Health Library

Note: Some parts of the Affordable Care Act (“Obamacare”) are being changed or eliminated via government policies and laws. It is likely that some of the rules and regulations affecting the health insurance marketplace will continue to change over time. To stay up to date on Obamacare and other health insurance issues, visit healthcare.gov and the website of the health commissioner’s office in your state.

In America today, we all need health insurance. You do. Your kids do. It’s not a “nice to have” anymore — it’s a “must-have.” And that’s the law. In most cases, parents who aren’t covered (or don’t have their kids covered) by health insurance might have to pay a fine each year. Going without also means that if someone gets sick or is injured, a family might have to pay all the bills for care received. That can cost a whole lot more than paying for coverage.

To help people get health insurance, the federal and state governments set up a health insurance marketplace (also called the health care exchange). This makes it easier than ever to get coverage, but the process can seem a bit confusing.

Here’s what to do to get health insurance.

Getting Started

Before you look for a health insurance plan, check to see if you or your child can get coverage some other way. The government considers a person covered if they have Medicare, Medicaid, a state-run child health insurance plan (CHIP), or insurance they get through a parent or spouse’s job. Your child could already be covered by or be eligible for free or low-cost coverage through a public program.

If you need to get insurance for yourself or your child, you can go online and visit the U.S. Government’s comprehensive health care website (www.healthcare.gov). There, you can apply for CHIP or Medicaid or shop for a plan.

It’s important to remember, however, that you can only buy insurance through the health care marketplace during the open enrollment period, which begins in mid-November and lasts until February. If the enrollment period is over, you or your child may have to get insurance through a private insurer to be covered for that year.

In some states, the health care exchange is run by healthcare.gov. Other states run it themselves. If you live in one of those states, you can visit your state’s official marketplace website directly or link to it through healthcare.gov.

If you don’t have regular access to a computer, you can call the U.S. Government’s help line at 1-800-318-2596 to fill out an application, enroll, or compare plans.

How to Apply for a Plan

Applying for an insurance plan through the health care marketplace can be done online through healthcare.gov or a state site, over the phone, or through regular mail by filling out a form that can be mailed to you or downloaded from the Internet.

Before you fill out an online application, you’ll need to create an account on either healthcare.gov or your state’s marketplace.

You’ll need to know a few things about each person applying for coverage. Be ready to provide:

• Social Security numbers (or document numbers for legal immigrants)
• information about employers and income
• policy numbers for any current health insurance plans

If you have a job that offers health insurance but you’re not happy with it, you can choose to get coverage through healthcare.gov instead. But before you apply, you’ll need to fill out a form called an Employer Coverage Tool that can be found on the healthcare.gov website.

The application will ask for standard information like your name, your child’s name, your address, phone number, and email. You’ll need to answer questions about citizenship, dependents, and whether you plan to file a federal income tax return the following year.

If you want help paying for insurance, you will have to provide information about your yearly income (and the income of anyone else applying for coverage). This includes income from jobs and other sources like:

• Social Security
• unemployment
• retirement accounts
• property rental
• alimony

If you pay alimony or interest on student loans, you can deduct the amount you pay when you fill out your application.

What Happens Next?

Once you’ve submitted an application, healthcare.gov or your state’s site will determine if you or your children qualify for Medicare, Medicaid, or CHIP. It will also determine if you or your children are eligible to get insurance through the health care marketplace. For most people, if you’re an American citizen or legal immigrant and you’re not in jail, you’ll be eligible.

Although it’s unlikely, sometimes parents are eligible to buy insurance through the health care marketplace but their children aren’t. Sometimes kids are eligible but their parents aren’t. If either of these apply to you, you would have the right to appeal the decision, and you could still get private insurance for anyone needing coverage.

If you’re eligible for coverage but don’t qualify for any publicly subsidized programs, the health care marketplace will present you with the insurance plans available in your state based on your income and family situation. It will be up to you to decide which policy to buy.

What to Look for When Choosing a Policy

The important words to remember when shopping for a policy are “premium” and “deductible.” The premium is the amount you pay each month for coverage. The deductible is the amount you need to pay each year for medical services before your health insurance kicks in. As a general rule, insurance plans with low premiums have high deductibles, and plans with high premiums have low deductibles.

These are the basic levels of coverage:

• Catastrophic insurance is designed to protect an otherwise healthy person in the event of a major injury or illness. It’s available only to people under age 30 and those who are exempt from other plans due to hardship. This type of insurance can have low premiums but very high deductibles. Plans generally cover less than 60% of the costs of health care.
• Bronze plans also have low premiums and high deductibles, but they offer better coverage than catastrophic insurance, typically paying for 60% of costs.
• Silver plans and gold plans have average-sized premiums and average-sized deductibles. Silver plans cover 70% of costs. Gold plans pay 80% of costs.
• Platinum plans, the highest level of coverage, have high premiums and low deductibles. These plans cover 90% or more of health care costs.

All catastrophic, bronze, silver, gold, and platinum plans offer free or discounted visits to the doctor for things like routine checkups or vaccinations and some preventive care. Most plans also offer discounts on prescription drugs and other services. Specific benefits differ from plan to plan, though, so you’ll need to learn what each plan offers. Think about what’s important to you and your family and make a decision based on how well the plan meets your needs.

When Can I Start Using My Insurance?

Once you’ve signed up for a plan and paid the first month’s premium, you or your child can start using the insurance. The insurance company should send you and everyone covered by your policy insurance cards with your policy number and other information. If you or your child need to see a doctor or go to a hospital before you receive your card, call your insurance company first to make sure your family has been entered into their system.

You should also make sure that any doctor you choose for you or your child is in your insurance plan’s network. A network is made up of doctors, specialists, and other health care providers who have agreed to work with your insurance company when it comes to payments and services. If you take your child to a doctor who isn’t in your plan’s network, you may have to pay full price for some services.

Ask around and learn what you can about the primary care physicians in your plan’s network, and then choose a doctor you like. Once you’ve done that, schedule checkups and use your insurance to help keep your family healthy.