Prepare to Apply for Health Coverage

Notice:

You may qualify for health coverage now if:

• You’re eligible for a Special Enrollment Period due to a life event or income change.
• You qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Steps to Get Ready:

1. Explore the Marketplace: Get a quick overview of how it works.
2. Check for Savings: See if you might save on health coverage.
3. Estimate Your Income: Learn how to estimate your income for your application.
4. Gather Required Documents: Use this checklist (PDF, 189 KB) to gather everything you need.
5. Find Local Assistance: Search by city, state, or ZIP code to find trained helpers in your area.

Ways to Apply for Health Insurance

You have several options to apply for and enroll in Marketplace health coverage:

1. Apply Online with HealthCare.gov:
This is the fastest way to apply. Log in or create an account on the official Marketplace website to get started.

2.Enroll Over the Phone:
Get personal assistance with your application, review your options, and enroll by phone. Free, unbiased help is available in multiple languages.
Contact us

3.Find Local Help:
Search by city, state, or ZIP code to find local organizations or people who can assist you in applying. Some offer help in languages other than English and provide in-person assistance.
Find local help

4. Use a Certified Enrollment Partner:
Apply and enroll in a Marketplace plan through an approved partner, such as an insurance company or online health insurance seller.

Preview Health Insurance Plans & Prices

To see health insurance plans and estimated costs based on your income:

1. Enter Your ZIP Code:
Start by entering your ZIP code and answering a few questions about your estimated income and household members. If needed, you can get help estimating your income.

2. View Available Plans:
You'll see a range of health insurance plans with estimated prices tailored to your situation.

3. Estimate Savings:
Premium estimates will reflect any savings you might qualify for, based on the basic information you provided.

4. Get Exact Prices:
The final step is to complete the Marketplace application, which asks for more detailed information. Once submitted, you'll receive exact pricing for the plans available to you.

Special Enrollment Period:
To enroll in or change plans outside of the Open Enrollment period, you must qualify for a Special Enrollment Period due to a recent life event, such as losing other coverage, getting married, having a baby, or based on your estimated household income. Check if you qualify.

Get Help Applying for Health Insurance

When applying and enrolling in a Marketplace plan, you have three ways to get assistance, including any cost savings you may qualify for: by phone, in person, or through an agent or broker.

As part of your Marketplace application, we’ll also check if anyone in your household is eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). If someone qualifies, we’ll forward your information to your state agency, and they’ll contact you about the next steps.

1. By Phone:
Call the Marketplace Call Center for free, unbiased support. Whether you need to ask a question, start or finish your application, compare plans, or enroll, assistance is available every day (excluding certain holidays) in multiple languages.

2. In-Person Help:
Find local assistance by searching with your city, state, or ZIP code. You’ll receive a list of individuals and organizations in your area who can help you apply, choose a plan, and enroll. Some offer multilingual services, specialized support, or in-person assistance.

3. Health Insurance Agents & Brokers:
Agents and brokers can assist with your Marketplace enrollment or handle the entire process on your behalf. They may receive a commission from health insurance plans when you enroll. You can search for nearby professionals or request that they contact you.

Protect Yourself from Fraud:
Guard Your Personal Information
Never share your personal details with anyone offering cash, gifts, or other incentives. This information could be used without your consent.

Learn More About:

• Enrollment periods
• Cost savings
• Choosing the right plan

How to Apply for Health Coverage if Your Income is Too High for the Premium Tax Credit

Notice:
You can still get health coverage if you qualify for:

• A Special Enrollment Period due to a life event or based on your income.
• Free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

If your income is too high to qualify for the premium tax credit on a Marketplace plan, you can still apply for health insurance through the Marketplace. Simply create an account or log in to start the application process.

Other Insurance Options:

• Private Insurance: You can purchase insurance directly from a private insurance company. Many companies offer websites where you can compare plans available in your area.
• Insurance Agent/Broker: Agents typically work for a single insurance company, while brokers can offer plans from multiple companies. Both can assist you in comparing plans and enrolling, and you won’t pay extra for their services. Agents and brokers are generally compensated by the insurance company whose plans they sell. Keep in mind, they might only offer plans from certain companies. Search for agents or brokers near you.
• Online Health Insurance Sellers: These platforms provide plans from various insurance companies, allowing you to compare prices and features before enrolling. However, they may not include all plans available in your area.

Quick Check:
Take a minute to check if your income qualifies you for savings. If you do qualify, the Marketplace is the only place where you can receive discounts on monthly premiums and other costs based on your income.

Learn how to estimate your income and household size for a more accurate assessment.

