Your Free Guide to Health Insurance

Health Insurance 101

Why Health Insurance Matters

Getting sick or hurt can happen to anyone — and paying for care without help can be really expensive. Did you know a short hospital stay can cost tens of thousands of dollars? Without health insurance, you might have to pay that all by yourself.

Health insurance helps protect you from those big medical bills. But let’s be honest: understanding how it all works can be confusing. There are tons of choices and a bunch of tricky words. That’s why we made this guide — to help you understand the basics and feel more confident choosing a plan that works for you and your family.

What Is Health Insurance?

Health insurance is like a safety net. It’s an agreement between you and an insurance company. You agree to pay a monthly fee, called a premium, and in return, the company helps cover your medical costs — things like doctor visits, hospital stays, or medications.

But not all health plans are the same. Some cover more, some cost more. That’s why it’s really important to read the details before you sign up. Picking the right plan can save you money and help you be ready for the unexpected.

Ways to Get Health Insurance

There are a few different ways people get health insurance, but finding the right option isn’t always easy. Let’s break down some of the most common ways people get covered.

Through Your Job

One of the most popular ways to get health insurance is through your job. If you work full-time, there’s a good chance your employer offers a health plan as part of your benefits.

In fact, U.S. law says that companies with 50 or more full-time workers must offer affordable health insurance to most of their employees. Full-time usually means you work about 30 hours a week or more.

With job-based insurance, your employer pays part of the cost, and you pay the rest. Your share is usually taken right out of your paycheck, so you don’t have to worry about making separate payments.

Here’s why job-based health insurance can be a good choice:

Your employer helps pay for it, so it’s often cheaper.
It’s easy to sign up through work.
Plans may also cover your spouse or kids.

Your employer helps pay for it, so it’s often cheaper.
It’s fairly simple to sign up through work.
Plans may also cover your spouse or kids.

But there can be a few downsides, too:

You usually have limited choices — you get what your job offers.
If you lose your job, you could lose your health insurance too.
Some plans may not cover everything you need, or your costs might still be high depending on the plan.

Staying on a Parent’s Health Plan

If you’re under 26, there’s good news — you can stay on your parent’s health insurance plan. As long as your mom, dad, or legal guardian gets health insurance through their job, their plan can usually cover you too.

This rule is part of a law called the Affordable Care Act. It says you can stay on their plan until your 26th birthday. After that, you’ll need to get your own health insurance. But don’t worry — turning 26 is considered a qualifying life event. That means you can shop for a new plan right away, without having to wait for open enrollment season.

What Is the Affordable Care Act?

You might’ve heard of the Affordable Care Act or “Obamacare.” It’s a health care law that started in 2010. The main idea? Make health insurance easier to get, more affordable, and fair for everyone.

Here’s what the Affordable Care Act (ACA) helps do:

Makes it easier for people to get health insurance
Stops insurance companies from being unfair (like refusing to cover people with pre-existing health problems)
Tries to bring down health care costs

How the ACA Helps Americans

This law changed a lot about health insurance. Here are some of the biggest ways it helps:

1. You can’t be denied for having a health issue.
Insurance companies can’t say “no” to covering you — even if you’ve had health problems before.

2. Plans have to cover the basics.
Every plan must include important services like:

Doctor visits for checkups
Mental health care
Prescription medicines
Preventive care (like vaccines and screenings)

And a lot of these services must be covered at no extra cost to you.

3. You can shop for plans in one place.
The ACA created health insurance marketplaces (also called exchanges). These are websites where you can compare different plans and prices. If you don’t get insurance from a job, this is a good place to start.

4. You might get help paying for it.
If you don’t make a lot of money, the government can help you pay for health insurance through tax credits. These make plans much cheaper for many people.

5. It expanded Medicaid in some states.
Medicaid is a free or low-cost insurance program for people with low incomes. The ACA let more people qualify — though not every state agreed to the change. (We’ll explain more about Medicaid in a later section.)

The Affordable Care Act has helped millions of people get the care they need without breaking the bank. Whether you’re staying on a parent’s plan or looking for one of your own, these protections are here to support you.

