Health Insurance

How to Choose a Health Plan

Step-by-Step Tips:

1. Estimate your annual healthcare needs (e.g., chronic conditions, prescriptions, regular visits)
2. Compare plan types (HMO, PPO, EPO, POS) for flexibility vs. cost
3. Look at total costs: Not just premiums, but also deductibles, copays, and coinsurance
4. Check provider networks to ensure your doctor or preferred hospitals are included
5. Review prescription coverage – is your medication on the plan’s formulary?

Helpful Tools:

• Health Plan Comparison Worksheet – CMS
• Healthcare.gov – Choosing a Plan

Understanding Premiums, Deductibles, Copays & Coinsurance

Key Terms:

• Premium – Your monthly payment for insurance
• Deductible – The amount you pay before insurance starts covering services
• Copay – A fixed amount (e.g., $20) you pay for services
• Coinsurance – A percentage you pay after meeting the deductible

Example:

• Plan with $1,500 deductible, 20% coinsurance, and $6,500 max out-of-pocket:
  If you have a $10,000 surgery:
• You pay first $1,500
• Then 20% of the next $8,500 = $1,700
• Total: $3,200

Helpful Link:

• Healthcare.gov – Health Insurance Costs Explained

Glossary of Health Insurance Terms

Popular Terms to Include:

• Premium
• Deductible
• Coinsurance
• Copayment
• Formulary
• In-network / out-of-network
• Prior authorization
• Explanation of Benefits (EOB)
• Special Enrollment Period (SEP)

Helpful Resource:

• Glossary – Healthcare.gov

How to Appeal an Insurance Denial

Steps to Take:

1. Review the Explanation of Benefits (EOB)
2. Contact your insurance company to ask for a reason
3. File an internal appeal — usually within 180 days
4. If denied again, request an external review through your state or federal process

Helpful Link:

• Appeal a Health Insurance Decision – Healthcare.gov

Insurance for Freelancers, Gig Workers, and the Self-Employed

Options:

• Marketplace Plans – eligible for subsidies
• Professional associations – some offer group plans
• Short-term or catastrophic plans – lower-cost options
• Health Savings Accounts (HSAs) – for those with high-deductible plans

Helpful Link:

• Marketplace Guide for Self-Employed

How to Report Life Changes

What Counts as a Life Change:

• Getting married or divorced
• Having a baby or adopting
• Losing job-based coverage
• Moving to a new ZIP code
• Income changes that affect subsidy eligibility

When to Report:

• Within 60 days of the event to qualify for a Special Enrollment Period

How to Report:

• Online via Healthcare.gov account
• Or through your state’s marketplace

What to Do if You’re Uninsured

Options to Explore:

• Check for eligibility for Medicaid or CHIP
• Apply for an ACA Marketplace plan — even outside Open Enrollment if you qualify for a Special Enrollment Period
• Visit a sliding-scale clinic or free clinic for care
• Seek care through community health centers or nonprofit hospitals

Helpful Links:

• Apply for Coverage – Healthcare.gov
• Find a Health Center – HRSA

ACA Subsidies (Premium Tax Credits & Cost-Sharing Reductions)

What it is:
The Affordable Care Act offers two main types of financial help through the Health Insurance Marketplace:

1. Premium Tax Credits – Lower your monthly premium
2. Cost-Sharing Reductions (CSRs) – Lower your out-of-pocket costs like deductibles and copays (available with Silver plans only)

Eligibility:

• Based on income and household size
• Available to those earning 100%–400%+ of the federal poverty level (FPL)
• Must enroll through Healthcare.gov or a state exchange

Helpful Links:

• Healthcare.gov – Lower Costs
• Subsidy Calculator – KFF

State-Specific Cost Assistance

What it is:
Some states offer additional premium help or expanded eligibility for public insurance programs beyond federal rules.

Examples:

• California Covered offers state subsidies for middle-income earners
• Massachusetts ConnectorCare offers low-cost plans for those up to 300% FPL
• New York Essential Plan covers adults earning up to 200% FPL for low/no cost

Helpful Link:

• Find Your State Marketplace

Nonprofit & Charity-Based Medical Aid

What it is:
Many hospitals and clinics offer free or discounted care to people who are uninsured, underinsured, or low-income.

Types of Programs:

• Hospital Financial Assistance Policies (FAPs) – Required for nonprofit hospitals
• Community health centers (FQHCs) – Provide sliding-scale services
• Prescription assistance programs – Run by nonprofits and pharmaceutical companies

Helpful Links:

• Find a Health Center – HRSA
• RxAssist Drug Assistance Directory
• Charity Care Policies – NBER Database

Medical Debt Forgiveness & Negotiation

What it is:
If you’ve received a large bill, there are strategies and programs that can help you reduce or eliminate medical debt.

Options Include:

• Asking for itemized bills and checking for errors
• Applying for financial assistance directly through hospitals
• Negotiating cash discounts for self-pay patients
• Seeking help from debt relief nonprofits or legal aid

Helpful Links:

• Dollar For – Erase Hospital Bills
• Medical Billing Advocates – LUNA
• Consumer Finance Protection Bureau (CFPB) – Medical Debt

Sliding Scale Clinics & Federally Qualified Health Centers (FQHCs)

What it is:
FQHCs and community clinics offer discounted medical, dental, and behavioral health care based on your income, regardless of insurance status.

