Health coverage helps pay for medical costs. A health care plan has a set of services that the plan provider agrees to pay for if you need them, like when you see a doctor or go to the pharmacy.

One way to get health coverage is through government programs, like Medicare and AHCCCS. Another way is through private insurance companies. The two main ways to get private health coverage are through your job, which is called employer-sponsored group health coverage, or by buying it on your own, called individual health coverage. You can buy an individual plan for yourself and for your entire family.

In the past, buying individual health coverage could be very difficult, especially for people with disabilities. Many people worried that they wouldn’t qualify for it and, even if they did qualify, they might not be able to afford the monthly payments (called premiums) or other fees, like copayments or deductibles.

However, this has changed. Now, private health coverage companies cannot reject your application because you have a health condition, and if you get your insurance through Healthcare.gov, there should be a private or public health plan you can afford.

This article is about getting health coverage through Healthcare.gov. It will help you understand:

  • If an individual plan is right for you
  • What services your plan will cover
  • How to choose a plan
  • How much you will have to pay for health care, and
  • How to sign up.

If you need more help in understanding individual health plans after reading this article, we recommend you talk to trained experts. Here are some good resources:

  • Healthcare.gov has a lot of great information introducing your options. You can also call Healthcare.gov at 1-800-318-2596 or 1-855-889-4325 (TTY).
  • Healthcare.gov has local help and you can use the Live Chat feature if you want to copy-and-paste a record of what was said.
  • If you have a disability, talk to a Work Incentive Consultant to learn if you have additional options.
Highlights
  • There is a single marketplace called Healthcare.gov where you can compare plans.
  • If your income is at or under 400% of the Federal Poverty Level (FPL), $48,560 for an individual ($100,400 for a family of four), and you can’t get affordable health coverage through your job or Healthcare.gov, the government will help pay your premium with tax credits, meaning you pay less.
  • The only things that can affect what an insurance company charges you are:
    • Your age
    • Whether you use tobacco
    • The plan you choose
    • Where you live
  • You cannot be turned down because you have pre-existing conditions.
  • If you don’t have any form of health coverage in 2018, you may have to pay a tax penalty.

Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. For news related to health coverage, visit the Kaiser Family Foundation.