Where can I sign up for health coverage? |
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How you sign up depends on the type of coverage you get:
For Medicaid or the Working Disabled Medicaid Buy-In, you can apply:
If you use the combined application for services, you can also apply for other benefits at the same time, such as APA, SNAP (formerly Food Stamps), and Alaska Temporary Assistance Program (ATAP). If you apply for Medicaid online, you will have to apply for other benefits separately. |
If my job offers me health coverage, can I still qualify for Medicaid or get subsidies for an individual plan on Healthcare.gov? |
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You can qualify for Medicaid if your family’s income qualifies, even if your job offers insurance.
You cannot get subsidies for purchasing an individual health plan through Healthcare.gov if your job offers you affordable insurance. |
Does it matter how I qualify for Medicaid? |
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In most cases, no. The actual medical coverage you get from Medicaid will be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and if you have a disability and start working, you can earn a lot more while still getting Medicaid coverage through the Working Disabled Medicaid Buy-In.
Note: If you qualify for APA-related Medicaid, you may also get a monthly payment from the APA program. Learn more in DB101's SSI and APA article. |
What is the most money I can make and still get Medicaid? |
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For income-based Medicaid, the main income rules are:
Income-based Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility. If you have a disability, you may be able to get Medicaid coverage if your income is a lot higher than this, thanks to the Working Disabled Medicaid Buy-In program. With the Working Disabled Medicaid Buy-In, the exact income limit depends on your living situation. If you live alone and don't have any unearned income, you could make as much as $7,673 per month and still qualify. (That's as much as $92,070 per year!) Learn more about the Working Disabled Medicaid Buy-In program. Health Coverage Income Limits for Your Family
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I’m an immigrant. Can I get Medicaid? |
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Note: You can get Medicaid coverage if you are a Native American born in Canada or Mexico who has rights to cross the border. |
What happens to my Medicaid coverage if I go back to work? |
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There are different health coverage options as your income goes up:
The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage. |
Who is eligible for the Working Disabled Medicaid Buy-In program? |
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To qualify for the Working Disabled Medicaid Buy-In, you must:
If you get Working Disabled Medicaid Buy-In coverage, you may need to pay a monthly premium. The amount you pay is based on your income and your family’s income. To learn how much your premium might be, try DB101's Benefits and Work Estimator. |
How many programs does Medicare offer? |
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Medicare has three main parts:
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How do I become eligible for Medicare? |
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If you or your spouse worked enough time while paying Medicare taxes, you will qualify for Medicare Parts A and B:
Note: If you have had a disability since before you were 22 years old, you will start getting Medicare if you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record. |
Will Medicare pay for all of my medical expenses? |
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No. Medicare will only help pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you’ll have to pay for it yourself, unless you have other coverage, such as Medicaid or employer-sponsored coverage.
For certain services, you’ll pay a deductible, copayment, or co-insurance before Medicare will begin to help pay for that service. For Medicare Part B and Part D, you may have to pay a monthly premium. You may qualify to get help paying for your Medicare premiums, copayments, and deductibles if you have low income. Medicare Savings Programs help pay for Part B coverage and the Low Income Subsidy (LIS) helps pay for Part D coverage. |
Can I be on Medicare and another form of health coverage at the same time? |
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Yes. Other types of coverage that you can have with Medicare include:
Learn more about how Medicare interacts with other types of coverage. |
How much will employer-sponsored health coverage cost and who pays for it? |
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You may be responsible for no cost, a percentage of the cost, or the amount of the cost of the coverage that is above what the employer agrees to pay.
Employers are supposed to offer plans that cost the employee, for the employee’s policy alone, less than 9.12% of the employee’s family income for the monthly premium. Also, that coverage must meet bronze-level standards for copayment, co-insurance, and deductible expenses. If your employer offers a plan that does not meet these standards, you may qualify for government help through tax subsidies to reduce the premium on an individual plan. Note: The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan. Before 2023, the spouse or children of an employee would not qualify for subsidies on Healthcare.gov if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." This changed starting in 2023. Learn more about affordability rules for family members and how it affects eligibility for tax credits on Healthcare.gov. |
Can I get coverage through my parent’s employer-sponsored insurance? |
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Yes, if you are under 26 and cannot get health coverage through your own employer. Employers who offer coverage to their employees must also offer it to their children under the age of 26.
Employers do not have to offer coverage to the spouses of employees, but many do. Note: While employers must offer this coverage to children, the employee may be required to pay for all of it. |
I have a disability. Will I really be able to get insurance that covers my medical problems? |
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Yes. Plans cannot deny people coverage. When you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.
Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer comprehensive coverage, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few. |
How does the government help people pay for individual coverage? |
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Depending on your situation, you may qualify to have the government help pay for your individual health plan through tax credits. Here's how it works:
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Do I have to get a silver-level plan on Healthcare.gov if I want government help paying for my insurance? |
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No, but depending on your income, you may get more help from the government if you get a silver-level plan:
When Healthcare.gov looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage. Health Coverage Income Limits for Your Family
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What happens if I sign up for an individual plan and then my income changes and I can no longer afford it? |
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Usually, when you sign up for a plan through Healthcare.gov, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2023, then you can’t leave that plan until 2024.
However, there are certain situations when you may be able to change plans mid-year:
The first one is the key. If your income goes down and you can’t afford your plan anymore, report your change in income to Healthcare.gov. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less). Note: American Indians and Alaska Natives do not have these restrictions and can change up to once a month. |