Where can I sign up for health coverage?

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How you sign up depends on the type of coverage you get:

If my job offers me health coverage, can I still qualify for Medicaid or get subsidies for an individual plan on Healthcare.gov?

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You can qualify for Medicaid if your family’s income qualifies, even if your job offers insurance.

You cannot get subsidies for purchasing an individual health plan through Healthcare.gov if your job offers you affordable insurance.

Does it matter how I qualify for Medicaid?

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In most cases, no. The actual medical coverage you get from Medicaid will be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and if you have a disability and start working, you can earn a lot more while still getting Medicaid coverage through Medicaid Buy-In for Workers with Disabilities (MBIWD).

What is the most money I can make and still get Medicaid?

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For income-based Medicaid, the main income rules are:
  1. If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($17,236 per year for an individual; $35,535 for a family of four), you may qualify.
  2. If you are 18 or younger and your family’s income is at or under 211% of FPG ($54,333 per year for a family of four), you may qualify.
  3. If you are pregnant and your family’s income is at or under 205% of FPG ($52,788 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

Income-based Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

If you have a disability and get Supplemental Security Income (SSI) benefits or used to get SSI benefits and now qualify for SSI 1619(b), you automatically are covered by Medicaid. If your income is higher, you can get Medicaid Buy-In for Workers with Disabilities (MBIWD) coverage. With MBIWD, you could make as much as $103,470 per year and still qualify, depending on your unearned income.

Health Coverage Income Limits for Your Family

I’m an immigrant. Can I get Medicaid?

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  • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
  • Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, if their income is at or below 400% of the Federal Poverty Guidelines (FPG), they can get private coverage subsidized by the government.
  • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

What will happen to my Medicaid coverage if I go back to work?

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There are different health coverage options as your income goes up:

The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.

Who is eligible for the Medicaid Buy-In for Workers with Disabilities?

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To qualify for the Medicaid Buy-In for Workers with Disabilities (MBIWD), you must:

You have to pay a monthly premium to get MBIWD coverage in any month where your countable income is over $1,561. The amount of your premium depends on your income and your family's income, as well as your family's medical expenses. To learn how much your premium might be, try DB101's MBIWD Estimator.

How many programs does Medicare offer?

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Medicare has three main parts:
  • Medicare Part A helps pay for medical care you get while you’re in a hospital.
  • Medicare Part B helps pay for medical care you get outside of a hospital.
  • Medicare Part D helps pay for prescription drugs.

Medicare Advantage (also called Medicare Part C) is a way to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower.

How do I become eligible for Medicare?

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If you or your spouse worked enough time while paying Medicare taxes, you will qualify for Medicare Parts A and B:
  • When you turn 65
  • When you’ve been getting Social Security Disability Insurance (SSDI) benefits for two years, or
  • If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

Note: If you have had a disability since before you were 22 years old, you will start getting Medicare if you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record.

Will Medicare pay for all of my medical expenses?

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No. Medicare will only help pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you’ll have to pay for it yourself, unless you have other coverage, such as Medicaid, employer-sponsored coverage, or a Medicare supplement (Medigap) policy.

For certain services, you’ll pay a deductible, copayment, or co-insurance before Medicare will begin to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage, you may have to pay a monthly premium.

You may qualify to get help paying for your Medicare premiums, copayments, and deductibles if you have low income. Medicare Premium Assistance Programs help pay for Part B coverage and the Low Income Subsidy (LIS) helps pay for Part D coverage.

Can I be on Medicare and another form of health coverage at the same time?

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Yes. Other types of coverage that you can have with Medicare include:

Learn more about how Medicare interacts with other types of coverage.

How much will employer-sponsored health coverage cost and who pays for it?

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You may be responsible for no cost, a percentage of the cost, or the amount of the cost of the coverage that is above what the employer agrees to pay.

Employers are supposed to offer plans that cost the employee, for the employee’s policy alone, less than 9.5% of the employee’s family income for the monthly premium. Also, that coverage must meet bronze-level standards for copayment, co-insurance, and deductible expenses.

If your employer offers a plan that does not meet these standards, you may qualify for government help through tax subsidies to reduce the premium on an individual plan.

Note: The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan. Even so, anybody who could get employer-sponsored coverage, even if it is not affordable for the family member, will not qualify for tax subsidies to buy an individual plan on Healthcare.gov.

Can I get coverage through my parent’s employer-sponsored insurance?

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Yes, if you are under 26 and cannot get health coverage through your own employer. Employers who offer coverage to their employees must also offer it to their children under the age of 26.

Employers do not have to offer coverage to the spouses of employees, but many do.

Note: While employers must offer this coverage to children, the employee may be required to pay for all of it.

I have a disability. Will I really be able to get insurance that covers my medical problems?

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Yes. Plans cannot deny people coverage. When you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer comprehensive coverage, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few.

How does the government help people pay for individual coverage?

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Depending on your situation, you may qualify to have the government help pay for your individual health plan through tax credits. Here's how it works:
  1. When you sign up at Healthcare.gov, you give details about your family's situation. Healthcare.gov reviews that information instantly. If your family qualifies for government help to pay for individual coverage, Healthcare.gov tells you and lists insurance options for you.
  2. Your insurance options list the full cost of the monthly premium, how much of that premium the government will pay each month, and how much you will pay each month. The way the government helps pay for the premium is by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
  3. In January or February, the government will send you a form listing how much your total health coverage tax credits were for the previous year. You will need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this will be sorted out when you file your taxes.

Do I have to get a silver-level plan on Healthcare.gov if I want government help paying for my insurance?

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No, but depending on your income, you may get more help from the government if you get a silver-level plan:
  • If your family makes 400% of the Federal Poverty Guidelines (FPG) or less, the government helps pay for your premium through tax credits. That means you pay less each month. You can get this help no matter what metal your plan is.
  • If you make 250% of FPG or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you’ll pay less each time you need medical services. If you get this help, your silver plan might actually be as good or better than many platinum or gold plans. If you do not get a silver plan, the government will not help you with these expenses.

When Healthcare.gov looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

Health Coverage Income Limits for Your Family

What happens if I sign up for an individual plan and then my income changes and I can no longer afford it?

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Usually, when you sign up for a plan through Healthcare.gov, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2019, then you can’t leave that plan until 2020.

However, there are certain situations when you may be able to change plans mid-year:

  • If your income changes and you gain or lose eligibility for government help paying for your coverage
  • If your health provider is not meeting its obligations
  • If you move, or
  • In other life-changing circumstances, such as having a child or getting married.

The first one is the key. If your income goes down and you can’t afford your plan anymore, report your change in income to Healthcare.gov. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).

Note: American Indians do not have these restrictions and can change up to once a month.