Orlando Harmon
If you or a loved one is unwell, you may be wondering about your options for medical insurance. It can be a complex process to navigate, but there are many resources available to help you find the right coverage. Firstly, it's important to understand the different types of insurance plans, such as employer-based insurance, government-provided insurance, and private insurance. Each type has its own eligibility criteria, costs, and benefits, so it's essential to research and compare plans to find the one that suits your needs. Financial professionals and insurance agents can also provide guidance and help you make an informed decision. This is especially important if you have specific healthcare requirements or are facing financial challenges due to illness.
How can I get medical insurance for a sick person?
| Characteristics | Values |
|---|---|
| Determine the real cost of protecting your income | Add up mortgage payments, student loans, credit card debt, and other costs of living |
| Disability income insurance | Protects against lost wages if you get too sick or injured to work |
| Check your coverage options before leaving a job | Most employer-offered insurance requires you to be an active employee |
| Government protection | US government disability is public insurance for individuals who suffer disabilities that prevent them from working for at least one year |
| Insurance for small businesses | Disability income insurance for small businesses is offered to protect businesses |
| Job-based insurance | If your employer’s plan meets a standard of minimum coverage and is considered “affordable,” you won’t qualify for a premium tax credit if you buy a Marketplace insurance plan |
| Marketplace insurance | Apply for and enroll in a Marketplace plan through an approved enrollment partner, like an insurance company or online health insurance seller |
| Medicaid | Provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities |
| CHIP | Provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance |
| COBRA continuation coverage | A federal law that allows you to maintain health coverage temporarily after your employment ends |
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What You'll Learn
Check eligibility for savings on a Marketplace plan
To check eligibility for savings on a Marketplace plan, you can use an online tool that allows you to input your information and income to see all the plans available to you. This will help you determine if you qualify for financial assistance, and what savings you may be eligible for. The Health Insurance Marketplace offers flexibility, choice, and online application and account management.
The amount you pay for health insurance is based on your income and household size. Your total income for the tax year, minus certain adjustments, will determine your eligibility for savings. Adjustments include deductions for IRA contributions, student loan interest, etc. You can refer to IRS Form 1040, line 11, for more details.
If you are unemployed, you can still qualify for savings on a Marketplace plan, and you may also be eligible for COBRA continuation coverage, which allows you to maintain health coverage after your employment ends. If you are employed, and your employer's plan is considered "affordable", you won't qualify for a premium tax credit if you buy a Marketplace plan. However, if your job does not offer health insurance, you can keep your Marketplace plan and continue to receive any savings you qualify for based on your household income.
It is important to report any changes in your circumstances, such as income or family size, as this may affect your eligibility for savings and advance payments of the premium tax credit. You will need to fill out a Marketplace application to get exact plan prices and savings.
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Understand the costs and lost income covered by standard health plans
Understanding the costs and income covered by standard health plans is crucial when considering medical insurance. Standard health plans can vary in terms of costs and coverage, but some common components are included in most plans. Here are some key aspects to consider:
Monthly Premiums
The monthly premium is the amount you pay to your insurance plan each month to maintain your health insurance coverage. This is a fixed cost that you need to pay regardless of whether you use any medical services during that month. The premium amount can vary depending on the type of plan, your age, family size, income, and location. Generally, lower premiums are associated with higher out-of-pocket costs, and vice versa.
Deductibles
A deductible is the amount you need to pay for covered health services before your insurance plan starts contributing. For example, if your deductible is $1,500, you will have to pay for covered health services until you reach this amount. After that, your plan will start sharing the costs with you. Deductibles can vary across plans, and some plans may have different deductibles for specific types of services or prescription drugs.
Copayments and Coinsurance
Copayments, or copays, are fixed amounts you pay each time you receive a covered health service. For example, you might pay $20 for a doctor's visit or a set percentage of hospital charges. Coinsurance is the percentage of the cost you pay after you've met your deductible. If your coinsurance is 20%, and a covered service costs $125, you would pay $25 ($125 x 20% = $25), and your plan would pay the remaining $100.
Out-of-Pocket Maximum
The out-of-pocket maximum is the maximum amount you will pay for covered services in a year. Once you reach this limit, your insurance company will pay 100% of the covered costs for the rest of the year. Plans with lower out-of-pocket maximums tend to have higher premiums. It's important to note that the out-of-pocket maximum usually doesn't include your monthly premiums, just the costs of services like copayments and coinsurance.
