Paul Sanchez
In the United States, Medicaid is the single largest source of health coverage. It is a joint federal and state program that provides health coverage to over 77.9 million Americans. Eligibility is based on income, with low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) being mandatory eligibility groups. However, those with higher incomes may not qualify for Medicaid or savings on a private insurance plan. In such cases, individuals with higher incomes can still obtain medical insurance by purchasing it directly from an insurance company, through an insurance agent/broker, or from an online health insurance seller. Additionally, job-based health plans offered by employers are also an option for those with higher incomes.
| Characteristics | Values |
|---|---|
| People with higher incomes can get medical insurance | Through private insurance companies, online insurance sellers, or agents/brokers |
| People with higher incomes may not qualify for savings on a private insurance plan | Depending on the state and income level |
| People with higher incomes can get health coverage | Through a job-based health plan or a Marketplace plan |
| People with higher incomes can still get insurance | Through Medicaid, depending on their state's eligibility criteria and income level |
| People with higher incomes can access insurance | Through the Children's Health Insurance Program (CHIP) if they have children |
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What You'll Learn
Private insurance companies
- Marketplace plans: These are often referred to as "Obamacare" plans and are sold by private insurance companies. They are available to anyone, regardless of income level, and can be purchased through an online marketplace. Marketplace plans offer comprehensive benefits, including free preventive care, and you cannot be denied coverage or charged more due to a pre-existing medical condition. The cost of these plans depends on factors such as age, location, household size, and income. You may also qualify for subsidies or premium tax credits if your income is below a certain threshold.
- Short-term health insurance plans: These plans are typically more affordable and can be a good option if you are unemployed or have no income. They are now available for up to one year and can be renewed. However, short-term plans may deny coverage or charge higher premiums based on health status, and they may exclude essential health benefits or impose annual and lifetime limits on coverage.
- Platinum, Gold, Silver, and Bronze plans: These plan tiers determine the balance between monthly rates and out-of-pocket costs. For example, a Bronze plan has lower monthly premiums but higher out-of-pocket expenses when you visit the doctor or need a prescription. In contrast, Platinum plans have the highest monthly rates but the lowest costs when you need medical care.
- Vision and dental plans: Many private insurance companies offer associated vision and dental plans that can be added to your medical insurance. These may be included automatically when you qualify for medical coverage, or you may have to pay an additional cost.
- Agent or broker assistance: If you are unsure about which plan to choose, you can seek help from a health insurance agent or broker. Agents typically work for a single insurance company, while brokers sell plans from multiple companies. They can help you compare plans, understand your options, and enroll in the plan that best suits your needs. Their services generally do not incur additional charges as they are usually paid by the insurance companies.
When considering medical insurance from private insurance companies, it is important to remember that costs and benefits can vary significantly. It is always a good idea to compare multiple plans and understand the specific details of each before making a decision. Additionally, keep in mind that income is not the only factor that determines eligibility and cost; other factors, such as age, location, and household size, also play a role.
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Online insurance sellers
If you are looking for medical insurance and have a higher income, there are a number of options available to you through online insurance sellers. Firstly, it is important to understand that insurance premiums are based on a number of factors, including your income, household size, and the state you live in. With that in mind, here are some ways you can obtain medical insurance through online sellers:
- Private Insurance Plans: If you have a higher income, you may be able to purchase private health insurance directly from an online insurance seller. These plans can vary in cost and coverage, so it is important to compare different options. Private insurance typically involves paying a monthly premium and may include additional out-of-pocket costs such as co-pays and coinsurance. Bronze, silver, and gold plans are common categories, with varying premium and coverage levels.
- Health Insurance Marketplaces: You can explore health insurance marketplaces, such as Healthcare.gov, which offer a range of plans from different providers. These marketplaces allow you to compare prices, coverage, and benefits. Additionally, you may be eligible for subsidies or savings on your premiums, depending on your income level and household size.
- Medicaid and CHIP: While Medicaid is typically associated with low-income individuals and families, some states have expanded their Medicaid programs to cover all adults below a certain income level. Even if your income is higher, it is worth checking if you meet the eligibility requirements, as they can vary by state. Similarly, the Children's Health Insurance Program (CHIP) is designed for children from families with higher incomes who do not qualify for Medicaid.
- Short-Term Insurance: If you are in between jobs or waiting for long-term coverage to begin, you can consider short-term insurance plans offered by online sellers. These plans typically provide temporary coverage for a limited duration, such as the PivotHealth Deluxe Plan or UnitedHealthcare Plus Elite.
- Employer-Sponsored Plans: If you are changing jobs or transitioning between employers, you may be able to retain your previous employer-sponsored health insurance plan for a period of time through COBRA (Consolidated Omnibus Budget Reconciliation Act). This allows you to continue receiving the same coverage until you find a new plan.
Remember, when choosing a medical insurance plan, consider your specific needs, budget, and eligibility. Compare different options offered by online insurance sellers to make an informed decision that best suits your circumstances.
