Health Insurance

Health insurance helps pay for prescriptions (medicines) and many doctors’ bills, sometimes including dentists and eye doctors. Since medicines and medical services can be expensive, having health insurance to help pay for them is important.

You may get health insurance through your job. Or you can apply for it at healthcare.gov or through your state’s health exchange (see links above).

A health exchange, or marketplace, is a place you can shop for health insurance for yourself and your family.

You can apply for health insurance by phone, on a health exchange website, in person, or through your employer. Depending on your income, you may qualify for a reduced cost, or premium. Or you may qualify for government programs like Medicare or Medicaid (see below).

These are government-run health insurance programs available to specific groups of people. Usually they’re affordable or even free.

Most U.S. citizens and legal residents 65 or older are eligible for Medicare. To qualify, you or your spouse will have had to work for 10 or more years while paying Medicare taxes. Other groups eligible for Medicare include certain Americans with disabilities and people suffering from end-stage renal disease (ESRD), a form of kidney disease.

While Medicare is mostly for those 65 and older, Medicaid is for many groups. These groups include—but are not limited to—people with low incomes, those who are pregnant, and those with disabilities. 

Healthcare.gov or your state’s health exchange will help you determine whether you or your family can get Medicare or Medicaid. 

Some states require you to have health insurance. These include California, the District of Columbia, Massachusetts, New Jersey, and Rhode Island. In these states, people without health insurance get tax penalties (or fees). Vermont also requires you to have health insurance, but you won’t get a tax penalty in Vermont if you don’t.

Even if it’s not required, having health insurance can save you money! Get help deciding which health insurance is right for you—and signing up when you’re ready.

If you’re employed:

The monthly cost (or premium) will be taken out of your paycheck. Usually, your employer will pay most of the monthly cost. Your monthly cost will vary depending on your employer.

If you aren’t employed or don’t get health insurance through your job:

You may be eligible for health insurance through the Affordable Care Act (also known as ACA or Obamacare) or through Medicaid or Medicare. If so, you’ll likely pay a low monthly fee (or premium). Or you may qualify to get your health insurance for free! Get help finding out if you qualify for free or low-cost insurance.

If you’re a young adult:

You may be eligible for health insurance coverage through a parent who has insurance. Get help finding out if you qualify for coverage through a parent.

Getting health insurance will lower the cost of most doctors’ bills, prescriptions, and hospital visits. In some cases, there won’t be a bill at all. But in some cases you may be billed. In those cases, the fee will usually be lower than without insurance. Healthcare bills may include a deductible, copayment, or coinsurance.

A deductible is the amount you have to pay before your insurance starts paying. The amount of the deductible should be provided in your health plan’s detailed information.

This is a specific amount of money you pay out of pocket when you go to the doctor or buy prescriptions.

Coinsurance is the remaining percentage of the medical cost you pay after your deductible has been met.

Medicare and Medicaid are government-run health insurance programs, and they are the most affordable way to get health coverage, and very often are free.