Financial help from the federal government
There are 2 kinds of federal financial help that may be available to you. One kind helps pay your monthly health plan premium. The other helps with your out-of-pocket expenses for care. You may qualify for 1 or both, and the federal government can pay your health plan directly.
- Qualification is based on your income and family size, where you live, other coverage that is available to you, and if you are a U.S. citizen or legal resident in the U.S.
- You can apply for federal financial help through your state or federal health insurance marketplace.
- You can only get financial help when you buy coverage through the marketplaces.
For some general income guidelines and to see if you qualify for federal financial help, visit buykp.org. Here you can also compare plans, calculate your rate, or apply online.
Health insurance marketplaces
Marketplaces are federally or state-run markets where you can shop, compare, and buy individual, family, or group health care coverage. They are sometimes called “exchanges.”
- You can choose a plan based on price, benefits, quality, and other features that are important to you.
- You can purchase Kaiser Permanente plans directly through us and they are available in the marketplaces. To qualify for financial assistance from the federal government you must purchase a plan through your marketplace.
(Exception: Residents of the District of Columbia, purchasing health care coverage on their own must buy coverage from their marketplace.)
Kaiser Permanente members, link directly to the marketplace for your region here.
Levels of coverage
Marketplaces offer health plans from different companies and several levels of coverage. You can choose from the plans according to your personal situation and needs.
All plans are grouped into several levels of coverage. These levels (referred to as metal plans) make it easier for people to compare plans offered by different insurance companies.
- All metal plans offer essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care). They also include certain preventive services at no cost.
- The most affordable level generally offers lower premiums but higher copays, coinsurance, and deductibles. The other levels generally have higher premiums but lower copays, coinsurance, and deductibles.
- If you qualify, you'll have the additional option of a Catastrophic plan (known as Minimum Coverage in California) which is usually a high-deductible plan with low monthly premiums. (Hawaii region doesn't offer a Catastrophic plan.)
- In general, you can only change or apply for health care coverage during the annual open enrollment period. But if you have a qualifying life event, you may be able to change or apply for coverage for a limited time before or after this event occurs. This is called a special enrollment period.
For more information on special enrollment periods and qualifying life events, visit kp.org/specialenrollment.
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