USA: Getting Health Insurance and Alternatives if You Don't Have It
The primary sources of health insurance in the United States are:
Many employers in the U.S. offer health insurance to their employees. Most employers pay a percentage of employee premiums (usually between 15% - 80%) and negotiate better premium rates by buying in bulk. About half of Americans get health insurance through their employers. It's usually the most affordable option.
Affordable Care Act (ACA) / Obamacare
HealthCare.gov is the federal government's health insurance marketplace under the Affordable Care Act (ACA). ACA is also known as Obamacare. It was created to provide affordable, quality healthcare to those who don't get insurance through an employer or the government.
✅ If your state operates its own healthcare marketplace, you use your state's marketplace (find your marketplace).
✅ ACA plans must offer 10 essential health benefits.
✅ People with pre-existing conditions can't be denied or charged more for plans.
✅ Subsidies and tax credits are available for those who fall below a certain income which varies from state to state. ACA subsidies and tax credits are based on projected annual income for the year.
✅ Open enrollment is a specific time of the year when you enroll in ACA plans. It usually runs from November 1 to December 15 but it varies from state to state. You can enroll outside this period if you have a qualifying life event such as getting married, having a child, losing a job, or a significant income change. You have at most 60 days after the life event to change your health plan.
Medicaid provides health insurance to low-income adults of all ages, children, pregnant women and people with disabilities. It is administered by states and funded by both the federal government and states. Eligibility rules and the name of the agency vary from state to state.
You apply for Medicaid through your state's ACA marketplace. If you don't qualify for Medicaid, it will tell you if you're eligible for subsidies or tax credits for ACA health plans. Find out if you qualify for Medicaid with this interactive form.
You qualify for Medicaid based on current monthly income. For this reason, if you lose your job or have a significant decrease in income, you may qualify for Medicaid based on your new monthly income. If your income significantly increases during the same year (i.e., you get a job or business income increases), you can re-apply for healthcare on the ACA marketplace.
If you aren't sure you qualify for Medicaid, you can get help from a local assister which you can find on HealthCare.gov. If your state has its own marketplace, it will have something comparable.
✅ You can apply for Medicaid any time during the year.
Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program provides low-cost, comprehensive health coverage to children (under 19) in families with incomes too high for Medicaid but too low for private insurance. Like Medicaid, it's funded jointly by states and the federal government and administered by states.
You apply for CHIP through your state's Affordable Care Act health insurance marketplace. If your children don't qualify for CHIP, it will tell you if your family is eligible for subsidies or tax credits for ACA healthcare plans. Find out if you are eligible for Medicaid or CHIP with this interactive form.
If you aren't sure you qualify for CHIP, you can get help from a local assister which you can find on HealthCare.gov. If your state has its own marketplace, it will have something comparable.
✅ You can apply for CHIP any time during the year.
Medicare provides health insurance for adults aged 65 or older or younger people with disabilities or kidney failure. It's intended for people who are no longer working — those who have retired or have a chronic disability. Medicare.gov is the official website. When you apply, you are redirected to Social Security which manages the financial support (monthly payments) for Medicare's healthcare.
Off-Marketplace Health Plans
Individual health insurance can be purchased directly from health insurance companies, through local insurance agents, or on health insurance websites. This is known as buying "off-exchange" or "off-marketplace."
✅ Short-term plans can be purchased any time during the year. These plans are intended for emergency coverage when you're between health plans. Short-term plans are not ACA-compliant so most don't cover pre-existing conditions. For this reason, short-term plans are not recommended as a substitute for major medical coverage which some states permit (some states allow 12-month terms to be renewed up to 3 years).
✅ Major medical coverage plans can be purchased during an open enrollment period. Like ACA, open enrollment usually runs from November 1 to December 15. All major medical coverage plans (on-marketplace or off-marketplace) must be ACA-compliant — they must include the 10 essential health benefits and people with pre-existing conditions can't be denied coverage or charged more.
Don't have health insurance?
There are other ways to get healthcare if you don't have health insurance:
✅ Federally Qualified Health Centers — These health centers are federally funded by the Health Resource & Service Administration (HRSA). HRSA health centers serve those who are low-income, uninsured, underinsured or have limited access to health care services. Nearly 30 million people in the U.S. depend on these services which provide primary care, dental, vision, specialty care and prescription assistance. Services are provided based on a sliding fee.
• Find a clinic near you: https://findahealthcenter.hrsa.gov
✅ Free/Charitable Clinics and Charitable Pharmacies — Free or charitable clinics provide medical, dental, pharmacy, vision and behavioral health services to economically disadvantaged individuals. These clinics are funded by the private sector (donations, grants, etc.). Services are provided free, or patients are charged a nominal/sliding fee.
• Find a clinic near you: https://www.nafcclinics.org/find-clinic
✅ Walk-in Retail Clinics — Walk-in retail clinics accept patients on a walk-in basis and by scheduled visits (many support telehealth appointments). Most provide various services, including monitoring chronic conditions like diabetes, high blood pressure, and high cholesterol. It can also be an alternative if you have health insurance and can't get a timely appointment with your provider (some insurers even cover walk-in clinic visits). CVS's MinuteClinic is an example of a retail clinic.
• Find a clinic near you by typing into a search engine: "walk-in clinics near me" or "walk-in clinics near type-your-zip-code-here."
The content of this site is for informational purposes only. You should not rely on this information as a substitute for professional medical advice, diagnosis, or treatment. If you think you may have a medical emergency, call your emergency services immediately (911 in the United States).