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Insurance agents/brokers
If you have a higher income and are looking for medical insurance, insurance agents and brokers can help you navigate the often confusing world of health insurance and match you with a suitable health plan.
Insurance Agents
Insurance agents work for a single health insurance company, selling only their policies. They are paid by the insurance company and receive commissions for selling plans. Agents can make policy recommendations and help you enroll in a health insurance plan.
Insurance Brokers
Insurance brokers, on the other hand, are independent and may represent several companies. They are licensed by state insurance regulatory agencies and are paid a commission by health insurance companies, not by consumers. Brokers can help you understand your options, provide guidance, and answer your questions about health insurance, including the types of plans available to you. They can help you find ACA health insurance marketplace coverage, where you can enter your household income, size, ZIP code, and other information to see a list of available health insurance options in your area.
Finding an Agent or Broker
You can find a health insurance agent or broker by visiting websites such as healthcare.gov's Find Assistance program, which offers an online directory of brokers, agents, and government-funded enrollment assistants. You can also contact the National Association of Health Underwriters or seek recommendations from trusted sources, such as friends or family members with experience using brokers or agents.
Choosing the Right Agent or Broker
When choosing an agent or broker, it is important to select someone you trust and who communicates well. They should be able to discuss the advantages and drawbacks of each plan and be open to offering alternatives. Verify their license and certifications to ensure they are qualified, and ask about their fee structures and how they earn commissions to understand the costs involved.
Income Considerations
It is important to note that, regardless of whether you use an agent or broker, your income will not affect the price you pay for coverage. However, if your income is too high for subsidies, a broker can be especially helpful in finding the best options for your situation.
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Job-based health plans
If you have a higher income, you may be able to get medical insurance through a job-based health plan. Many employers offer health insurance as a benefit, and in some cases, this may be the most affordable option for individuals with higher incomes.
In 2025, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by your employer is less than 9.02% of your household income. This standard of minimum coverage applies to most job-based health plans. If your employer's plan meets this standard and is considered affordable, you won't qualify for a premium tax credit if you buy a Marketplace insurance plan instead.
It's important to note that if you have a Marketplace plan and get offered health insurance through a new job, you may no longer qualify for savings on your Marketplace plan, even if you don't accept the job-based coverage. You can update your Marketplace application to see how the offer impacts your savings before making a decision. If you already accepted job-based insurance, you may want to cancel your Marketplace plan and enrol in the new job-based coverage for yourself and anyone else in your household who is eligible.
If you lose your job-based health insurance, you may be able to keep your coverage through COBRA continuation coverage. COBRA allows you to pay to stay on your job-based health insurance for a limited time, usually 18 months, after your job ends. You can also buy a Marketplace plan to bridge the gap until your new job-based insurance starts. However, once you enrol in the new job-based insurance, you'll have to pay the full price for any Marketplace plan you decide to keep.
Additionally, if your income is too high to qualify for savings on a Marketplace plan, you can still apply for health coverage directly from an insurance company, through an insurance agent or broker, or from an online health insurance seller. These options allow you to compare plans and prices to find the best fit for your needs and budget.
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State-specific programs
Medicaid, a joint federal and state program, provides health coverage to over 77.9 million Americans. It is the single largest source of health coverage in the United States. To participate in Medicaid, federal law requires states to cover specific groups, including low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI). States can also choose to cover other groups, such as individuals receiving home and community-based services and children in foster care. The Affordable Care Act of 2010 allowed states to expand Medicaid to cover nearly all low-income Americans under 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state, and most states have chosen to expand coverage to adults. However, some states have not adopted the ACA expansion, and eligibility for adults remains limited.
The Children's Health Insurance Program (CHIP) is another option for children in families that earn too much to qualify for Medicaid but not enough to buy private insurance. CHIP qualifications vary by state and depend mainly on income. In some states, CHIP also covers pregnant women.
Some states have additional programs to provide medical assistance to certain low-income individuals who do not qualify for Medicaid. For example, Nevada has the Nevada Check Up program, a low-cost, comprehensive health insurance program for children not covered by private insurance or Medicaid. New York has the Child Health Plus program, which is the state's version of CHIP. Virginia has stricter Medicaid eligibility requirements than many other states, but subsidized ACA marketplace plans are available.
To find out about state-specific programs and eligibility, individuals should check with their state's Medicaid agency and Health Insurance Marketplace.
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Frequently asked questions
If your income is too high to qualify for Medicaid, you can still get medical insurance by purchasing a plan from a private insurance company, either directly or through an online insurance seller or an agent/broker. You can also get insurance through your employer, if applicable.
CHIP is a federal-state program that provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but not enough to buy private insurance. CHIP qualifications and coverage differ by state.
To qualify for Medicaid, you must be a resident of the state where you are applying for benefits and meet certain income requirements. Each state has its own eligibility criteria, so you should check with your state's Medicaid agency to see if you qualify.