Health Insurance From the Government

If you’re a senior, living with a disability, or part of a low-income household, you might be able to get health insurance through a government program — sometimes for free or at a very low cost.

These programs are run by the federal government, and sometimes by your state, too. The three main options are:

Medicaid
CHIP (Children’s Health Insurance Program)
Medicare

Let’s break each one down.

Medicaid: Free or Low-Cost Insurance for Low-Income Families

What is it?
Medicaid is a government health insurance program that helps people with low incomes get the medical care they need. About 1 in 5 Americans is covered by Medicaid.

Who runs it?
Medicaid is paid for by both the federal and state governments. But each state has its own version of the program, so the rules can be a little different depending on where you live.

Who can get it?
You usually have to meet income limits based on your household size. Some states also require you to meet other guidelines — like being pregnant, having kids, living with a disability, or being over a certain age.

Is it the same as Medicare?
Nope. People often mix them up, but they’re different. Medicaid is based on income. Medicare is mostly for people over 65 or those with certain disabilities. Some people can qualify for both, which is called dual eligibility — this can help lower costs and cover more services.

👉 Want to learn more about Medicaid where you live? Check out our free Medicaid guide.

CHIP: Health Insurance for Kids (and Sometimes Pregnant Women)

What is it?
CHIP stands for the Children’s Health Insurance Program. It’s for families who make too much money to qualify for Medicaid but still need help paying for their kids’ health insurance.

Who can get it?
CHIP is mostly for children, but some states also offer it to pregnant women. Like Medicaid, every state runs its own version of the program, so rules and costs can vary.

How much does it cost?
Some families pay a small monthly premium, but it can’t be more than 5% of your household income. Many CHIP services are free or very low-cost.

What’s a “waiting period”?
Some states may require you to go without insurance for a short time before you can sign up for CHIP. This is called a waiting period. But don’t worry — by law, it can’t be longer than 90 days.

👉 Want more info? Download our free CHIP guide to see your state’s rules.

Medicare: Health Insurance for Seniors and Some Disabled Adults

What is it?
Medicare is a federal health insurance program mainly for people who are 65 or older. Some younger adults with certain disabilities can also qualify, including those with End Stage Renal Disease (ESRD) or those who get Social Security Disability Insurance (SSDI).

Is it based on income?
No — your income doesn’t affect whether you qualify. But if you have a low income, you might also qualify for Medicaid, which can help cover more and reduce your out-of-pocket costs.

How does it work?
Medicare has four parts, and you can mix and match them depending on your needs:

Part A: Inpatient and hospital coverage
Part B: Outpatient and general medical coverage
Part C: Also known as Medicare Advantage plans, these plans offer an alternative way to get Parts A and B through private providers, with different costs and coverage options. Availability of these plans is based on where you live
Part D: Prescription drug coverage

In addition to the standard parts of Medicare, you can also choose to enroll in something called a Medigap plan. These plans are offered by private companies and help pay for things that Medicare Part A and Part B don’t fully cover, like copays or extra supplies.

When should you sign up for Medicare?
Your initial enrollment period starts three months before your 65th birthday, includes your birthday month, and lasts for three months after that. If you’re getting Medicare because of a disability, coverage usually begins after you’ve been receiving SSDI for 24 months.

Don’t wait too long.
If you don’t sign up during your initial enrollment period and don’t qualify for a special enrollment period, you might face late fees. These are added to your monthly Part B premiums and can get more expensive the longer you wait.

What’s a special enrollment period?
You might qualify if you or your spouse is still working and you have job-based health insurance. This gives you more time to sign up without penalties.

If you miss both the initial and special enrollment periods, you’ll need to wait for the general enrollment period, which runs from January 1 to March 31 each year.

To learn more about Medicare, including who qualifies and how to apply, check out our free Medicare guide.

What Is the Health Insurance Marketplace?

The Health Insurance Marketplace is an online website where you can shop for health insurance. It was created as part of the Affordable Care Act in 2010. Think of it like a store where you can compare different health insurance plans and choose the one that works best for your needs and budget.

The Marketplace is a great option if:

You don’t get insurance through your job,
You’re self-employed,
Or your current plan doesn’t cover enough.