Key Features:

• Fees are based on a sliding income scale
• Services may include checkups, chronic disease care, family planning, and immunizations
• Available in both rural and urban communities

Helpful Link:

• Find a Sliding Scale Clinic – HRSA

Affordable Care Act (ACA) – Core Protections

Key Features:

• Guaranteed coverage (no denial for pre-existing conditions)
• Essential health benefits required in all ACA-compliant plans
• Free preventive care (e.g., screenings, immunizations)
• Dependent coverage to age 26
• Marketplace subsidies based on income

Legal Requirement:

• No federal mandate penalty (as of 2019), but some states still require insurance (see below)

Helpful Link:

• Healthcare.gov – ACA Benefits

State Individual Mandates

What it is:
While the federal tax penalty for not having insurance was eliminated, some states have their own mandates and penalties:

Helpful Link:

• KFF Summary of State Mandates

HIPAA – Health Privacy & Portability

What it is:
The Health Insurance Portability and Accountability Act (HIPAA) protects sensitive health data and guarantees certain rights:

Key Protections:

• You can request and review your health records
• Your health info is protected from unauthorized sharing
• Job changers have rights to group plan access (pre-ACA)

Helpful Link:

• HHS – HIPAA Rights & Guidance

COBRA – Temporary Employer Plan Continuation

What it is:
COBRA lets you keep your job-based insurance after losing or leaving a job — but you pay the full cost, often 102% of the premium.

Eligibility:

• Applies to companies with 20+ employees
• Available for 18–36 months, depending on the reason
• Includes coverage for dependents

Helpful Link:

• COBRA Fact Sheet – DOL

No Surprises Act

What it is:
A federal law that protects consumers from unexpected medical bills from out-of-network providers during:

• Emergency room visits
• Non-emergency care at in-network facilities (e.g., anesthesiologist)
• Air ambulance services

Key Protections:

• You can’t be billed more than in-network rates for covered services
• Providers must give Good Faith Estimates for self-pay patients

Helpful Links:

• CMS No Surprises Guide
• Consumer Help – No Surprises Act

Appeals & Grievances

What it is:
You have the legal right to appeal insurance decisions or file complaints if a claim is denied or a service is refused.

Appeals Process:

• Internal Appeal: Ask the insurer to reconsider
• External Review: A third party reviews the decision

Time Limits:

• Usually 180 days to file an appeal
• Expedited review available in urgent situations

Helpful Link:

• Appeal a Health Plan Decision – Healthcare.gov

Consumer Assistance Programs (CAPs)

What it is:
Funded by the ACA, CAPs help individuals file appeals, understand their rights, and enroll in coverage.

Services Provided:

• One-on-one assistance with billing disputes, appeals, and plan selection
• Available in many states, often through legal aid or health departments

Helpful Link:

• CAP Directory – CMS

Short-Term Health Plans

What it is:
Low-cost, temporary insurance often marketed as alternatives to ACA plans — but they’re not ACA-compliant.

Risks:

• Don’t cover pre-existing conditions
• Exclude many essential benefits (e.g., maternity, mental health)
• Can be canceled with little notice
• No guaranteed renewability

Best for:
Short gaps in coverage, not long-term use

Helpful Link:

• Consumer Alert – Short-Term Plans (Commonwealth Fund)

Losing Coverage Without Realizing It

Common Triggers:

• Turning 26 and aging out of a parent’s plan
• Job loss (ending employer-sponsored coverage)
• Divorce or legal separation
• Medicaid redetermination (especially post-COVID unwind)
• Non-payment of premiums

Tip:
Be proactive — most of these qualify for a Special Enrollment Period (SEP)

Helpful Link:

• Healthcare.gov – Losing Coverage SEP Info

“Junk” Insurance Plans & Scams

What to watch for:

• Telemarketers pushing “private insurance”
• Plans that sound like ACA plans but aren’t
• Fake discount cards or “medical membership associations”
• No network coverage or real insurer backing

Red Flags:

• No written documentation
• Vague answers about pre-existing conditions
• High-pressure sales tactics
• Asking for payment upfront or over the phone

How to verify:

• Use your state insurance department or NAIC consumer tool

In-Network vs. Out-of-Network Confusion

Key Issue:
Even with insurance, seeing an out-of-network provider can lead to high bills or claim denials.

Tips:

• Double-check if the facility AND provider are in-network
• Emergency services are generally protected under the No Surprises Act, but air ambulance and follow-ups may not be
• For surgeries or hospitalizations, ask in advance for an in-network care team

High-Deductible Health Plans (HDHPs) Without Understanding the Cost

Common Mistake:
Choosing a plan based only on low premiums, without realizing that you’ll pay thousands out-of-pocket before coverage starts.

Tips:

• Know your deductible and out-of-pocket max
• Pair an HDHP with an HSA to save pre-tax
• Use preventive services (which are free) to lower risk

Not Updating Life Changes Promptly

Why It Matters:
Life events can affect eligibility, premiums, and plan choices.

Examples:

• Income change → subsidy eligibility changes
• New baby → needs to be added within 60 days
• Marriage or divorce → changes household size and access to job-based plans

Tip:
Report changes to your state marketplace or Healthcare.gov within 30–60 days to avoid losing coverage or subsidies

Missing Open Enrollment Deadlines

Marketplace Open Enrollment:

• Typically Nov 1 – Jan 15 (varies by state)
• Outside that window, you need a Special Enrollment Period

Employer Plans:

• May have their own enrollment windows once per year
• Missed the window? You may be stuck with your current plan until next year

Helpful Link:

• Healthcare.gov – Enrollment Dates

Failing to Compare Plans Annually

Why It’s a Problem:

• Plan networks and formularies change every year
• Your medications may no longer be covered
• Premiums and deductibles may increase

Tip:
Always re-shop during open enrollment — even if you’re happy with your current plan

College Students

Coverage Options:

• Stay on parent’s plan until age 26
• Student health plans offered by colleges/universities
• Marketplace coverage – often subsidized if income is low
• Medicaid – available in many states based on income

Tips:

• Check if campus health services require a specific plan
• Review out-of-state coverage for parent plans

Helpful Links:

• Healthcare Options for Students – Healthcare.gov

Young Adults Turning 26

Coverage Options:

• Enroll in an ACA Marketplace plan (may qualify for subsidies)
• Enroll in employer-sponsored coverage, if available
• Apply for Medicaid if income is limited
• Some states let young adults stay on a parent’s plan beyond 26 (e.g., New Jersey, New York)

When to Act:

• Turning 26 creates a Special Enrollment Period — you have 60 days to sign up for a new plan

Helpful Link:

• Turning 26 – Healthcare.gov Guide

New Parents & Insurance for Newborns

Key Points:

• Having or adopting a baby triggers a Special Enrollment Period
• You can add your child to your current plan or switch to a new one
• Medicaid/CHIP is available for babies and children in most states

To-Do List:

• Enroll your newborn in a plan within 60 days
• Check if your plan covers maternity and pediatric care
• Explore CHIP for low-cost or no-cost coverage for your child

Helpful Links:

• CHIP Overview – Medicaid.gov
• Marketplace Coverage for Newborns – Healthcare.gov

Turning 65 – Transition to Medicare

When to Enroll:

• Initial Enrollment Period: 3 months before to 3 months after turning 65
• Enroll in Part A (hospital) and Part B (medical)
• Consider adding Part D (drug coverage) and/or a Medigap or Medicare Advantage plan

Special Cases:

• Still working? You may delay Part B if you have employer coverage
• Automatically enrolled if receiving Social Security

Helpful Links:

• Sign Up for Medicare – SSA.gov
• Medicare Plan Finder

Recently Unemployed

Coverage Options:

• COBRA: Keep your employer coverage temporarily (expensive)
• Marketplace Plan: Likely eligible for high subsidies
• Medicaid: Available if your income drops significantly
• Short-term plans: A lower-cost option if you need emergency-only coverage

Act Quickly:

• Losing job coverage qualifies you for a Special Enrollment Period
• You have 60 days to sign up

Helpful Link:

• Unemployed & Need Coverage – Healthcare.gov

Retirees Under 65

Coverage Options:

• Marketplace plans with income-based subsidies
• COBRA (if recently left employer coverage)
• Spousal coverage through a working partner
• Short-term plans (limited use)

Planning Tip:

• Budget for health care costs during the gap years before Medicare eligibility at 65
• Look into HSAs if you’re planning early retirement

Helpful Links:

• Early Retirement Coverage Guide – Healthcare.gov

Healthcare.gov (ACA Marketplace)
• Description: Official federal health insurance marketplace for Affordable Care Act (ACA) plans.
• Who Qualifies: U.S. citizens and legal residents not eligible for Medicare; income-based subsidies may apply.
• Intake Process: Apply online during open enrollment (Nov–Jan) or after a qualifying life event. Requires income, ID, and household details.
• Hours: Website 24/7; Call Center: 8am–10pm ET, 7 days/week
• Contact: 1-800-318-2596

Medicaid
• Description: Joint federal and state program offering free or low-cost health coverage.
• Who Qualifies: Low-income individuals and families, pregnant women, children, seniors, and people with disabilities (varies by state).
• Intake Process: Apply through state Medicaid office or Healthcare.gov. Proof of income and ID required.
• Hours: Online portals 24/7; local office hours vary

Medicare
• Description: Federal insurance for people 65+ or with disabilities or ESRD.
• Who Qualifies: U.S. citizens or legal residents 65+ or with qualifying disabilities.
• Intake Process: Apply via Medicare.gov or SSA; some are automatically enrolled.
• Hours: Website 24/7; Call Center: Mon–Fri, 8am–8pm local time
• Contact: 1-800-MEDICARE (1-800-633-4227)

CHIP – Children’s Health Insurance Program
• Description: Low-cost or free coverage for children in working families.
• Who Qualifies: Children under 19; income eligibility varies by state.
• Intake Process: Apply via your state CHIP agency or Healthcare.gov.
• Hours: Website 24/7; state phone hours vary
• Contact: 1-877-KIDS-NOW (1-877-543-7669)

COBRA
• Description: Temporary continuation of employer-sponsored coverage after job loss or other events.
• Who Qualifies: Former employees and dependents covered under a qualifying employer plan.
• Intake Process: Contact employer or plan admin within 60 days; full premiums must be paid.
• Hours: No set hours; varies by employer or plan

VA Health Care
• Description: Health care for eligible U.S. veterans.
• Who Qualifies: Veterans with active duty service and non-dishonorable discharge; based on need and service.
• Intake Process: Apply online, by phone, or in person with DD214 and financial info.
• Hours: Website 24/7; VA facility hours vary
• Contact: 1-877-222-VETS (1-877-222-8387)

Indian Health Service (IHS)
• Description: Health services for enrolled members of federally recognized Tribes and Alaska Natives.
• Who Qualifies: Enrolled members or descendants of federally recognized Tribes.
• Intake Process: Apply at local IHS clinic with tribal documentation.
• Hours: Varies by clinic; website 24/7

Community Health Centers (FQHCs)
• Description: Sliding scale or free care for all patients, regardless of insurance.
• Who Qualifies: Open to everyone, including uninsured, underinsured, and those on Medicaid/Medicare.
• Intake Process: Walk-in or appointment; sliding fee requires income verification.
• Hours: Varies by location; typically Mon–Fri, 8am–5pm

HHS Marketplace Call Center
• Description: Phone support for ACA marketplace and enrollment.
• Who Qualifies: Anyone applying through Healthcare.gov.
• Intake Process: Speak with a representative for help applying or reviewing eligibility.
• Hours: 8am–10pm ET, 7 days/week
• Contact: 1-800-318-2596 (TTY: 1-855-889-4325)

Alabama

Alabama Medicaid
• Description: State program for low-income families, children, pregnant women, seniors, and disabled individuals.
• Who Qualifies: Income-based; eligibility varies by category.
• Intake Process: Apply online via MyAlabama.gov or in person at county offices.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-800-362-1504

ALL Kids (CHIP)
• Description: Low-cost health coverage for children under 19.
• Who Qualifies: Uninsured Alabama children with family income below 317% of FPL.
• Intake Process: Apply online or by mail; proof of income and residency required.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-888-373-5437

SHIP Alabama
• Description: Free Medicare counseling and plan assistance.
• Who Qualifies: Medicare recipients and their caregivers.
• Intake Process: Call or connect through Area Agencies on Aging.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-243-5463

