Alyssa Lane
If your employer doesn't offer you health insurance, you have several options to obtain coverage. Firstly, you can explore the possibility of creating your own benefits package by purchasing individual or family health insurance through the Marketplace/exchange. Premium tax credits and subsidies may be available to make these plans more affordable, depending on your income and household size. Alternatively, if you've recently left a job that provided health insurance, you may be eligible for COBRA continuation coverage, which allows you to temporarily retain your previous insurance plan. If you don't qualify for COBRA or Marketplace plans, you can look into Medicaid or the Children's Health Insurance Program (CHIP), which offer free or low-cost coverage based on income and household size.
| Characteristics | Values |
|---|---|
| If you work part-time or as a contractor | You may need to create your own "benefits package" |
| If your employer offers a QSEHRA or ICHRA | They will reimburse you a certain amount of money each month to cover some or all of the cost of a self-purchased health insurance plan |
| If you're offered a QSEHRA | You may be eligible for premium tax credits |
| If you're offered an ICHRA and you accept it | You won't be eligible for a premium tax credit |
| If you don't have a qualifying event | You'll need to enroll in individual-market coverage during the ACA open enrollment period |
| If you've lost your job-based health insurance | You may be able to keep your insurance through COBRA continuation coverage |
| If you're unemployed | You can apply for free or low-cost coverage from Medicaid or the Children's Health Insurance Program (CHIP) |
| If you're unsure if you can afford coverage | You can apply for a Marketplace plan, as most people qualify for savings |
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What You'll Learn
Create your own 'benefits package'
If your employer doesn't offer health insurance, you'll need to create your own benefits package. This will involve shopping for your own health coverage, but it also means you can customise it to fit your family's needs and budget.
Firstly, if your employer is offering a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) or ICHRA (Individual Coverage Health Reimbursement Arrangement), they will reimburse you a certain amount of money each month to cover some or all of the costs of a self-purchased health insurance plan. This means you can select any available plan in your area and still get an employer contribution. If you're offered a QSEHRA, you may also be eligible for premium tax credits, although the tax credit amount will be reduced by the amount your employer contributes. If you're offered an ICHRA, you won't be eligible for a premium tax credit.
If you don't have a qualifying event like this, you'll need to enrol in individual-market coverage during the ACA open enrolment period. Premium subsidies could make your health insurance very affordable. For most people who buy individual or family coverage through the Marketplace, premium tax credits (premium subsidies) established by the Affordable Care Act pay a substantial portion of the monthly cost of the health plan.
If you've lost your job-based health insurance, you may be able to keep your existing plan through COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage. This 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're unemployed, you may be eligible for free or low-cost coverage from Medicaid or the Children's Health Insurance Program (CHIP). Savings and eligibility are based on your household size and your estimated income for the year you need coverage, not by your employment status.
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Apply for ACA-compliant coverage
If your employer does not offer you health insurance, you can apply for ACA-compliant coverage. ACA-compliant coverage refers to a major medical health insurance policy that conforms to the Affordable Care Act (ACA) regulations, also known as Obamacare. ACA-compliant coverage can be purchased on the health insurance exchange (Marketplace) or directly from a health insurance company.
ACA-compliant individual and small-group policies must include coverage for the ten essential health benefits with no annual or lifetime coverage maximums. These plans are guaranteed issue during open enrollment, meaning pre-existing conditions are not a factor in eligibility. ACA-compliant policies also cannot be rescinded except in cases of fraud or intentional misrepresentation.
If you are self-employed or work for a small business that does not offer health benefits, you will need to create your own "benefits package". This means you can customize the plan to fit your family's needs and budget. Premium subsidies may be available to make your health insurance more affordable.
If your employer is offering a QSEHRA or ICHRA, they will reimburse you a certain amount each month to cover some or all of the costs of a self-purchased health insurance plan. With a QSEHRA, you may also be eligible for premium tax credits, while accepting an ICHRA means you will not be eligible for these credits.
If you have recently lost your job-based health insurance, you may be able to keep your previous plan through COBRA continuation coverage. This allows you to pay to stay on your previous insurance for a limited time, usually 18 months, after which you can switch to a Marketplace plan.
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Apply for Medicaid or CHIP
If you are not offered health insurance by your employer, you may want to consider applying for Medicaid or the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage to eligible individuals and families. Eligibility and benefits vary by state, but in general, they cater to low-income people, families and children, pregnant women, the elderly, and people with disabilities.
