If you need health insurance, it’s important to know all of your choices for job-based, public, and private coverage. These options have already expanded under the Affordable Care Act, and will continue to grow in 2014 and beyond.
What are my options for job-based coverage?
If you don’t have coverage, you may be eligible for health insurance coverage through your own job or that of your spouse or parent.
If an employer or tribal government offers coverage, you generally can’t be turned away or charged a higher premium because of your health status or disability. This protection is called “nondiscrimination.”
Employers may refuse or restrict coverage for other reasons (such as part-time employment), as long as these are unrelated to your health status and are applied consistently.
What are my options if I can’t get coverage through work?
If you can’t get insurance through your or your spouse’s employer, you have a number of options:
- Insurance Under a Parent’s Policy: If you are under 26, you may be eligible for coverage under your parent’s insurance policy.
- Individual Insurance Policies: If you cannot get health insurance through work, you may be able to buy a health insurance policy for yourself or your family. Be aware that policies are often expensive, and that until 2014 you can be charged more, be rejected for coverage, or have your coverage restricted due to a health condition or other factors.
For background on the private insurance marketplace, visit our “Insurance Basics” section.
- Pre-Existing Condition Insurance Plan: If you have a pre-existing health condition and have been uninsured for the past six months, you may qualify for the Pre-Existing Condition Insurance Plan (PCIP) created under the Affordable Care Act. Learn more about the Pre-Existing Condition Insurance Plan.
- Medicaid:Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities. The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level.Beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state.
- Children’s Health Insurance Program (CHIP): All states provide coverage for children through Medicaid and the Children’s Health Insurance Program (CHIP). Your children are likely to be eligible for coverage if your income is up to about $45,000 per year (for a family of four).
- Indian Health Service: If you are not eligible for coverage through your tribal government or other employer, and are an American Indian or Alaska Native, you can still access health care at an IHS, tribal, or urban clinic.
What if I’m losing work-based coverage?
If you are losing your work-based coverage because you are leaving your job, you may have the option of keeping the coverage through a program called COBRA.
COBRA is a federal law that may let you and your family keep your employee health insurance for a limited time after your employment ends or after you would otherwise lose coverage. This is called “continuation coverage.”
Since your employer doesn’t pay for COBRA coverage, you’ll probably pay for the whole cost of the monthly premium.
Here’s what you need to know about COBRA coverage:
- In general, COBRA coverage requirements apply only to employers with 20 or more employees.
- If your family was covered under your employer coverage, they may also qualify for COBRA coverage.
- In most situations, you should get a notice from your employer’s benefits administrator or the health plan telling you that your coverage is ending and offering you the right to take COBRA coverage.
- In most cases, you have 60 days after your last day of coverage to sign up for COBRA.
- COBRA coverage usually lasts for 18 months but could last up to 36 months.
For more information about COBRA coverage:
- Call your employer’s benefits administrator for questions about your specific COBRA coverage options.
- If your health plan coverage was from a private employer (not a government employer), you can visit the Department of Labor’s website, or call 1-866-444-3272.
- If your health plan coverage was from a state or local government employer, you can call 1-877-267-2323, extension 61565.
- If your coverage was through employment with the federal government, you can visit the Office of Personnel Management’s website at www.opm.gov.
“Conversion” Coverage and HIPAA-Eligible Coverage
When you’re leaving job-based coverage, you might be able to convert your job-based health insurance plan to an individual policy. This is called “conversion” coverage, and isn’t the same as “continuation coverage” (COBRA), in which you keep your job-based coverage. If you have a choice, you should consider your options carefully.
You might also have special rights to buy individual coverage as a “HIPAA eligible individual.”
Contact your State Department of Insurance to see if these coverage options are available to you.
If you have lost your insurance through work, find a complete list of options above under “What are my options if I can’t get coverage through work?”