Income Considerations
When considering the costs covered by standard health plans, it's important to think about your income and any tax implications. If you obtain health insurance through your employer, your premiums may be deducted from your salary before taxes, which can reduce your taxable income. Additionally, if your household income is within certain guidelines, you may be eligible for a premium tax credit, which can lower your premium costs.
Understanding these components of standard health plans will help you make informed decisions about your medical insurance choices, especially when considering the specific needs of a sick person.
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Explore free or low-cost health coverage options
There are several options for free or low-cost health coverage for those who are unemployed or on low incomes. Firstly, you can apply for a Marketplace plan, which may be more affordable than you think, and you can find out if you qualify for savings based on your income and household size. You can also apply for Medicaid or CHIP, which offer free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. If you don't qualify for a Marketplace plan or cannot afford it, you can find low-cost health care at a nearby community health center. These centers are located in both urban and rural areas and the amount you pay depends on your income.
If you have recently lost your job, you may be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage. This is a federal law that allows you to maintain health coverage temporarily after losing your job or your coverage as a dependent. However, you will have to pay 100% of the premium yourself. If you are offered a new job with health benefits, you can choose to keep your Marketplace plan and continue to receive any savings you qualify for based on your household income.
Short-term health insurance is another option, but it is not suitable for everyone. These plans are not considered minimum essential coverage and do not have to follow the ACA's rules. They often place a cap on benefits and may not cover pre-existing conditions or essential health benefits such as maternity and mental health care.
To find out more about your options, you can search for local organizations that can help you apply for coverage. These organizations can often provide assistance in languages other than English and offer in-person support.
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Learn about job-based insurance plans
If you have a job-based insurance offer or are already enrolled in one, you won't qualify for savings on a Marketplace plan. In 2025, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.02% of your household income. If the job-based insurance isn't affordable, you and other members of your household may qualify for savings on a Marketplace plan. You can apply to see if you qualify for savings, but you won't automatically get coverage.
If you have a Marketplace plan and then get an offer of health insurance through a job, you may no longer qualify for savings on your Marketplace plan, even if you don't accept the job-based coverage offer. If you have job-based coverage and want to explore Marketplace coverage options, you can. However, you will need to provide information about premium costs and who in your household can get coverage. You may be able to find this information in an online employee portal or an email from your employer.
If you lose your job-based health insurance, you may be able to keep your job-based health plan through COBRA continuation coverage. COBRA coverage lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee. If you already have COBRA coverage and want to switch to a Marketplace plan, you can.
If you have a Marketplace plan and want to switch to job-based insurance, you can cancel your Marketplace plan without penalty. However, you will have to pay the full price for your job-based insurance.
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Contact a certified agent for help
If you're unsure about how to get medical insurance for yourself or a loved one who is unwell, a certified agent can be a great source of help. These agents are trained professionals who are licensed and certified to sell health insurance plans. They are well-versed in the different types of health insurance, including plans for individuals, families, and groups. They can guide you through the entire process, from selecting the right policy for your needs and budget to paying premiums and making claims for medical care.
There are a few ways to get in touch with a certified agent. You can search for one by using your city, state, or ZIP code to find a list of local people and organizations that can assist you with the application process. Some of these agents may even offer help in languages other than English and provide in-person assistance. Alternatively, you can contact your local state agency, which will then connect you with an agent who can help you with enrollment.
When you reach out for help, the certified agent will be able to help you navigate the different coverage options available to you. They can do this online, over the phone, or in person, depending on what is most convenient for you. They will guide you in making the right decision and selecting the insurance plan that best suits your needs.
Keep in mind that these agents are generally paid by insurance companies when people they assist enroll in the plans that they sell. So, while their services are valuable, it's important to do your own research and understand the different options available to you before making a decision.
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Frequently asked questions
If you are unemployed, you can look into government-provided insurance programs that offer free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. You may also qualify for COBRA continuation coverage, which allows you to maintain health coverage temporarily after losing your job.
If you are self-employed or own a small business, you can explore disability income insurance designed specifically for this purpose. This type of insurance can help protect your business and personal income in the event of an accident or illness.
You can seek assistance from certified agents, web brokers, or insurance companies to navigate different health insurance coverage options. They can help you understand your eligibility, financial assistance, and costs associated with various plans.
First, clarify the terms of your job-based insurance and understand your coverage options. Some employer-offered insurance requires you to be an active employee, while others may offer full portability. You may also need to apply for government disability benefits before receiving income from your employer's insurance plan, so be mindful of potential income gaps.
