Health insurance can be expensive, especially when you have to pay monthly premiums, deductibles, copayments, and coinsurance. If the cost of coverage is putting pressure on your budget, there may be programs that can make health insurance more affordable.
Depending on your income, household size, age, family situation, and other circumstances, you may qualify for help through the Health Insurance Marketplace, Medicaid, CHIP, Medicare-related programs, or other sources of coverage. HealthCare.gov says Marketplace applicants can find out whether they qualify for savings based on household income and size.
Who May Qualify for Help With Health Insurance Costs?
Financial help may be available to:
- Low-income individuals and families
- People who do not receive affordable health insurance through an employer
- Families with children
- Pregnant women
- Seniors who qualify for Medicare-related assistance
- People with disabilities
- Young adults
- People who recently lost employer-sponsored coverage
- Households experiencing a change in income or family size
Eligibility depends on the specific program. Some programs are based primarily on income, while others consider age, disability, family circumstances, employment, or other requirements.
Check What You May Qualify For
Available programs can vary based on your income, household size, age, location, and employment situation.
- ✓ Free eligibility check
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Programs vary based on income, household size, age, location, and employment situation.
Types of Help With Health Insurance Costs
Marketplace Premium Tax Credits
If you purchase coverage through the Health Insurance Marketplace, you may qualify for a premium tax credit that reduces your monthly insurance premium. The amount is based on information such as your expected household income and household size. The Marketplace is the only place where you can receive the premium tax credit.
Lower Out-of-Pocket Costs
Some Marketplace applicants may also qualify for cost-sharing reductions. These can lower deductibles, copayments, coinsurance, and the annual out-of-pocket maximum. These additional savings are available only if you choose a Silver Marketplace plan when you qualify for them.
Medicaid
Medicaid provides free or low-cost health coverage to eligible people with lower incomes. Eligibility varies by state and can depend on income, household size, age, pregnancy, disability, and other factors.
Children's Health Insurance Program
CHIP provides health coverage for eligible children and teens in families whose income may be too high to qualify for Medicaid. Eligibility and income limits vary by state. CHIP can cover medical and dental care for qualifying children.
Medicare-Related Assistance
People with Medicare may qualify for programs that help with certain healthcare costs depending on income and circumstances. If you are older or have a disability, it is worth checking whether you qualify for additional assistance rather than assuming Medicare will cover every expense.
Employer Health Insurance
If you have access to coverage through an employer, compare the employee premium and out-of-pocket costs with other available options. For some households, employer-sponsored coverage may be more affordable than purchasing an individual plan. Your eligibility for Marketplace savings can also depend on whether you have access to qualifying employer coverage.
Special Enrollment Opportunities
You may be able to enroll in or change Marketplace coverage outside the annual Open Enrollment period if you experience certain qualifying life events. Examples can include losing other health coverage, getting married, having a baby, or moving.
How Health Insurance Assistance Typically Works
- Look at your current coverage. Write down your premium, deductible, copays, coinsurance, and other major costs.
- Estimate your household income. Marketplace savings are based on expected income for the coverage year.
- Check available programs. Compare Marketplace savings, Medicaid, CHIP, Medicare-related assistance, and employer coverage where applicable.
- Submit an application. The application can determine which savings or programs you may qualify for.
- Compare total costs. Do not look only at the monthly premium. Consider deductibles, copayments, coinsurance, and the out-of-pocket maximum.
- Report important changes. If your income or household changes, update your Marketplace application so your savings can be calculated correctly.