Can You Get Discounts?

Yes! You may be able to get help paying for your plan. These savings come in two forms:

Premium tax credits (help lower your monthly payment)
Cost-sharing reductions (help reduce the amount you pay when you go to the doctor)

Whether you qualify depends on how much money your household makes and how many people live with you.

The Marketplace will also let you know if you qualify for other programs like Medicaid, Medicare, or CHIP based on the info you give.

What If You Already Have Job-Based Insurance?

You can still choose a Marketplace plan, even if your employer offers insurance. But here’s the catch:

You can’t have both at the same time.
You may not qualify for savings unless your job’s plan doesn’t cover enough or costs too much.

A job-based plan is considered “affordable” and good enough if:

It covers at least 60% of your expected health care costs, and
It includes major services like hospital stays and doctor visits.

If your job’s insurance meets those rules, you can still buy a Marketplace plan — but you’d have to pay full price.

Most people can only sign up during open enrollment, which happens once a year. For 2026 coverage, open enrollment runs from November 1, 2025, to January 15, 2026.

But if something big happens in your life — like losing your job, having a baby, or turning 26 — you might qualify for a special enrollment period that lets you sign up outside of the regular window.

Marketplace Plan Types: Bronze, Silver, Gold, and Platinum

Marketplace health plans come in four main categories:

Bronze
Silver
Gold
Platinum

These don’t tell you how good the insurance is — they show how you and the insurance company share the costs.

Here’s a quick breakdown:

Plan Type	You Pay More When You Get Care	You Pay More Each Month
Bronze	✅ Yes	❌ Lower monthly premium
Silver	➖ In the middle	➖ Mid-range premium
Gold	❌ Less out of pocket	✅ Higher monthly premium
Platinum	❌ Very little out of pocket	✅ Highest monthly premium

So, if you don’t expect to go to the doctor much, a Bronze plan might save you money. But if you need frequent care, a Gold or Platinum plan might actually cost less overall.

States That Use Their Own Health Insurance Marketplace

Most people use the federal Health Insurance Marketplace at HealthCare.gov, but some states run their own insurance websites instead.

If you live in one of the states listed below, you’ll need to apply for health insurance through your state’s marketplace, not the federal one.

These states have their own health insurance marketplaces:

Each state’s site works a little differently, but they all let you compare plans, check for discounts, and apply online just like HealthCare.gov. Be sure to visit your state’s marketplace to view your options and sign up during open enrollment or after a qualifying life event.

Unfortunately, you can’t just sign up for health insurance whenever you feel like it — unless it’s for programs like Medicaid, Medicare, or CHIP, which follow their own rules.

For most other plans, there are only two times you can enroll:

During open enrollment
After a major life event (called a Qualifying Life Event or QLE)

What Is Open Enrollment?

Open enrollment is a set time each year when anyone can sign up for a new health insurance plan or make changes to their current one.

For coverage starting in 2026, the open enrollment period runs from:

🗓️ November 1, 2025 – January 15, 2026

If you miss this window and don’t qualify for a special exception, you’ll have to wait until the next year to enroll.

What Is a Qualifying Life Event (QLE)?

A Qualifying Life Event is a big change in your life that lets you sign up for insurance outside of the normal open enrollment period. This is also known as a Special Enrollment Period.

Some examples of QLEs include:

Losing your health insurance (such as from a job loss)
Turning 26 and aging off a parent’s plan
Getting married or divorced
Having a baby or adopting a child
Moving to a new ZIP code or state
Becoming a U.S. citizen
Leaving jail or prison

If you experience one of these events, you typically have 60 days to enroll in a new plan.

Special Enrollment Through Work

If you just started a new job, you might be able to sign up for your employer’s health insurance plan right away — even if it’s not during open enrollment. Most employers give you a special window when you first become eligible for benefits.

Understanding Common Health Insurance Plans

Whether you’re picking an employer-sponsored plan or shopping for private insurance, it helps to know the basics of the most popular types of health plans. Knowing how each one works — plus their pros and cons — can make choosing the right coverage easier for you and your family.