Alaska

Alaska Medicaid
• Description: Health coverage for low-income Alaskans, administered by DHSS.
• Who Qualifies: Low-income adults, children, seniors, pregnant women, and disabled individuals.
• Intake Process: Apply via MyAlaska or local public assistance office.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-478-7778

Denali KidCare
• Description: Health insurance for children and teens under 19 and pregnant women.
• Who Qualifies: Families earning up to 208% FPL.
• Intake Process: Same process as Medicaid; use same application.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-888-318-8890

SHIP Alaska
• Description: Medicare counseling and plan help.
• Who Qualifies: Medicare recipients and families.
• Intake Process: Call or connect through senior centers or DHSS.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-478-6065

Arizona

AHCCCS – Arizona Medicaid
• Description: State Medicaid agency offering comprehensive services to eligible residents.
• Who Qualifies: Low-income individuals, families, seniors, pregnant women, and those with disabilities.
• Intake Process: Apply online at healthearizonaplus.gov.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-855-432-7587

KidsCare (CHIP)
• Description: Low-cost insurance for children under 19.
• Who Qualifies: Families earning under 205% FPL and not eligible for Medicaid.
• Intake Process: Apply via Health-e-Arizona Plus.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-855-432-7587

SHIP Arizona
• Description: Free Medicare information and help.
• Who Qualifies: Medicare beneficiaries.
• Intake Process: Contact through Area Agency on Aging or SHIP office.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-432-4040

Arkansas

Arkansas Medicaid
• Description: Medicaid program for eligible low-income Arkansans.
• Who Qualifies: Low-income individuals and families, seniors, pregnant women, people with disabilities.
• Intake Process: Apply via Access Arkansas.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-855-372-1084

ARKids First (CHIP)
• Description: Health coverage for uninsured children.
• Who Qualifies: Arkansas children under 19; income up to 211% FPL.
• Intake Process: Apply online via Access Arkansas.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-888-474-8275

SHIP Arkansas
• Description: Medicare counseling and insurance help.
• Who Qualifies: Medicare-eligible residents.
• Intake Process: Call to speak to a SHIP counselor or local AAA.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-800-224-6330

California

Medi-Cal
• Description: California’s Medicaid program. Offers free or low-cost coverage.
• Who Qualifies: Income-qualified adults, children, seniors, pregnant people, and disabled individuals.
• Intake Process: Apply online via CoveredCA.com or through county social services.
• Hours: Online 24/7; local office hours vary
• Contact: 1-800-541-5555

Covered California
• Description: State-run ACA marketplace for private health plans and subsidies.
• Who Qualifies: California residents not eligible for Medi-Cal; subsidies based on income.
• Intake Process: Apply online; upload documents for verification.
• Hours: Mon–Fri, 8am–6pm; Sat 8am–5pm
• Contact: 1-800-300-1506

California CHIP (via Medi-Cal)
• Description: No-cost or low-cost Medi-Cal for children in families above standard limits.
• Who Qualifies: Children under 19 with family income up to 266% FPL.
• Intake Process: Included in Medi-Cal application.
• Hours: Varies; same as Medi-Cal

HICAP (California SHIP)
• Description: Free, unbiased Medicare counseling.
• Who Qualifies: Medicare recipients and families.
• Intake Process: Contact local Area Agency on Aging or call state hotline.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-434-0222

Florida

Florida State Medicaid Managed Care
• Description: Health coverage for low-income families, elderly, and disabled individuals.
• Who Qualifies: Income-qualified individuals and families; eligibility varies.
• Intake Process: Apply online at ACCESS Florida.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-866-762-2237

Florida KidCare (CHIP)
• Description: Affordable health coverage for children under 19.
• Who Qualifies: Florida residents under 19; income-based tiers.
• Intake Process: Apply online; one application for all KidCare programs.
• Hours: Mon–Fri, 7:30am–7:30pm
• Contact: 1-888-540-5437

SHIP Florida
• Description: Free Medicare counseling through SHINE program.
• Who Qualifies: Medicare beneficiaries and caregivers.
• Intake Process: Contact local SHINE office or call the helpline.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-963-5337

Georgia

Georgia Medicaid
• Description: Health coverage for low-income residents, administered by Georgia Department of Community Health.
• Who Qualifies: Low-income families, pregnant women, seniors, and people with disabilities.
• Intake Process: Apply online via Gateway, by phone, or in person.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-877-423-4746

PeachCare for Kids (CHIP)
• Description: Low-cost health insurance for uninsured children.
• Who Qualifies: Georgia children under 19 whose families earn too much for Medicaid.
• Intake Process: Apply through Gateway.
• Hours: Mon–Fri, 7am–6pm
• Contact: 1-877-427-3224

Georgia SHIP
• Description: Free counseling for Medicare beneficiaries.
• Who Qualifies: Medicare-eligible residents and their caregivers.
• Intake Process: Call SHIP hotline or contact Area Agency on Aging.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-866-552-4464, Option 4

Hawaii

Med-QUEST (Hawaii Medicaid)
• Description: Hawaii’s Medicaid program for low-income residents.
• Who Qualifies: Low-income individuals, children, pregnant women, seniors, and disabled residents.
• Intake Process: Apply online via Medical.mybenefits.hawaii.gov or in person.
• Hours: Mon–Fri, 7:45am–4:30pm
• Contact: 1-877-628-5076

Hawaii CHIP (via Med-QUEST)
• Description: Coverage for children in families who earn too much for Medicaid.
• Who Qualifies: Children under 19 in moderate-income households.
• Intake Process: Use same application as Medicaid (Med-QUEST).
• Hours: Mon–Fri, 7:45am–4:30pm

SHIP Hawaii
• Description: Free Medicare counseling services.
• Who Qualifies: Medicare beneficiaries and families.
• Intake Process: Call or visit local SHIP office.
• Hours: Mon–Fri, 8am–4pm
• Contact: 1-888-875-9229

Idaho

Idaho Medicaid
• Description: Medicaid coverage for qualified Idaho residents.
• Who Qualifies: Low-income families, pregnant people, disabled individuals, and children.
• Intake Process: Apply online via Idalink, by phone, or in person.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-877-456-1233

