs that aren’t on its list.
    More: Use our Health plan shopping guide to learn more questions to ask before you decide.
  • Fill out your application accurately and completely. If you lie or leave something out on purpose, an insurance company may cancel your coverage or refuse to pay your claims.

What rights do I have shopping for a plan?

An insurance company or HMO:

  • can't deny you health coverage during open enrollment.
  • can't deny you health coverage for pre-existing conditions.
  • can only decide your premium rate based on three factors: your age, where you live, and if you use tobacco.

An insurer must provide you with plan summary documents that allow you to compare plans:

  • a summary of benefits and coverage (SBC) provides plan provisions in a standard format,
  • an outline of coverage provides similar information to the SBC, but may provide more detail, and
  • health plan disclosures describe a plan's detailed terms and conditions, as well as other in-depth information on benefits, exclusions, and networks.

Next section: How to compare plans



Question? Call us at 1-800-252-3439.

Last updated: 11/05/2019