Keep reading to get the lowdown on common plan types, what they cover, and what to watch out for.

What Is an HMO (Health Maintenance Organization)?

An HMO plan offers a broad range of health care services, but mostly through a set group of doctors, hospitals, and specialists that are part of the HMO network.

Here’s how HMOs usually work:

You pick a primary care provider (PCP) — your main doctor who manages your overall care.
To see a specialist, you typically need a referral from your PCP.
You usually have to stay within the HMO network for your care to be covered — except in emergencies.

Advantages of HMO Plans

Lower out-of-pocket costs: HMOs often have lower premiums, deductibles, and co-pays compared to other plans.
Coordinated care: Your PCP helps manage your health and coordinates referrals, which can mean smoother care.
Simplicity: With a set network and referrals, it’s easier to understand what services are covered and how much you’ll pay.
Predictable costs: Because of fixed co-pays and fewer out-of-network bills, you’re less likely to face surprise expenses.

Disadvantages of HMO Plans

Limited provider choice: You generally must use doctors and hospitals within the HMO network. Going outside the network usually means no coverage (except emergencies).
Referral requirements: To see a specialist, you need a referral from your primary care doctor, which can slow down access to certain specialists.
Less flexibility: If you want to see a particular doctor or specialist outside the network, you might not be able to without paying full price.
Potential for extra hoops: Some people find the need for referrals and prior authorizations frustrating or time-consuming.

What Are PPO Plans? (Preferred Provider Organizations)

Preferred Provider Organization plans, or PPOs, are one of the most popular types of health insurance, especially through employers.

Unlike HMOs, PPOs give you more freedom to choose your doctors and hospitals. While you get the best benefits and lower costs by using doctors in the PPO network, you can still see providers outside the network — though usually at a higher cost.

With a PPO plan, you don’t have to pick a primary care doctor. Also, you can see specialists without needing a referral first.

Advantages of PPO Plans

Flexibility to choose providers: You can visit any doctor or specialist you want, whether they’re in or out of the network.
No referral needed: You don’t have to get approval from a primary care doctor to see a specialist.
Large provider networks: PPOs usually have extensive networks of doctors and hospitals, giving you plenty of choices.
Coverage for out-of-network care: While more expensive, PPOs still offer some coverage for services outside the network.

Disadvantages of PPO Plans

Higher costs: PPO plans usually come with higher monthly premiums, deductibles, and co-pays compared to HMOs.
More paperwork: Seeing out-of-network providers can mean submitting claims yourself and dealing with more bills.
Cost surprises: If you go outside the network, your share of the costs can be significantly higher, leading to unexpected medical bills.
Less coordinated care: Without a required primary care doctor, managing your overall health can sometimes feel less organized.

The drawbacks of choosing a PPO plan as your health insurance include the following:

What You Should Know About EPO Plans (Exclusive Provider Organizations)

Exclusive Provider Organization (EPO) plans combine some features of HMOs and PPOs. With an EPO, you must get your care from doctors and hospitals within the plan’s network to be covered—except in emergencies.

Like HMOs, you often need to pick a primary care doctor and get referrals to see specialists. But EPOs usually come with lower deductibles than PPO plans, plus smaller copayments for visits and services.

Benefits of Choosing an EPO Plan

Lower out-of-pocket costs: EPOs often have lower deductibles and copays compared to PPO plans, helping keep your expenses down.
No coverage for out-of-network care: This helps keep overall costs and premiums lower.
Coordinated care: You usually have a primary care doctor to guide your healthcare and referrals, which can improve care quality.
Simpler than PPOs: Without coverage for out-of-network providers, managing your plan can be less complicated.

Potential Drawbacks of EPO Plans

Strict network rules: You must use in-network providers for your care to be covered (except emergencies), which limits your choice of doctors and hospitals.
Referral needed for specialists: You usually need a referral from your primary care doctor before seeing a specialist, which can slow down access.
No out-of-network coverage: Unlike PPOs, EPOs typically don’t cover any care outside the network, even if it means paying the full cost yourself.
Less flexibility: If your preferred doctor or hospital isn’t in-network, you’ll have to switch or pay out of pocket.