Idaho CHIP (Health Coverage for Children)
• Description: Insurance for children in families with income too high for Medicaid.
• Who Qualifies: Idaho children under 19; income-based.
• Intake Process: Use same Medicaid application (Idalink).
• Hours: Mon–Fri, 8am–5pm

Your Health Idaho (Marketplace)
• Description: State-based ACA exchange for private insurance and subsidies.
• Who Qualifies: Idahoans not eligible for Medicaid or employer coverage.
• Intake Process: Apply online; upload documents for income verification.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-855-944-3246

SHIP Idaho
• Description: Medicare counseling and assistance.
• Who Qualifies: Idaho residents with Medicare.
• Intake Process: Contact through Idaho Department of Insurance.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-247-4422

Illinois

Illinois Medicaid
• Description: Medicaid services for low-income Illinoisans.
• Who Qualifies: Adults, children, pregnant women, seniors, and people with disabilities.
• Intake Process: Apply through ABE.Illinois.gov.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-843-6154

All Kids (CHIP)
• Description: Health coverage for children in working families.
• Who Qualifies: Illinois children under 19; income and residency-based.
• Intake Process: Use the same ABE portal or apply by mail.
• Hours: Mon–Fri, 8am–5pm

Get Covered Illinois (Marketplace Support)
• Description: State ACA support resource (uses Healthcare.gov to enroll).
• Who Qualifies: Illinois residents needing marketplace insurance or help enrolling.
• Intake Process: Get help locating a navigator or applying online.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-866-311-1119

SHIP Illinois
• Description: Free Medicare help for Illinois residents.
• Who Qualifies: Medicare-eligible individuals and caregivers.
• Intake Process: Contact SHIP via Department on Aging.
• Hours: Mon–Fri, 8:30am–5pm
• Contact: 1-800-252-8966

Indiana

Indiana Medicaid
• Description: State-run Medicaid program with multiple coverage categories.
• Who Qualifies: Income-eligible adults, children, seniors, and disabled individuals.
• Intake Process: Apply through FSSABenefits.IN.gov or call.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-800-403-0864

Hoosier Healthwise (CHIP)
• Description: Health coverage for children and pregnant women.
• Who Qualifies: Indiana children under 19 and pregnant women, based on income.
• Intake Process: Apply through same Medicaid portal.
• Hours: Mon–Fri, 8am–4:30pm

SHIP Indiana
• Description: Medicare counseling and support.
• Who Qualifies: Medicare-eligible residents and caregivers.
• Intake Process: Call SHIP or contact Area Agency on Aging.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-800-452-4800

Iowa

Iowa Medicaid
• Description: Public insurance for low-income Iowans.
• Who Qualifies: Children, pregnant people, parents, seniors, and disabled individuals.
• Intake Process: Apply online via OASIS or call DHS.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-855-889-7985

Hawki (CHIP)
• Description: Iowa’s CHIP program for children.
• Who Qualifies: Children under 19 in families earning too much for Medicaid.
• Intake Process: Apply via same Medicaid portal or by phone.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-257-8563

SHIP Iowa
• Description: Statewide Medicare support and counseling.
• Who Qualifies: Medicare recipients and caregivers.
• Intake Process: Call or visit a local SHIIP site.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-800-351-4664

Kansas

KanCare (Kansas Medicaid)
• Description: Kansas Medicaid managed care program.
• Who Qualifies: Low-income children, parents, pregnant women, seniors, and disabled individuals.
• Intake Process: Apply online via KanCare Application Portal, by mail, or at local DCF offices.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-792-4884

Kansas CHIP (via KanCare)
• Description: Coverage for children in families with income above Medicaid levels.
• Who Qualifies: Uninsured children under 19 in households up to 255% FPL.
• Intake Process: Same as KanCare; one application.
• Hours: Mon–Fri, 8am–5pm

SHIP Kansas
• Description: Medicare counseling for seniors and caregivers.
• Who Qualifies: Medicare beneficiaries.
• Intake Process: Contact local SHICK (SHIP) site or call hotline.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-860-5260

Kentucky

Kentucky Medicaid
• Description: Health coverage for eligible Kentucky residents.
• Who Qualifies: Low-income individuals, families, children, pregnant people, seniors, and people with disabilities.
• Intake Process: Apply via kynect.ky.gov or local DCBS offices.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-855-459-6328

KCHIP
• Description: Free or low-cost health insurance for kids.
• Who Qualifies: Kentucky children under 19 with income above Medicaid limits.
• Intake Process: Use the same Kynect portal as Medicaid.
• Hours: Mon–Fri, 8am–5pm

SHIP Kentucky
• Description: State Health Insurance Assistance Program for Medicare counseling.
• Who Qualifies: Medicare-eligible residents.
• Intake Process: Call SHIP or visit Area Agency on Aging.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-877-293-7447

Louisiana

Healthy Louisiana (Medicaid)
• Description: State Medicaid coverage through managed care plans.
• Who Qualifies: Low-income adults, children, pregnant women, seniors, and those with disabilities.
• Intake Process: Apply via LA Medicaid Self-Service Portal or call.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-888-342-6207

LaCHIP (CHIP)
• Description: Free health coverage for children.
• Who Qualifies: Louisiana children under 19 in households up to 255% FPL.
• Intake Process: Apply through same portal as Medicaid.
• Hours: Mon–Fri, 8am–5pm

SHIP Louisiana
• Description: Medicare help and plan counseling.
• Who Qualifies: Seniors and Medicare-eligible residents.
• Intake Process: Contact Louisiana Department of Insurance SHIIP.
• Hours: Mon–Fri, 8am–4:30pm
• Contact: 1-800-259-5300

Maine

MaineCare (Medicaid)
• Description: Medicaid program providing health coverage for low-income Mainers.
• Who Qualifies: Adults, children, seniors, pregnant individuals, and people with disabilities.
• Intake Process: Apply online via My Maine Connection or at DHHS offices.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-855-797-4357

