Prepare to Apply for Health Coverage

Notice:

You may be eligible to apply for health coverage now 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).

Check if you qualify.

Steps to Get Ready:

• Overview of the Marketplace: Get a brief introduction to how the Marketplace works.
• Potential Savings: Check if you could save on your health coverage.
• Estimate Your Income: Learn how to accurately estimate your income for your application.
• Gather Documents: Use this checklist (PDF, 189 KB) to collect the necessary documents for your application.
• Find Local Help: Search by city, state, or ZIP code to locate trained helpers in your area who can assist with your application.

Ways to Apply for Health Insurance

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

• Apply Online at HealthCare.gov:

  • This is the fastest way to apply. As the official source for the Marketplace, you can log in (or create an account) and get started right away.
  • Create Account
  • You can also apply through the HealthCare.gov app for a more convenient experience on your mobile device.

• Enroll Over the Phone:

  • Get help with filling out your application, reviewing your options, and enrolling. Receive free, unbiased assistance, with support available in multiple languages.
  • Contact Us

• Find Local Assistance:

  • Search by city, state, or ZIP code to find local individuals and organizations who can help you apply for coverage. Some offer in-person assistance and help in languages other than English.
  • Find Local Help

• Use a Certified Enrollment Partner:

  • Apply for and enroll in a Marketplace plan through an approved partner, such as an insurance company or online health insurance provider.
  • Find a Partner

• Submit a Paper Application

Preview Health Insurance Plans & Prices

To preview health insurance plans and prices 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 size. Get help estimating your income.
2. View Available Plans: You'll see a list of health insurance plans with estimated prices available to you.
3. See Potential Savings: Premium estimates will reflect any savings you qualify for based on the basic information you provide.
4. Get Exact Prices: The actual Marketplace application will ask for more detailed information, giving you exact prices once completed.

Preview Plans

Enroll or Change Plans Outside of Open Enrollment

Open Enrollment typically runs from November 1 to January 15 each year. During this period, you can enroll in a Marketplace health insurance plan.

If you need to enroll or make changes outside this period, you must qualify for a Special Enrollment Period. This can be triggered by recent life events such as losing other coverage, getting married, having a baby, or changes in household income.

Get Help Applying for Health Insurance

You can receive assistance applying for and enrolling in a Marketplace health plan, including any potential cost savings, through three main methods: by phone, in-person assistance, or with the help of an agent or broker.

What to Expect When You Apply

When you submit your Marketplace application, we'll also check if you or anyone in your household qualifies for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). If it looks like you qualify, we'll forward your information to your state agency, which will then reach out to you about enrollment.

3 Ways to Get Help:

1.By Phone

• Contact the Marketplace Call Center to get free, unbiased help. You can ask questions, start or finish an application, compare plans, or enroll. Assistance is available daily, except on certain holidays, and in multiple languages.

2. In-Person Assistance

• Find local help by searching with your city, state, or ZIP code. You'll get a list of local people and organizations who can assist you with applying, selecting a plan, and enrolling. Some offer services in languages other than English or provide specialized support.

Health Insurance Agents & Brokers

• Agents and brokers can guide you through the enrollment process in the Marketplace or manage the entire process for you. They may receive commissions from health insurance companies when they enroll you in a plan. You can search for a nearby agent or broker or request that they contact you.

Protect Yourself from Fraud

• Warning: Be cautious and protect your personal information. Never share your details with anyone offering cash, gifts, or other incentives. Misuse of your information could occur without your consent.

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

Notice:
Even if your income is too high to qualify for the premium tax credit, you can still get health coverage. Here’s how:

1.Special Enrollment Periods:
If you experience a life event (like losing coverage, getting married, or having a baby) or your income changes, you may qualify for a Special Enrollment Period to apply for health coverage.

2.Medicaid or CHIP:
Check if you qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Steps to Apply for Marketplace Health Coverage

• Create an Account or Log In:
  Even if you don’t qualify for savings, you can apply for health coverage through the Marketplace by creating an account or logging in.

Explore Other Options:
If you don’t qualify for savings, consider these alternatives:

• Direct from an Insurance Company:
  Contact any health insurance company to find and compare plans in your area. Many companies offer online tools to help you compare their plans.
• Through an Agent or Broker:
  Agents typically work with one insurance company, while brokers offer plans from multiple companies. Both can help you compare options and enroll. You won’t pay extra for using an agent or broker since they’re usually compensated by the insurance companies.
• From an Online Insurance Seller:
  These platforms let you compare health plans from various insurers and enroll directly with the insurance company. However, they may not offer all plans available in your area.
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Quick Check: Can You Save on Health Coverage?

Take just 1 minute to see if your income qualifies you for savings on Marketplace plans. If you qualify, the Marketplace is the only way to get these savings on monthly premiums and other costs. Learn how to estimate your income and household size to get started.