Complete Your Enrollment & Pay Your First Premium

After enrolling in a health insurance plan, your next step is to pay your first premium to activate your coverage. Insurance companies manage payments differently, so it’s essential to follow the instructions provided by your insurer. In many cases, you can make your payment online.

Important: Pay Your Premium to Start and Maintain Coverage
Your health insurance coverage will not begin until you pay your first premium. All subsequent premium payments should be made directly to your insurance company, not through the Marketplace. It's crucial to pay your monthly premiums on time, as failing to do so may result in the termination of your coverage.

How to Verify Your Coverage:

• Check if Your Coverage Is Active:
  Log into your Marketplace account and review your application status. Under "My Plans & Programs," you can see which plan(s) you’re enrolled in and when your coverage started.

• Confirm Enrollment and Payment:
  If you’re unsure about your coverage status, or if you haven’t received your plan materials, call your insurance company. They can confirm whether you’ve completed enrollment and paid your first premium. If issues persist, contact the Marketplace Call Center for assistance.

Accessing Your Plan Enrollment Materials: After enrollment, your insurance company will send you a membership packet, which includes enrollment materials and a health insurance card. This card serves as proof of insurance, and you’ll need it to access healthcare services, so keep it safe.
Review your membership packet carefully, and consult your plan’s provider directory to identify where you can receive care. If you haven’t received your health insurance card, contact your insurer to confirm whether one has been sent and ensure your coverage is active.

Ready to Use Your New Coverage?
Learn how to find a provider within your network, schedule appointments, and understand your benefits to make the most of your new health insurance coverage.

Changing Plans After Enrollment

Once you've enrolled in a health insurance plan, you'll generally keep that plan for the entire year unless you become eligible for coverage through another source, such as your job, Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

When You Can Change Plans:

• During Open Enrollment: You can switch plans freely.
• Outside of Open Enrollment: You can only change plans if you qualify for a Special Enrollment Period, which may be triggered by life events like changing jobs, getting married, having a baby, or based on changes to your household income. It's important to check if you qualify.

Typically, you have 60 days from the life event to enroll in a new plan, but it's advisable to report your changes as soon as possible.

Reporting a Change to Qualify for a Special Enrollment Period: Reporting any life changes ensures you receive the correct savings on your Marketplace plan. It might also make you eligible to switch plans.

1. Report the Change: Update your application with the new information.
2. Review Your Eligibility Results: If you qualify for a Special Enrollment Period, you'll be able to shop for new plans and enroll in one that better suits your needs.

For detailed instructions, learn more about how to report changes and change plans with a Special Enrollment Period.

How to Cancel Your Plan Without Replacing It: You can cancel your Marketplace plan at any time, but there are important factors to consider:

• Re-Enrolling: Once you cancel your coverage, you may have to wait until the next Open Enrollment Period to enroll again.
• Health and Financial Risks: Health coverage provides significant benefits, including protection against unexpected medical costs. Without insurance, medical care can be very expensive. Coverage also gives you access to regular care, including free preventive services, to maintain your health.

For more information, learn about the benefits of health coverage and how to cancel your plan.

Premium Payments, Grace Periods & Losing Coverage

To keep your health coverage, it's crucial to pay your monthly premium in full to your insurance company—not the Marketplace—by the due date.

Missed a Payment?

• If you miss a payment, your health insurance company may end your coverage.
• Before canceling your plan, they’ll give you a short grace period to catch up on payments.

Grace Period Details:

• Typically, the grace period is 3 months if you:
  • Have a Marketplace plan with a premium tax credit.
  • Have already paid at least one full month's premium during the benefit year.
• If you don’t use the premium tax credit, your grace period may be different. Contact your state’s Department of Insurance for specifics.

During the Grace Period:

• Pay all outstanding premiums before the grace period ends to avoid losing coverage.
• Important: If you don't pay, you could lose coverage retroactively, dating back to the first month you missed a payment.

Example:

• You miss your May premium payment but pay on time for June and July. If you don't pay May’s premium by July 31, your plan will end your coverage as of May 31.

Coverage Loss Due to Non-Payment:

• If your coverage ends due to non-payment, you won’t qualify for a Special Enrollment Period to get a new plan. You'll need to wait for the next Open Enrollment Period unless you qualify for a Special Enrollment Period for another reason.
• Losing coverage before mid-December means you won't be automatically re-enrolled for the following year.

Re-Enrolling:

• At your next chance to enroll, you can choose the same plan (if available) or a new one, but you must pay your first month’s premium to complete your enrollment.

Appealing a Decision:

• If you believe your coverage was wrongly canceled, you have the right to appeal your insurance company’s decision.