Where to Start If You Need Medical Coverage

If you don't have health insurance, your first step depends on your situation: whether you're employed, unemployed, self-employed, retired, or a parent with children. The main routes are Medicaid (a state-run program for people with lower incomes), Medicare (for people 65 and older, or with certain disabilities), the Health Insurance Marketplace (where you buy private plans, sometimes with cost help), or coverage through an employer or spouse's job.

Each route has different income limits, paperwork, and timelines. The program that works for you depends on your age, income, and whether you may have access to for any special circumstances. This guide walks you through how each one works and how to find out which applies to you.

Key Takeaways

  • Medicaid is free or very low-cost coverage run by your state, with income limits that vary by state and family size.
  • The Health Insurance Marketplace lets you compare private plans and shows you upfront what your monthly cost will be based on your income.
  • Medicare is for people 65 and older, or younger people with certain disabilities or end-stage renal disease.
  • You can enroll in Marketplace plans during open enrollment (usually November through January), or when ready if you have a may have access to life event like losing a job or having a baby.
  • Your state's Medicaid office or a local health department can tell you in one conversation whether you meet the income and citizenship rules.

Medicaid: State-Run Coverage for Lower Incomes

Medicaid is health coverage paid for by your state and the federal government. It is free or costs very little per month. Income limits vary by state and family size—a single person might may have access to with an income under $1,500 per month in one state and $2,000 in another. Your state's Medicaid office can tell you the exact limit for your household in minutes.

To find your state Medicaid office, search "[your state] Medicaid" or call your local health department. You will need to provide proof of income (recent pay stubs, tax return, or a letter from your employer), proof of citizenship or legal residency, and proof of your address. Some states let you explore online; others require you to visit an office or mail in forms. Processing usually takes two to four weeks.

Medicaid covers doctor visits, hospital care, prescription drugs, and preventive services. What it covers and what you pay per visit varies by state. Some states have expanded Medicaid to cover more people; others have not. If you are turned down, ask whether your state has a separate program for people who don't quite meet the Medicaid income limit.

Medicare: Coverage for People 65 and Older

Medicare is federal health coverage for people 65 and older, regardless of income. You become may be able to access automatically at 65 if you have worked and paid Medicare taxes for at least 10 years. If you have not worked that long, you may still may have access to through a spouse's work history.

Medicare has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative plan that combines A, B, and D. You enroll in Parts A and B when you turn 65. If you miss the important date, you pay a penalty for the rest of your life, so sign up in the three months before your 65th birthday.

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or at your local Social Security office. You will need your Social Security number and proof of citizenship. Medicare is not free—you pay a monthly premium for Part B and Part D, and you share costs when you use care—but it is much cheaper than buying private insurance at that age.

Health Insurance Marketplace Plans

The Health Insurance Marketplace is where you can buy private health insurance directly. You can compare plans side by side and see the exact monthly cost before you enroll. If your income is below a certain level (which varies by family size and state), you may receive a tax credit that lowers your monthly premium.

You can enroll in a Marketplace plan during open enrollment, which runs from November 1 through January 15 each year. If you miss that window, you can still enroll when ready if you have a may have access to event: losing your job, getting married, having a baby, moving to a new state, or losing other coverage. You have 60 days from the event to enroll.

To shop for plans, go to Healthcare.gov (or your state's Marketplace website if your state runs its own). Enter your income, family size, and zip code. The site will show you available plans, their monthly cost after any tax credits, and what you will pay when you use care. You can enroll online, by phone, or with help from a local navigator—a person trained to walk you through the process for free.

Coverage Through an Employer or Spouse

If you work for a company with 50 or more employees, your employer may offer health insurance. The cost is usually split between you and your employer—you pay a monthly premium from your paycheck, and your employer pays part of it. Coverage usually starts on your first day of work or on the first of the month after you are hired.

If you are married or in a domestic partnership, you may be able to join your spouse's or partner's plan. You can enroll when you first become may be able to access (usually within 30 days of marriage or when your partner's plan allows new members). If you lose your job or your spouse's job, you may have the right to stay on that plan for up to 18 months by paying the full premium yourself—this is called COBRA. Ask your employer's human resources department for details.

Special Programs for Specific Situations

If you are pregnant, many states have programs that cover prenatal care and delivery even if you don't meet Medicaid income limits. Search "[your state] pregnancy Medicaid" or call your local health department to learn the income limit in your state.

If you have a disability or end-stage renal disease and are under 65, you may may have access to for Medicare. You will need medical documentation of your condition. Contact Social Security at 1-800-772-1213 to start the process.

If you are a veteran, you may be covered by the Veterans Health Administration (VA). Call the VA at 1-800-827-1000 or visit VA.gov to learn whether you may have access to and what coverage is available.

If you are a Native American or Alaska Native, you may be covered by the Indian Health Service (IHS) or a tribal health program. Contact your tribe's health office or call the IHS at 1-855-925-4687.

What Happens After You Enroll

Once you enroll, you will receive a card or a letter with your member ID number and coverage start date. Keep this information safe—you will need it when you see a doctor or fill a prescription. Your coverage usually starts on the first of the month after you enroll, though Marketplace plans may start on the first of the following month.

Before you use your coverage, call the customer service number on your card and ask which doctors and hospitals are in your plan's network. Using in-network providers costs you less. If you need a specialist, ask your primary care doctor for a referral, or check your plan's website to find one in your network.

If your income or family size changes, tell your insurance company or Medicaid office right away. Your coverage amount or cost may change, and you may owe money if you don't report the change. You can update your information online, by phone, or by mail.

Frequently Asked Questions

What if I don't have a Social Security number?

You can still enroll in Medicaid or a Marketplace plan. You will need proof of identity (a passport, driver's license, or state ID) and proof of your address. Some states ask for an Individual Taxpayer Identification Number (ITIN) instead of a Social Security number. Call your state Medicaid office or your local health department to ask what documents they accept.

Can I enroll in Medicaid or a Marketplace plan if I'm undocumented?

Medicaid rules vary by state. Some states cover undocumented immigrants; others do not. Marketplace plans are not available to undocumented immigrants. Call your state Medicaid office to ask what programs are available in your state. Some states and cities also run health programs specifically for uninsured people regardless of immigration status.

What if I can't afford the monthly premium even with help?

If you enroll in a Marketplace plan, you may receive a tax credit that covers part or all of your premium. If you enroll in Medicaid, there is usually no monthly premium. If you still can't afford care, ask your doctor's office or hospital about financial information programs—many offer discounts or payment plans for uninsured or underinsured patients.

How long does it take to get coverage?

Medicaid processing usually takes two to four weeks. Marketplace plans start on the first of the month after you enroll (or the following month, depending on when you enroll). Medicare coverage starts the first of the month you turn 65. Employer coverage usually starts on your first day of work or the first of the month after you are hired.

What if I was denied Medicaid or a Marketplace plan?

Ask why you were denied—the letter should explain the reason. If you believe the decision is wrong, you have the right to appeal. Contact your state Medicaid office or the Marketplace customer service line to ask how to file an appeal. You may also be able to enroll in a different program if one route doesn't work.