Maine CHIP (Cub Care)
• Description: Low-cost health coverage for children.
• Who Qualifies: Uninsured children under 19 with household income up to 208% FPL.
• Intake Process: Use same portal as Medicaid (My Maine Connection).
• Hours: Mon–Fri, 8am–5pm

SHIP Maine
• Description: Medicare plan assistance and benefits counseling.
• Who Qualifies: Maine residents on Medicare.
• Intake Process: Call SHIP line or reach out to your local Area Agency on Aging.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-877-353-3771

Maryland

Maryland Medicaid
• Description: Free or low-cost health coverage for qualifying residents.
• Who Qualifies: Low-income families, seniors, people with disabilities, and children.
• Intake Process: Apply via Maryland Health Connection.
• Hours: Mon–Fri, 8am–6pm
• Contact: 1-855-642-8572

Maryland CHIP (MCHP)
• Description: Insurance for children and pregnant women above Medicaid income limits.
• Who Qualifies: Kids under 19 and pregnant individuals in households up to 322% FPL.
• Intake Process: Apply via Maryland Health Connection portal.
• Hours: Mon–Fri, 8am–6pm

SHIP Maryland
• Description: Medicare counseling and plan comparison.
• Who Qualifies: Medicare recipients and caregivers.
• Intake Process: Contact your local SHIP office.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-243-3425

Massachusetts

MassHealth (Medicaid + CHIP)
• Description: Combines Medicaid and CHIP for eligible Massachusetts residents.
• Who Qualifies: Low-income adults, families, children, seniors, and those with disabilities.
• Intake Process: Apply via MA Health Connector, online or by mail.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-841-2900

Massachusetts Health Connector
• Description: State-run ACA marketplace for private health plans and subsidies.
• Who Qualifies: Residents not eligible for MassHealth; income-based plans.
• Intake Process: Apply online; verification required.
• Hours: Mon–Fri, 8am–6pm; Sat 8am–2pm
• Contact: 1-877-623-6765

SHIP Massachusetts (via SHINE)
• Description: Medicare counseling and advocacy.
• Who Qualifies: Medicare-eligible residents.
• Intake Process: Call local SHINE program or Aging Services Access Point (ASAP).
• Hours: Mon–Fri, 9am–5pm
• Contact: 1-800-243-4636

Michigan

Michigan Medicaid
• Description: Public health coverage for income-eligible Michigan residents.
• Who Qualifies: Children, parents, pregnant women, seniors, and people with disabilities.
• Intake Process: Apply via MI Bridges or at local offices.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-855-275-6424

MIChild (CHIP)
• Description: Low-cost coverage for children under 19.
• Who Qualifies: Michigan children whose families make too much for Medicaid.
• Intake Process: Apply through MI Bridges.
• Hours: Mon–Fri, 8am–5pm

SHIP Michigan (MMAP)
• Description: Medicare assistance and plan counseling.
• Who Qualifies: Michigan Medicare recipients.
• Intake Process: Call MMAP or contact Area Agency on Aging.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-803-7174

Mississippi

Mississippi Medicaid
• Description: Provides health coverage for eligible low-income residents.
• Who Qualifies: Low-income children, parents, pregnant women, aged, and disabled.
• Intake Process: Apply online, by mail, or in person.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-800-421-2408

CHIP Mississippi
• Description: Low-cost health coverage for uninsured children.
• Who Qualifies: Kids under 19 with income above Medicaid limits.
• Intake Process: Use the same Medicaid application system.
• Hours: Mon–Fri, 8am–5pm

SHIP Mississippi
• Description: State Medicare counseling and benefits education.
• Who Qualifies: Medicare-eligible residents and their caregivers.
• Intake Process: Call SHIP via the Mississippi Department of Human Services.
• Hours: Mon–Fri, 8am–5pm
• Contact: 1-844-822-4622

Missouri

MO HealthNet (Medicaid)
Description: Free or low-cost healthcare coverage for eligible low-income Missourians.
Who Qualifies: Low-income individuals, children, pregnant people, seniors, disabled individuals.
Intake Process: Apply online or through a local Family Support Division office.
Hours of Operation: Mon–Fri 7am–6pm.
Contact Info: mydss.mo.gov or 1-855-373-4636.

Show Me Healthy Kids (CHIP)
Description: Health coverage for uninsured Missouri children.
Who Qualifies: Children under 19 in households with moderate income.
Intake Process: Apply through MO HealthNet.
Hours of Operation: Mon–Fri 7am–6pm.
Contact Info: mydss.mo.gov or 1-855-373-4636.

Missouri SHIP
Description: Free Medicare help and counseling for seniors.
Who Qualifies: Medicare beneficiaries and caregivers.
Intake Process: Call or use online request form.
Hours of Operation: Mon–Fri 9am–4pm.
Contact Info: missouriship.org or 1-800-390-3330.

Montana

Montana Medicaid
Description: Public health insurance for low-income Montanans.
Who Qualifies: Children, adults, seniors, pregnant individuals, disabled individuals.
Intake Process: Apply at local Office of Public Assistance or online.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dphhs.mt.gov or 1-888-706-1535.

Healthy Montana Kids (CHIP)
Description: Health coverage for uninsured Montana children.
Who Qualifies: Children under 19 in families with incomes too high for Medicaid.
Intake Process: Apply online at Apply.mt.gov.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dphhs.mt.gov or 1-877-543-7669.

Montana SHIP
Description: Free Medicare guidance for older adults.
Who Qualifies: Medicare recipients and their families.
Intake Process: Call to connect with a local counselor.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: aging.mt.gov or 1-800-551-3191.

Nebraska

Nebraska Medicaid (Heritage Health)
Description: Managed care Medicaid for income-eligible Nebraskans.
Who Qualifies: Low-income adults, children, elderly, pregnant people, disabled individuals.
Intake Process: Apply through ACCESSNebraska online or by phone.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhhs.ne.gov or 1-855-632-7633.

