Health insurance.
Choose with clarity.

Which kind of coverage do you need?

For individual or family coverage outside Medicare, start by reviewing Obamacare (ACA) options. The Marketplace offers private medical plans and determines whether you qualify for financial help. Eligibility depends on household circumstances, expected income, available coverage and other requirements.

If you have Medicare, the comparison is different. Medicare Advantage (Part C) provides Part A and Part B benefits through a private Medicare-approved plan. Most plans include prescriptions. Review the specific plan’s network, costs and rules.

How much does health insurance cost?

Monthly premiums alone do not tell you which plan fits. Premiums depend on the plan and permitted factors such as age, location and people covered. Eligible Marketplace savings may reduce your payment. There is no universal price or guaranteed subsidy.

Compare what you pay when you use coverage, too. A lower premium may come with a higher deductible. If you regularly see specialists or take prescriptions, consider those expenses alongside premiums to estimate yearly costs.

Four costs to understand

Premium: a recurring payment to keep coverage active. Deductible: what you pay for certain covered services before the plan starts sharing those costs; some services may be covered before it is met.

Copay: a fixed amount for a covered service. Coinsurance: your percentage of a covered cost. The out-of-pocket maximum limits certain covered expenses for the year; premiums and noncovered services generally do not count. Read each plan’s benefit documents.

Coverage for self-employed people and families

Being self-employed does not prevent you from exploring the Marketplace. Savings use expected household income for the coverage year, rather than simply last year’s earnings. Update your application if your income changes.

An offer of job-based coverage can affect financial help. Family members may qualify for different programs, especially adults and children. Before cancelling an existing policy, confirm eligibility and the new effective date.

What Marketplace plans cover

Marketplace plans cover essential benefits such as doctor visits, hospitalization, prescriptions, maternity care and mental health services. They also cover pre-existing conditions. This does not mean every doctor, prescription or treatment is covered by every plan.

Costs, authorizations and networks vary by policy. Some preventive services are generally covered at no cost when received in-network under applicable conditions. Adult dental and vision coverage should be checked separately.

When you can apply

The Marketplace has an annual enrollment period. Some life changes, such as losing qualifying coverage or having a baby, may qualify you for a special enrollment period. Events, dates and documentation matter; not every change qualifies.

Medicare has its own enrollment periods. Annual enrollment and Medicare Advantage change opportunities work differently from Obamacare. We can help you identify the period that applies before you start an application.

Have these details ready

• ZIP code and ages of people who need coverage.
• Expected household income for the coverage year.
• Doctors, prescriptions and your usual pharmacy.
• Current coverage and loss date, if applicable.

Explore your next step

Health insurance questions