Understanding Point of Service (POS) Plans

Point of Service (POS) plans blend features from both PPOs and HMOs, giving you a mix of flexibility and structure. With a POS plan, you’re usually required to pick a primary care doctor who helps coordinate your care, just like with an HMO.

However, if you want to visit a specialist or get care outside your network, POS plans often let you do that—though your insurance will cover less of the cost when you go out-of-network. On the plus side, seeing your primary care doctor may come with lower or even no deductibles, which can save you money.

POS plans can offer a few advantages:

More flexibility in choosing providers
Balanced options among coverage and costs

However, these plans also usually require you to choose a primary care provider. They also typically come with a deductible if you go out of your network.

Health Savings Accounts (HSA)

A Health Savings Account, or HSA, is like a special savings account that helps you pay for medical costs with pre-tax dollars. Some employers might offer you the chance to open one—and sometimes they even put money into it for you!

With an HSA, you can set aside part of your paycheck before taxes, up to a yearly limit set by the IRS. What’s great is that any money you don’t spend rolls over year after year and even earns interest without being taxed.

You can use the money for qualified medical expenses whenever you need it. If you decide to take money out for other reasons before you turn 65, you’ll probably have to pay extra taxes and penalties. But once you’re 65 or older, you can withdraw money for anything without penalties (though you’ll pay regular income tax if it’s not for health expenses).

Extra Insurance to Help with Costs

Sometimes, your main health insurance doesn’t cover everything. Supplemental insurance plans are extra options you can add on to help pay for things like copays, deductibles, or other medical expenses that your regular plan might miss. You might get these plans through your job or buy one yourself through the Health Insurance Marketplace.

Vision Insurance: See Clearly for Less

Vision insurance helps pay for eye care costs. Most plans cover regular eye exams and glasses, and some also help with contact lenses. What you get and how much it costs can be different depending on the plan you pick.

Dental Insurance: Keep Your Smile Healthy

Dental insurance helps cover costs for taking care of your teeth. Usually, it pays for regular cleanings, check-ups, and X-rays. Some plans also cover bigger treatments like fillings or even implants. The more dental services a plan covers, the higher the cost—but dental insurance is usually an affordable extra you can add to your main health plan.

Critical Illness Insurance: Support for Serious Health Problems

Critical illness insurance helps with the big costs if you get very sick with conditions like a heart attack, cancer, or stroke. Even with regular health insurance, these illnesses can lead to expensive bills and lost income. These plans can be affordable and give you extra financial help, but it’s important to check which illnesses are covered before you sign up.

Accident Insurance: Extra Help When Things Go Wrong

Accident insurance gives you extra money if you get hurt in an accident. It usually pays a lump sum that you can use to cover medical bills or even everyday expenses like rent or groceries if you can’t work because of your injury.

Understanding the Common Costs of Health Insurance

Health insurance can help you save money on medical care, but exactly how much depends on your individual situation. When you add up monthly premiums, copayments, and other expenses, it’s natural to wonder if having insurance is worth it.

Keep reading to learn about the common costs you might face with health insurance plans. This can help you decide which plan is right for you.

Monthly Premiums: Your Regular Payment

A premium is the amount you pay each month to keep your health insurance active. Usually, the higher your premium, the more benefits your plan offers. And if you pay more upfront with premiums, your out-of-pocket costs—like copays and deductibles—are often lower.

If you get your health insurance through your employer, your premium is usually taken directly out of your paycheck automatically.

Things That Can Influence Premium Costs

Premium amounts are determined by several factors, including the following:

Age: Older individuals typically pay higher premiums because they tend to need more medical care.
Location: Health care costs vary by region, so premiums may be higher or lower depending on where you live.
Plan Type and Coverage Level: Plans with more comprehensive coverage or lower out-of-pocket costs generally have higher premiums.
Tobacco Use: Smokers often face higher premiums due to increased health risks.
Individual vs. Family Coverage: Family plans covering multiple people usually cost more than individual plans.
Health Status: Although insurers can no longer charge more or deny coverage based on pre-existing conditions due to the Affordable Care Act, some factors related to health risk may still influence premium pricing in certain situations.
Employer Contributions: For employer-sponsored plans, the portion your employer pays toward your premium can affect your share of the cost.
Income: For plans purchased on the Health Insurance Marketplace, your income may affect eligibility for subsidies that lower your premium costs.