Kids Connection (CHIP)
Description: Health coverage for uninsured Nebraska children.
Who Qualifies: Children under 19 in families earning up to 213% FPL.
Intake Process: Apply via ACCESSNebraska.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhhs.ne.gov or 1-855-632-7633.

Nebraska SHIP
Description: Free Medicare counseling and support.
Who Qualifies: Medicare recipients.
Intake Process: Call or visit a local SHIP site.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: doi.nebraska.gov or 1-800-234-7119.

Nevada

Nevada Medicaid
Description: State Medicaid program for low-income residents.
Who Qualifies: Children, adults, seniors, pregnant individuals, people with disabilities.
Intake Process: Apply online or through DWSS office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhcfp.nv.gov or 1-800-992-0900.

Nevada Check Up (CHIP)
Description: Low-cost health coverage for children.
Who Qualifies: Children under 19 in households under 200% FPL.
Intake Process: Apply through Nevada Health Link.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhcfp.nv.gov or 1-877-543-7669.

Nevada Health Link
Description: ACA marketplace offering private insurance plans.
Who Qualifies: Uninsured residents not eligible for Medicaid/Medicare.
Intake Process: Enroll online or get assistance via navigator.
Hours of Operation: Mon–Fri 9am–5pm.
Contact Info: nevadahealthlink.com or 1-800-547-2927.

Nevada SHIP
Description: Medicare help and education services.
Who Qualifies: Medicare beneficiaries and caregivers.
Intake Process: Call or contact local SHIP site.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: adsd.nv.gov or 1-800-307-4444.

New Hampshire

New Hampshire Medicaid
Description: Comprehensive health coverage for eligible NH residents.
Who Qualifies: Low-income individuals, pregnant people, children, seniors, people with disabilities.
Intake Process: Apply via NH EASY or at DHHS office.
Hours of Operation: Mon–Fri 8am–4:30pm.
Contact Info: dhhs.nh.gov or 1-844-ASK-DHHS.

NH Healthy Families (CHIP)
Description: CHIP coverage for uninsured children in NH.
Who Qualifies: Children up to age 19 in working families.
Intake Process: Apply through NH EASY.
Hours of Operation: Mon–Fri 8am–4:30pm.
Contact Info: nhhealthyfamilies.com or 1-866-769-3085.

New Hampshire SHIP
Description: Free Medicare education and help.
Who Qualifies: Medicare recipients and caregivers.
Intake Process: Schedule through ServiceLink.
Hours of Operation: Mon–Fri 8am–4:30pm.
Contact Info: servicelink.nh.gov or 1-866-634-9412.

New Jersey

NJ FamilyCare (Medicaid/CHIP)
Description: Health coverage for children, adults, and pregnant people.
Who Qualifies: Low-income families, immigrants, and undocumented children under 19.
Intake Process: Apply online, by phone, or in person.
Hours of Operation: Mon–Fri 8am–8pm, Sat 9am–1pm.
Contact Info: njfamilycare.org or 1-800-701-0710.

Get Covered NJ
Description: State health insurance marketplace for private plans.
Who Qualifies: Individuals and families without employer or public coverage.
Intake Process: Enroll online or with a navigator.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: getcovered.nj.gov or 1-833-677-1010.

New Jersey SHIP
Description: Free help with Medicare coverage and questions.
Who Qualifies: Seniors and disabled individuals enrolled in Medicare.
Intake Process: Call county SHIP office.
Hours of Operation: Mon–Fri 8:30am–4:30pm.
Contact Info: state.nj.us or 1-800-792-8820.

New Mexico

New Mexico Medicaid
Description: State Medicaid program for low-income residents.
Who Qualifies: Children, adults, pregnant individuals, seniors, people with disabilities.
Intake Process: Apply online or through HSD office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: yes.state.nm.us or 1-800-283-4465.

New Mexico CHIP
Description: Low-cost or no-cost health coverage for children.
Who Qualifies: Children under 19 in families up to 240% FPL.
Intake Process: Apply through YES New Mexico portal.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: yes.state.nm.us or 1-855-637-6574.

beWellnm (ACA Marketplace)
Description: ACA marketplace offering private insurance plans.
Who Qualifies: Uninsured residents not eligible for Medicaid/Medicare.
Intake Process: Apply online or get help from a certified assister.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: bewellnm.com or 1-833-862-3935.

New Mexico SHIP
Description: Medicare counseling and enrollment help.
Who Qualifies: Medicare beneficiaries and their caregivers.
Intake Process: Call or visit local SHIP provider.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: nmaging.state.nm.us or 1-800-432-2080.

New York

New York Medicaid
Description: State Medicaid program for low-income residents.
Who Qualifies: Children, adults, pregnant individuals, people with disabilities, seniors.
Intake Process: Apply online, through NY State of Health, or local DSS.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: health.ny.gov or 1-800-541-2831.

Child Health Plus (CHIP)
Description: Free or low-cost health coverage for children.
Who Qualifies: Children under 19 in families up to 400% FPL.
Intake Process: Enroll through NY State of Health.
Hours of Operation: Mon–Fri 8am–6pm.
Contact Info: health.ny.gov or 1-800-698-4543.

NY State of Health
Description: Official health insurance marketplace for New York.
Who Qualifies: Uninsured residents, small businesses.
Intake Process: Enroll online or via navigator help.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: nystateofhealth.ny.gov or 1-855-355-5777.

New York SHIP (HIICAP)
Description: Health insurance counseling for Medicare enrollees.
Who Qualifies: Medicare recipients and caregivers.
Intake Process: Contact HIICAP via local Office for the Aging.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: aging.ny.gov or 1-800-701-0501.

North Carolina

NC Medicaid
Description: Medicaid program for low-income North Carolinians.
Who Qualifies: Low-income adults, children, pregnant individuals, seniors, disabled.
Intake Process: Apply online or through county DSS.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: medicaid.ncdhhs.gov or 1-888-245-0179.

