If you need to buy health insurance, you’re in good company. Only half of Americans are covered by an employer’s health insurance plan, according to the nonprofit Kaiser Family Foundation’s estimates. Another 14% are covered by Medicare, and 21% rely on Medicaid and the Children’s Health Insurance Program (CHIP). Another 1% of Americans are covered by the military or the Veteran’s Administration. Everyone else—roughly 50 million of us —is on their own.
We’ll explain each option for buying your own health insurance so you can decide which path might be best for you.
- Your best chance to buy affordable, comprehensive health insurance is during the annual open enrollment window that runs from November 1 to December 15th.
- 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 2021 coverage begins November 1, 2020, and ends December 15, 2020. Coverage begins January 1, 2021. 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” page.
If you aren’t sure whether you qualify for Medicaid or CHIP, you can find out by visiting your state’s Medicaid website or by filling out an application at Healthcare.gov.
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, such as covering preexisting conditions, providing essential benefits, and offering preventive care at no cost before you meet your deductible. 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. Pay close attention to what you’re signing up for if you apply through a private exchange.
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.
Option #4: Buy Through an Online Health Insurance Brokerage
Online health insurance brokerage—also called private enrollment websites or private exchanges—offers to help you compare health insurance plans or get the best available plan based on the information you give them. Comparison shopping is smart, but consumers should understand that these sites will not show them every plan in the market that meets their requirements.
Instead, these private exchanges will show a selection of plans that will earn them a commission if the consumer enrolls. They may display more prominently or provide more information on the plans that earn the brokerage a higher commission, the Kaiser Family Foundation cautions.
These marketing incentives don’t necessarily mean the plans these sites offer aren’t good plans. It just means consumers should be aware that they might not be getting a complete picture of their options when they visit one of these sites.
Private enrollment websites may ask you for personal information that the federal and state marketplaces do not. They may ask about your height, weight, and pre-existing conditions—factors that can affect your eligibility for plans that don’t comply with the Affordable Care Act. Your personal information may also be used by the company behind the website you give it to as well as their business partners to market other products to you.
As with buying a policy directly from a health insurance company, you cannot get premium tax credits (subsidies) if you buy your health insurance policy through a private exchange.
Option #5: Buy Through a Membership Organization
If you belong to a union, alumni association, professional organization, or any other large group, you may be able to purchase health insurance through it at group rates. Freelancer’s Union, for example, offers health insurance through its subsidiary, Freelancers Insurance Agency, and through one of its partners, HealthPlanServices.
When looking for health insurance through an association or membership organization, make sure you will actually be purchasing insurance and not just a health services discount plan. Discount plans might save you money on prescriptions or eyeglasses, but they won’t help you if you get cancer. Also be aware that even if the association itself is a not-for-profit organization, it may be tied to or even established by a for-profit insurance agency through which it sells policies to association members.
Beware of Healthcare-Sharing Ministries
Healthcare-sharing ministries may be attractive to healthy individuals looking for low-cost coverage, but they do not provide true health insurance. Instead, they offer an arrangement where individuals who share the same religious faith contribute to a pool of money that the ministry doles out to its members to cover certain healthcare costs. These ministries usually do not cover pre-existing conditions, may charge higher rates based on health status, and do not guarantee reimbursement even for the conditions they cover.
The Bottom Line
If you don’t get health insurance through work or through Medicare, you have several ways to apply for coverage.
If you’re comfortable doing the research and comparing plans on your own, you can apply yourself through Healthcare.gov. Going through the government’s website can also tell you if you’re eligible for Medicaid and or CHIP.
If you need help finding the right plan or applying, you can work with a marketplace assistance counselor, navigator, or broker. All of these individuals’ services are free.
You don’t have to buy health insurance through the federal exchange or your state’s exchange (or at all), but you won’t be eligible for premium tax credits unless you do.
Finally, make sure to buy a policy during the annual open enrollment window that runs from November 1 to December 15th. It’s your best opportunity to buy affordable, comprehensive coverage.