Deductibles

A deductible is the amount you must pay out of pocket for your health care expenses before your insurance starts covering costs. Generally, plans with lower monthly premiums tend to have higher deductibles.

For example, if your deductible is $1,500 and you receive a $1,700 emergency room bill, you would pay the first $1,500. After meeting your deductible, the remaining $200 would then be shared between you and your insurance based on your coinsurance rate (explained below). Deductible amounts reset annually.

Copayments

Copayments, or copays, are fixed fees you pay for specific medical services or visits. These amounts can vary depending on the type of care. For instance, you might pay $25 for a regular doctor visit, $50 to see a specialist, and $150 for an emergency room visit. Copay amounts differ widely across insurance plans.

Coinsurance

Coinsurance is the percentage of your medical costs you pay after you’ve met your deductible. Using the previous example, if you owe $200 after the deductible and have a 20% coinsurance rate, you would pay $40, while your insurance covers the remaining $160.

Out-of-Pocket Maximums

The out-of-pocket maximum is the total amount you’ll have to pay for covered medical expenses in a year, including deductibles, copays, and coinsurance. Once you reach this limit, your insurance will cover 100% of the remaining covered costs for the rest of the year.

Some Things to Keep in Mind

Before enrolling in any health insurance plan, it’s important to carefully review all policy details. Make sure to understand which medical services are covered, which providers and facilities are in-network, and how prescription drugs are handled.

For example, if you have a preferred doctor, check whether they and their office are included in the plan’s network. While plans like PPOs may allow you to see out-of-network providers, this usually means higher out-of-pocket costs.

Also, verify that the plan covers your current medications and any services you regularly use. If you often visit a chiropractor, for instance, find out whether chiropractic care is included and how many visits are covered, or if there are any limits on frequency.

Losing Health Insurance Coverage

Health insurance providers can’t cancel your coverage on a whim. Laws protect you by limiting when and how an insurer can terminate a policy. Typically, if your insurer plans to cancel your coverage, they must give you at least a 30-day notice, giving you time to appeal or find alternative coverage.

Here’s a closer look at common reasons people lose their health insurance:

Loss of Employment or Divorce

If you have health insurance through your or your spouse’s employer and lose your job or get divorced, you may lose coverage. However, under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you can often continue your group health insurance for 18 to 36 months. Keep in mind, COBRA coverage can be costly since your or your spouse’s employer no longer helps pay premiums, so it’s usually a temporary option while you find new insurance.

If You Stop Paying Your Monthly Premiums

One of the most common reasons for losing coverage is falling behind on premium payments. Insurers generally offer a grace period before canceling your policy. For example, if you have a Marketplace plan, the grace period is usually 90 days—provided you’ve paid at least one full month’s premium during the benefit year and qualify for advance premium tax credits. During this time, you must repay missed premiums to keep your coverage. If your coverage ends due to missed payments, you’ll need to wait for the next open enrollment period or qualify for a special enrollment event to rejoin.

Aging Out of Your Parents’ Insurance

Under the Affordable Care Act, you can remain on your parents’ insurance until you turn 26. After that, you lose coverage and your parents’ insurer isn’t required to offer you another plan.

No Longer Meeting the Requirements

If you have coverage through federal programs like Medicaid or CHIP, you may lose eligibility if your circumstances change—such as an increase in income—causing you to exceed program guidelines. If this happens, you’ll need to find a new insurance plan.

If an Insurer Stops Offering Your Plan

Sometimes insurers discontinue specific plans. If this happens, your insurer must offer you an alternative plan. If they don’t have any other plans available in your area, you’ll need to find new coverage elsewhere.

