How to Get Health Insurance
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You can get health insurance through work, on the marketplace or outside of the marketplace. The kind of health insurance you buy depends on whether you have access to an employer-sponsored plan, your age, your location, your family structure and your health care needs, among other things.
Getting health insurance in the U.S. can be a complex process — or as simple as getting a job that offers health insurance benefits. Nearly everyone in the country has health insurance coverage, so it’s important to understand how it works.
Types of health insurance plans
There are several types of health insurance plans, and they all have advantages and disadvantages.
Comparing health insurance plans: HMO vs. PPO vs. EPO vs. POS
Plan type | Do you have to stay in-network to get coverage? | Do procedures & specialists require a referral? | Snapshot: |
|---|---|---|---|
HMO: health maintenance organization | Yes, except for emergencies. | Yes, typically. | Lower out-of-pocket costs and a primary doctor who coordinates your care for you, but less freedom to choose providers. |
PPO: preferred provider organization | No, but in-network care is less expensive. | No. | More provider options and no required referrals, but higher out-of-pocket costs. |
EPO: exclusive provider organization | Yes, except for emergencies. | No, typically. | Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers. |
POS: point of service plan | No, but in-network care is less expensive. | Yes. | More provider options and a primary doctor who coordinates your care for you, with referrals required. |
Plan type | Snapshot |
|---|---|
HMO: health maintenance organization | Lower out-of-pocket costs and a primary doctor who coordinates your care for you, with referrals required to see a specialist. You must stay in-network except for emergencies. |
PPO: preferred provider organization | More provider options and no required referrals, but higher out-of-pocket costs. You can go out of network, but care will be more expensive. |
EPO: exclusive provider organization | Lower out-of-pocket costs and usually no required referrals, but less freedom to choose providers. You must stay in-network except for emergencies. |
POS: point of service plan | More provider options and a primary doctor who coordinates your care for you, with referrals required to see a specialist. You can go out-of-network, but care will be more expensive. |
High-deductible health plans
High-deductible health plans (HDHPs) have a higher deductible than standard health plans, and they come in various plan types, including HMOs and PPOs. HDHPs have lower premiums but higher upfront costs, since you must cover the deductible before your insurance starts covering care. HDHPs can also give you access to a health savings account (HSA), which allows you to save pretax money for health care expenses. (You must enroll in an HDHP that is “HSA-eligible.”)
Where to buy health insurance
Health insurance through work
The majority of people in the U.S. get health insurance through an employer, whether it’s their own or their partner’s. For those people, getting health insurance means signing up for a plan when you join a company. Generally, employers will cover part of your health care premiums and you’ll pay the remainder with pretax money.
Health insurance through the marketplace
If you don’t have access to health insurance through a job — or the plan that’s offered isn’t affordable — you can purchase coverage from the federal or state marketplace, depending on where you live. Start at HealthCare.gov and choose your state to determine where you’ll shop.
Plans on the marketplace come in metal “tiers” that signify what percentage of costs you’ll pay for coverage: Bronze, Silver, Gold and Platinum. There are also Catastrophic plans available that have a very high deductible and low premiums, but those plans are only available if you’re under 30 or qualify for a hardship exemption.
Bronze plans cover the smallest percentage of your health care costs (60%), while platinum plans cover the largest (90%). If you qualify for extra savings, you’ll be required to enroll in a Silver plan to get those savings.
For marketplace plans, you may also qualify for a premium tax credit to help with the costs of health insurance, regardless of the plan tier.
Off-marketplace health insurance
You can purchase health insurance directly from an insurance company or broker. But you won’t be eligible for premium tax credits or subsidies to help with the cost.
When can you sign up for health insurance?
Unlike other kinds of insurance, you can’t sign up for health insurance whenever you want. You can get a health insurance policy in the following situations:
You started a new job that offers health benefits. You must sign up during the benefits window specified by your employer — it typically lasts 14 to 30 days.
Annual open enrollment from Nov. 1 to Jan. 15. (This can vary slightly by state, so check open enrollment dates in your location.)
You have a qualifying life event. If you experience a life change, such as getting married or having a baby, you may qualify for a special enrollment period.
Once you have health insurance, you can change your coverage during your employer’s open enrollment period (generally each year in the fall) or during general open enrollment in your state if you have a marketplace or off-marketplace plan. You can also change coverage if you have a life event that triggers a special enrollment period.
How to compare health insurance plans
Your plan choices will depend on how you’re getting health insurance. If you’re getting coverage through an employer, you’ll have more limited options. On your state or federal marketplace, you may have many plans to choose from. Here are tips on picking the best coverage:
Evaluate your budget. Sign up for the plan with a monthly premium you can manage, as well as out-of-pocket costs that make sense for you. You should also consider whether you might want a high-deductible health plan.
Ponder how much network flexibility you want. Do you want to be able to go out-of-network to see specialists? If so, you’ll want a plan with out-of-network coverage options.
Check your preferred doctors. What insurance plans do your preferred providers and facilities accept? Make sure you choose a plan that includes them in their network.
Evaluate the scope of services. Look through each plan’s summary of benefits to understand the overall coverage situation, particularly if you have specific needs, such as coverage for fertility treatments or physical therapy.
Keep prescriptions in mind. If you take regular prescription medication, see how each plan covers it and how much it will cost you.
>> Need to back up a bit?: Learn more about how to choose health insurance
What to do if you lose coverage
If you lose your employer-based health insurance, you have some options:
Enroll in COBRA coverage. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to keep the health insurance you were getting through work, even after you’ve lost your job. You can keep COBRA for 18 to 36 months, but you’ll be paying the full premium out-of-pocket without employer help, so it can be pricey.
Sign up for a marketplace plan. Losing health benefits counts as a qualifying life event, so you can buy health insurance through the federal or state marketplace even if it’s not an open enrollment period.
Buy off-marketplace health coverage. You may be able to buy plans directly from an insurance company or broker, but you won’t be eligible for premium tax credits or other savings.
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