To apply for Medicaid or CHIP, you must first check your eligibility. Each state has its own requirements, which may include factors such as income, household size, family status, disability, and age. You can find your state's Medicaid agency online and review the specific eligibility criteria and required documentation. Some states have expanded their Medicaid programs to cover all individuals below certain income levels, so it is essential to review your specific state's guidelines.
Once you have determined that you may be eligible, you can create an account with the Health Insurance Marketplace and fill out an application. You will need to provide information about your household, income, and any existing insurance plans you have. If it appears that anyone in your household qualifies for Medicaid or CHIP, your information will be forwarded to your state agency, and they will contact you regarding enrollment.
It is important to note that even if you don't qualify for Medicaid based on income, you may still qualify for other reasons, such as having children, being pregnant, or having a disability. Additionally, if your income is too high for Medicaid, your child may still be eligible for CHIP, which offers coverage for uninsured children and teens up to age 19.
Applying for Medicaid or CHIP can provide you with access to free or low-cost health coverage, ensuring that you and your family can receive the medical care you need without financial strain. Don't hesitate to take advantage of these valuable programs if you meet the eligibility requirements.
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Apply for COBRA continuation coverage
If you've lost your job-based health insurance, you may be able to keep your previous health plan through COBRA continuation coverage. COBRA, or the Consolidated Omnibus Budget Reconciliation Act, lets you pay to stay on your job-based health insurance for a limited time after your employment ends. This is typically between 18 and 36 months, with an average of 18 months.
COBRA coverage is helpful if you want to continue seeing the same doctors and receiving the same health plan benefits. Your dependents (i.e., spouse, former spouse, or children) are also eligible for COBRA coverage, even if you, the former employee, do not sign up. Additionally, you can choose to switch from COBRA to a Marketplace plan if your COBRA coverage is running out, or if you can find a better deal.
To apply for COBRA continuation coverage, you must have experienced a qualifying event, such as losing your job-based coverage, the death of the covered employee, divorce or legal separation of the covered employee from their spouse, or the covered employee becoming entitled to Medicare. Once you've experienced a qualifying event, you will have 60 days to decide whether to elect COBRA continuation coverage. You will receive a notice from your employer with information about deadlines for enrollment.
When you receive your COBRA election notice, it should contain the address to which premium payments should be sent, along with the amount of the premium due and its due date. You will usually pay the full premium yourself, plus a small administrative fee.
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Apply for a premium tax credit
If your employer does not offer health insurance, you can apply for a premium tax credit to help cover the cost of a Marketplace insurance plan. The premium tax credit is a subsidy established by the Affordable Care Act that pays a substantial portion of the monthly cost of health insurance.
To be eligible for the premium tax credit, you must meet certain requirements. Firstly, your household income must be within a certain range. For tax years other than 2021 and 2022, your income must be at least 100% and no more than 400% of the federal poverty line for your family size. For 2021, if you received unemployment compensation at any time, your household income is considered to be no greater than 133% of the federal poverty line. It is important to note that simply meeting the income requirements does not guarantee eligibility, as there are other eligibility criteria to consider. For example, you cannot be claimed as a dependent by another person. Additionally, if you are married and filing taxes separately, you will not be eligible for the premium tax credit unless you are a victim of domestic abuse or spousal abandonment and can meet certain criteria.
When you apply for Marketplace coverage, the Marketplace will estimate the amount of the Premium Tax Credit you may be able to claim for the tax year. This estimate is based on information such as your family composition, projected household income, and whether those you are enrolling are eligible for non-Marketplace coverage. Based on this estimate, you can choose to have all, some, or none of the estimated credit paid in advance directly to your insurance company to lower your monthly premiums.
If you receive advance credit payments, you must file a federal income tax return and attach Form 8962, Premium Tax Credit (PTC), to your return. You will use Form 8962 to claim the premium tax credit and reconcile the credit with the amount of your advance credit payments for the year. Filing your return without reconciling your advance credit payments may delay your refund and affect your eligibility for future advance credit payments. It is important to note that the actual Premium Tax Credit for the year may differ from the advance credit amount estimated by the Marketplace if there are changes in your family size, household income, or other circumstances.
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Frequently asked questions
You can fill out an application through the Marketplace to see if you qualify for a health insurance plan with savings on your monthly premiums and out-of-pocket costs based on your household size and income.
You may be eligible for free or low-cost coverage from Medicaid or the Children's Health Insurance Program (CHIP). If you are unemployed, you may be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage.
If you work part-time or as a contractor, you may need to create your own "benefits package". Premium subsidies could make your health insurance more affordable.
