If You Can’t Get Health Insurance at Work

Coverage under the Affordable Care Act (also called Obamacare)

Under the health care law, people looking for health coverage will be able to compare plans and select the best one for them from online health insurance Marketplaces in each state. Your state’s Marketplace will collect information from you to find out if you qualify for Medicaid (or if your child is eligible for your state’s Child Health Insurance Program, called CHIP) or financial help to pay for coverage. Visit healthcare.gov or CuidadoDeSalud.gov for your state’s information.

You might also want to consider the different types of health plans that are offered on the Marketplace. There are HMO plans, which may offer you a fixed set of services from a single group or facility, and at the other extreme, Point of Service plans that allow you more choice of health providers. You can read about the different types of plans in Types of Health Insurance Plans.

Gather the information you’ll need to apply for Marketplace coverage

First, get your updated income estimates and household information together and be sure they’re correct. (Visit the Marketplace website first to see what other information you will need to apply through the Marketplace and to learn whether you qualify for Medicaid or CHIP. Or you can call 1-800-318-2596 to find out.)

After you get your information together, call the number above or go to the Marketplace online at healthcare.gov to re-apply. Find out what kind of plan you can get and when the new coverage will start.

If you don’t have Internet access, you can get Marketplace information and sign up by phone. For the phone number of your state marketplace, call 1-800-318-2596.

    What You Need to Know About the Marketplace

  • If you’re under 65 and don’t have access to health coverage through your employer or Medicare, you can shop the Marketplace for a plan to cover you and your dependents.
  • If the employer-based coverage you’re offered has very high premiums compared to your pay, you may still qualify to shop the Marketplace.
  • Young adults may be covered under their parent’s health insurance plan (if it covers dependents) up to age 26.
  • You must shop for and choose a health plan and pay premiums to keep the policy in force
  • You might qualify for help paying premiums if your income is low
  • If you lost your insurance coverage more than 60 days ago, may have to wait for Open Enrollment on the Marketplace
  • You can’t be turned down for insurance based on pre-existing illness such as cancer
  • When you complete your Marketplace application, the system will tell you if your family qualifies for Medicaid or your child qualifies for Medicaid or CHIP.
  • Scammers will often try to take advantage of people who might be looking for “Obamacare” insurance coverage

Individual insurance policies

You can buy individual insurance plans outside the marketplace to cover yourself and your family. Most plans will meet the requirements for sufficient coverage so that you avoid the penalty at tax time, but some won’t. Be sure to ask whether it meets the minimum requirement. An independent insurance broker may be able to help you find a reasonable benefit package.

If you are employed, before you leave your job, find out if you can convert your group insurance to an individual plan. Some group plans have a clause that allows people to convert to individual plans, but premiums are often much higher. You usually must apply for these individual plans within 30 days of leaving a job. (This is different from COBRA, which lets you keep group insurance for a limited time.)

    What You Need to Know About Individual Health Insurance

  • People with lower incomes don’t get help with cost reductions or premium payments on non-Marketplace plans; these cost savings are only available on Marketplace plans.
  • Non-Marketplace plans that cover children may allow young adult children to be covered up to age 26 (as do Marketplace plans)
  • A few non-Marketplace plans might not meet the requirements for minimum coverage so that you still might have a penalty at tax time
  • Scammers will try to take advantage of people who might be looking for insurance coverage

     

Consolidated Omnibus Budget Reconciliation Act (COBRA)

If you have been covered under your work health insurance plan for at least one day you should be able to keep your medical insurance through COBRA. Your employer must tell you, in writing, about your COBRA option. For more information, please see COBRA If COBRA is too costly, you might still qualify for a special enrollment period to buy a Marketplace plan.

    What You Need to Know About COBRA

  • Must have left your job recently, you have 60 days to accept the COBRA benefit when offered
  • May qualify for 18- to 36-month extension of job-based group health benefits
  • Must pay full premiums, which can be high, and may cost more than a Marketplace plan
  • If you recently lost job-based coverage, you might qualify for a special enrollment period in the Marketplace; if so, you have 60 days to enroll (You don’t have to wait for open enrollment on the Marketplace as long as you don’t choose COBRA)
  • If you elect COBRA, you can’t shop for a plan on the Marketplace until the Marketplace has its next open enrollment period.

Medicare or Medicaid

Look into Medicare, which covers most people who are 65 or older, as well as those under 65 who are disabled—including children--and who have been getting Social Security disability benefits (SSI or SSDI) for 2 years.

If you are in a low-income bracket or are unemployed, find out if you or your family are eligible for Medicaid, or if your children qualify for CHIP. CHIP programs vary from state to state, as does eligibility. They usually cover children up to age 19. The family must be below certain income levels.

    What You Need to Know About Medicare

  • A type of federal health insurance for people 65 and older, and or disabled people who have applied for and met the Social Security definition of disability benefits for 2 years
  • May cost money for people with higher income; must pay for Part B of Medicare
  • Some very low-income people over 65 or disabled qualify for Medicaid and Medicare at the same time
  • Many doctors don’t take Medicare
  • For more on Medigap, Medicare Advantage, and the Medicare Part D (Drug Plan), see our Medicare Information

    What You Need To Know About Medicaid

  • Eligibility based on family size, assets, and income
  • Medicaid is a type of health insurance, but the caseworkers may know of other helpful resources for people with low incomes
  • Many doctors do not accept Medicaid
  • If your income is too high to qualify for Medicaid, find out if you qualify for help buying a plan on your state marketplace
  • If you make too much for Medicaid, your child or children may still qualify for CHIP
  • If your child is disabled and has been getting SSI or SSDI, they might qualify for Medicare

 

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: November 17, 2015 Last Revised: March 1, 2016

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