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 insurance premium. The other helps with your out-of-pocket expenses for care. You may qualify for one 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 Marketplace.
Here are some general income guidelines that might be used by the government to see if you qualify for federal financial help. The amounts below are based on 2014 numbers, and are likely to be slightly higher for 2015.
- If you’re single, you could qualify if you make less than $46,680 (or if you live in Hawaii, less than $53,680).
- For couples, you could qualify if you make less than $62,920 (or if you live in Hawaii, less than $72,360).
- For a family of 4, you could qualify if you make less than $95,400 (or if you live in Hawaii, less than $109,720).
Health Insurance Marketplaces
Marketplaces are state- or federally run markets where you can shop, compare, and buy individual or family 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.
- Kaiser Permanente plans will be available in the Marketplace.
You don’t have to buy from the Marketplace. You can still buy directly from Kaiser Permanente. (Exception: Residents of Washington, D.C., must buy coverage from the Marketplace.)
Kaiser Permanente members, link directly to the Health Insurance Marketplace for your state here.
Levels of coverage
Marketplaces offer health plans from different insurers and several levels of coverage. You can choose among the plans according to your personal situation and needs.
- All plans offer essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care), and include certain preventive services at no cost.
- 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.
- The most affordable level generally offers lower premiums but higher copayments, coinsurance, and deductibles. The other levels generally have higher premiums but lower deductibles, coinsurance, and copays.
- If you qualify, you will have the additional option of a Catastrophic plan, which is usually a high-deductible plan with low monthly premiums. (Hawaii does not offer a Catastrophic plan.)
- You may change or apply for health care coverage during an annual open enrollment period. Outside of the open enrollment period, you can enroll or change your coverage only if you have experienced a situation known as a triggering event. See your state or jurisdiction guidelines on special enrollment periods:
District of Columbia,
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