Complete Your Enrollment & Pay Your First Premium

To activate your health coverage, you must complete your enrollment by paying your first premium. Here's what you need to know:

Important: Pay Your Premium to Start and Maintain Coverage

Your coverage won’t begin until you’ve paid your first premium. You’ll make payments directly to your insurance company, not through the Marketplace. Be sure to pay your premiums on time each month to avoid losing your coverage.

Steps to Pay Your Premium

• If Online Payment is Available:

  1. Log into your Marketplace account.
  2. Go to "Your applications" and select your completed application.
  3. Click on "Pay Your First Health Insurance Monthly Premium."
  4. Choose "Pay for Health Plan Now" to be directed to your insurance company’s website to make your payment.

• If Online Payment is Not Available:
  Your insurance company should reach out with instructions on how to pay. If you don't receive any details, contact them directly. You can find their contact information in your plan brochure or on their website.

Confirming Your Health Insurance is Active

• Check Your Online Marketplace Account:
  Log in to your account, select your completed application, and go to "My Plans & Programs." Here, you can see which plan you’re enrolled in and when your coverage started.

• If You’re Unsure About Your Enrollment:
  If you can’t find your plan summary or still have doubts, call your insurance company. They can confirm if your enrollment is complete and whether your first premium was received. If you’re still experiencing issues, contact the Marketplace Call Center.

Accessing Your Plan Enrollment Materials

After enrolling, you’ll receive a membership packet from your insurance company containing enrollment materials and your health insurance card. This card is your proof of insurance and is necessary when accessing health care services, so keep it secure.

• If You Haven’t Received Your Card:
  If your card hasn’t arrived, contact your insurer to check if it’s been sent and to ensure your coverage is active. You can find your insurer’s phone number on their website.

Make sure to review all the materials carefully, and use the provider directory included to find where you can receive care.

Changing Plans After You're Enrolled

Once you've enrolled in a health plan, you'll typically need to stay with it for the entire year, unless you qualify for alternative coverage through sources like your job, Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

Changing Plans During Open Enrollment

You can switch plans during the Open Enrollment period. However, outside of this period, you can only change plans if you qualify for a Special Enrollment Period. This can happen due to significant life events, such as changing jobs, getting married, having a baby, or changes in your estimated household income. It’s essential to check if you qualify for this special enrollment.

Timeframe for Enrollment

If you experience a qualifying life event, you usually have 60 days to enroll in a new plan. However, it's important to report your change as soon as possible to ensure smooth processing.

Reporting a Change to Qualify for a Special Enrollment Period

To ensure you receive the correct savings on your Marketplace plan, it's crucial to report any life changes. Doing so may also allow you to switch plans. Here's how to proceed:

1. Report the Change: Update your application with the new information.
2. Review Eligibility Results: After reporting, check your Eligibility Results. If you qualify for a Special Enrollment Period, you can browse available plans and select one that fits your needs.

For more details, learn how to report changes and explore your options during a Special Enrollment Period.

How to Cancel Your Plan Without Replacing It

You can cancel your Marketplace plan at any time, but consider the following:

• Re-enrollment Restrictions: Once you cancel, you might have to wait until the next Open Enrollment Period to enroll in a new plan.
• Health and Financial Risks: Canceling your coverage can leave you vulnerable. Health insurance provides crucial protection against high medical costs if unexpected illness or injury occurs. Without it, you may face significant financial challenges.

Always weigh the benefits and risks carefully before deciding to cancel your coverage.

Premium Payments, Grace Periods, & Losing Coverage

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

If You Miss a Monthly Premium Payment

If you fall behind on your monthly premiums, your health insurance company may terminate your coverage. However, before they can do so, you typically have a short grace period to make your payment.

• Grace Period Duration: The grace period is usually three months if you:
  • Have a Marketplace plan and receive the premium tax credit.
  • Have already paid at least one full month's premium during the benefit year.
  If you do not use the premium tax credit, your grace period might differ. Check with your state's Department of Insurance for specific information on grace periods in your state.

During Your Grace Period

To avoid losing your coverage, pay all outstanding premiums before your grace period ends.

Important:

• Don’t Risk Losing Coverage: If you don’t pay all your owed premiums, your coverage could be terminated, effective from the first month you missed a payment. You might also have to wait until the next Open Enrollment Period to get health coverage.
• Grace Period Example: If you miss your premium payment for May but pay for June and July, your grace period ends on July 31. If you don’t pay for May by then, your coverage will be terminated retroactively to May 31.

During the second or third month of your grace period, check with your insurance company to see if they will cover any services.

If Your Plan Ends Due to Non-Payment

If your coverage is terminated due to non-payment, you won’t qualify for a Special Enrollment Period to enroll in a new plan. You’ll have to wait until the next Open Enrollment Period unless you qualify for a Special Enrollment Period for another reason.

• Re-enrollment Restrictions: If you lose your coverage before mid-December, you won’t be automatically re-enrolled for the following year.
• Enrolling Again: When you can next enroll in a Marketplace plan, you may be able to re-enroll in the same plan if it’s still available and you’re still eligible. Whether you choose a new plan or your previous one, you must pay your first month’s premium to complete your enrollment.