Things That Cannot Cause You to Lose Health Insurance Coverage

Certain situations cannot be used by insurers or employers as reasons to cancel your health insurance coverage. These include:

Pre-existing Medical Conditions: You cannot be denied coverage or dropped from your plan because of a pre-existing illness or health condition.
Age (Under 26): You cannot lose coverage just for being under age 26 if you’re on your parents’ insurance.
Gender or Health Status: Your gender, current health, or disability status cannot be grounds for losing your insurance.
Filing a Claim: Using your health insurance to file claims for covered medical services cannot be a reason to cancel your policy.
Pregnancy: Being pregnant cannot cause your coverage to be canceled or denied.
Participation in Clinical Trials: Taking part in approved clinical trials cannot be a cause for losing your insurance.
Race, Ethnicity, or National Origin: Discrimination based on race, ethnicity, or national origin is prohibited as a cause for losing coverage.
Employment Status (if insured through Marketplace or government programs): Losing or changing jobs by itself cannot cause loss of coverage if you maintain Marketplace or government health plans properly.

What to Do if You Lose Your Health Insurance Coverage

If you lose your health insurance, you may qualify for a special enrollment period because losing coverage counts as a qualifying life event (QLE). This special enrollment window usually lasts about 60 days from the date your coverage ends, so it’s important to act quickly to select a new plan.

In addition to Marketplace plans, you should also check if you qualify for federal assistance programs like Medicaid or CHIP—especially if your loss of coverage came with a significant drop in income, such as after losing a job.

How to Appeal

If your insurance company cancels your coverage or denies a claim or service, you have the right to appeal their decision.

Each insurer has a formal appeals process that lets you challenge these decisions. For example, if coverage for a medication or treatment is denied, you can file an appeal to have the decision reviewed. During this internal appeal, your insurance company must conduct a fair, thorough review and allow you and your healthcare providers to submit supporting evidence.

The appeals process can differ depending on your insurance type. If your coverage comes from a federal program like Medicare, Medicaid, or CHIP, you must follow the appeal procedures established by those programs.

What if You Don’t Have Health Insurance?

Without health insurance, you’ll generally be responsible for paying all medical bills out of pocket. These expenses can quickly add up, potentially leading to significant medical debt. In some cases, healthcare providers may pursue legal action or involve debt collectors to recover unpaid bills. Additionally, many hospitals and providers charge higher rates to uninsured patients compared to those with insurance coverage.

While the federal government no longer imposes a tax penalty for not having health insurance—after repealing the Affordable Care Act’s individual mandate—some states still require residents to maintain health coverage and may enforce their own penalties if you remain uninsured.

States with their own health insurance mandates currently include:

California
Massachusetts
New Jersey
Rhode Island
Vermont
District of Columbia

If you are uninsured, here are some ways to find affordable health coverage:

Explore the Health Insurance Marketplace: Check if you qualify for subsidies or special enrollment periods.
Consider Medicaid or CHIP: If your income qualifies, these programs provide low-cost or free coverage.
Look for Employer-Sponsored Plans: If employed, see if your workplace offers health insurance benefits.
Review Short-Term or Catastrophic Plans: These can provide limited coverage at lower premiums but may have restrictions.
Seek Assistance: Many communities have health navigators or counselors to help you find the best options.

Alternative Options to Traditional Health Insurance

Some individuals may find traditional health insurance plans unaffordable or may not qualify for discounted federal or state programs like Medicaid, which often have eligibility limits and restrictions varying by state.

If you’re between jobs or seeking a more budget-friendly approach to healthcare, consider the following alternative options.

Subscription Healthcare Services

Subscription healthcare is gaining popularity across the U.S. These services operate on a monthly fee basis, granting you access to a set range of medical services, prescriptions, providers, and facilities.

Each provider partners with different doctors, dentists, mental health professionals, and hospitals to offer discounted rates. Some plans even provide unlimited access to approved services without deductibles or copays.

Since offerings vary widely, it’s important to carefully review the details of each subscription plan before enrolling to avoid unexpected costs.

Cost-sharing programs involve groups of members pooling monthly contributions into a shared fund used to cover qualifying medical expenses for participants.

Many cost-sharing groups have a religious affiliation, though some are open to others as well. Coverage rules, fees, and eligible expenses vary by program, so reviewing plan details thoroughly is recommended, just as you would with a traditional insurance policy.