Health Insurance

Be an informed consumer when reviewing your options for healthcare coverage. The Affordable Care Act established guidelines for what constitutes Minimum Essential Coverage. Plans that advertise “gap” coverage are most often very limited. Remember, if it sounds too good to be true, it probably is. Always review the Explanation of Benefits to understand the features of any plan.

Nineteen states and the District of Columbia operate their own healthcare marketplaces through the authority of the Affordable Care Act. If you are or will be a resident of any of these, you must apply for insurance coverage through your state’s marketplace. Plans offered outside of the Marketplaces are not required to provide Minimum Essential Coverage and cannot offer subsidized coverage or cost-sharing reductions.

Be wary of any offer of enrollment outside of the Federal (Healthcare.gov) or State Marketplaces. Many of these contacts collect and sell your Personally Identifiable Information.

For guidance on choosing between Medicaid and the Health Insurance Marketplace, you can utilize resources like the HealthCare.gov website, local help resources, and the Marketplace Call Center, which offer free, impartial assistance with

understanding your options and enrolling in a plan.

Here's a breakdown of where to find advice and assistance:

• HealthCare.gov: Provides an overview of Medicaid and CHIP (Children's Health Insurance Program) coverage. 

  • Local Help: Use the "Find Local Help" tool on HealthCare.gov to find trained and certified assisters in your community who can provide free, impartial assistance. 

  • Marketplace Call Center: Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) for personalized assistance with applications, plan comparisons, and enrollment. 

  • Healthcare.gov - 10 printed resources: Information on losing job-based coverage, how to apply for insurance and Medicaid, drug plans, and more

• State Health Insurance Assistance Program (SHIP): Provides insurance counseling and assistance to Medicare-eligible individuals, their families, and caregivers.

• State Medicaid Agencies: Each state has its own Medicaid agency and you must contact them directly for information on eligibility and application materials. 

• The Center for Health Care Strategies: A nonprofit with resources and information about Medicaid and health insurance. 

• What Are Your Options for Health Insurance With No or Low Income? - by Nicole Pajer on Good Rx (updated on July 1, 2024)

• How FEHB and Medicare Work in Retirement - My Federal Retirement