NC Health Choice (CHIP)
Description: Low-cost health coverage for children.
Who Qualifies: Children under 19 whose families earn too much for Medicaid.
Intake Process: Apply via ePASS or local DSS.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: epass.nc.gov or 1-800-367-2229.

HealthCare.gov (ACA Marketplace)
Description: Federal marketplace offering private insurance plans.
Who Qualifies: Uninsured individuals not on Medicaid or Medicare.
Intake Process: Apply through HealthCare.gov.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

North Carolina SHIIP
Description: Counseling for Medicare beneficiaries.
Who Qualifies: Seniors, Medicare recipients, and caregivers.
Intake Process: Contact SHIIP at the Department of Insurance.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: ncshiip.com or 1-855-408-1212.

North Dakota

North Dakota Medicaid
Description: Public health coverage for eligible residents.
Who Qualifies: Low-income individuals, families, seniors, disabled, pregnant.
Intake Process: Apply online or at local human service zone office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: nd.gov/dhs or 1-844-854-4825.

Healthy Steps (CHIP)
Description: Health coverage for uninsured children.
Who Qualifies: Children up to age 18 in households up to 175% FPL.
Intake Process: Apply online or contact state office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: nd.gov/dhs or 1-800-755-2604.

HealthCare.gov (ACA Marketplace)
Description: Federal health insurance marketplace.
Who Qualifies: Residents not eligible for Medicaid or employer plans.
Intake Process: Enroll online or by phone.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

ND SHIC (SHIP Program)
Description: Medicare counseling and information.
Who Qualifies: Medicare-eligible individuals and caregivers.
Intake Process: Call SHIC for appointment or questions.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: nd.gov/ndins or 1-888-575-6611.

Ohio

Ohio Medicaid
Description: Medical coverage for eligible Ohioans.
Who Qualifies: Low-income individuals, families, seniors, people with disabilities.
Intake Process: Apply through Ohio Benefits portal.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: medicaid.ohio.gov or 1-800-324-8680.

Healthy Start/Healthy Families (CHIP)
Description: Free or low-cost insurance for children and pregnant individuals.
Who Qualifies: Families with income up to 206% FPL.
Intake Process: Apply online through benefits.ohio.gov.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: benefits.ohio.gov or 1-800-324-8680.

HealthCare.gov (ACA Marketplace)
Description: ACA insurance plans for individuals and families.
Who Qualifies: Anyone not covered by Medicaid or employer plans.
Intake Process: Apply through HealthCare.gov.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Ohio SHIP
Description: Free Medicare education and counseling.
Who Qualifies: Seniors, people with disabilities, caregivers.
Intake Process: Call or connect with local SHIP office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: insurance.ohio.gov or 1-800-686-1578.

Oklahoma

SoonerCare (Oklahoma Medicaid)
Description: State Medicaid coverage for eligible residents.
Who Qualifies: Low-income children, adults, seniors, disabled, pregnant individuals.
Intake Process: Apply online via MySoonerCare.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: mysoonercare.org or 1-800-987-7767.

SoonerCare for Children (CHIP)
Description: Health coverage for uninsured children.
Who Qualifies: Children under 19 in eligible income brackets.
Intake Process: Use SoonerCare application system.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: oklahoma.gov/ohca or 1-800-987-7767.

HealthCare.gov (ACA Marketplace)
Description: Affordable health plans for uninsured Oklahomans.
Who Qualifies: Residents not covered by Medicaid or employer plans.
Intake Process: Apply through HealthCare.gov.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Oklahoma SHIP
Description: Free assistance with Medicare questions and enrollment.
Who Qualifies: Medicare-eligible residents and caregivers.
Intake Process: Contact SHIP via Oklahoma Insurance Department.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: oid.ok.gov or 1-800-763-2828.

Oregon

Oregon Health Plan (OHP)
Description: Medicaid coverage for low-income residents.
Who Qualifies: Children, adults, seniors, pregnant individuals, disabled.
Intake Process: Apply through ONE Oregon portal.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: one.oregon.gov or 1-800-699-9075.

Healthy Kids (CHIP)
Description: Free or low-cost health insurance for children.
Who Qualifies: Children under 19 in families up to 300% FPL.
Intake Process: Apply through OHP/ONE system.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: health.oregon.gov or 1-800-699-9075.

HealthCare.gov (ACA Marketplace)
Description: Federal health insurance marketplace.
Who Qualifies: Individuals not covered by OHP or other programs.
Intake Process: Apply through HealthCare.gov or a local assister.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Oregon SHIBA (SHIP)
Description: Medicare information and counseling.
Who Qualifies: Medicare recipients and their families.
Intake Process: Call or find a local SHIBA counselor.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: shiba.oregon.gov or 1-800-722-4134.

Pennsylvania

Pennsylvania Medicaid (Medical Assistance)
Description: Public health coverage for low-income Pennsylvanians.
Who Qualifies: Children, adults, seniors, pregnant individuals, disabled.
Intake Process: Apply online via COMPASS or local CAO.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhs.pa.gov or 1-800-692-7462.

CHIP Pennsylvania
Description: Affordable coverage for uninsured children.
Who Qualifies: Children under 19 regardless of income.
Intake Process: Apply online or through CHIP providers.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: chipcoverspakids.com or 1-800-986-5437.

Pennie (ACA Marketplace)
Description: Pennsylvania’s state-run health insurance marketplace.
Who Qualifies: Uninsured individuals not on Medicaid/Medicare.
Intake Process: Apply online or with help from a Pennie assister.
Hours of Operation: Mon–Fri 8am–6pm.
Contact Info: pennie.com or 1-844-844-8040.

PA MEDI (SHIP)
Description: Medicare education and counseling services.
Who Qualifies: Seniors, people with disabilities, caregivers.
Intake Process: Contact PA MEDI via local Area Agency on Aging.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: aging.pa.gov or 1-800-783-7067.

Rhode Island

Rhode Island Medicaid
Description: State health coverage for low-income individuals.
Who Qualifies: Children, pregnant individuals, parents, seniors, disabled.
Intake Process: Apply online or through DHS office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: eohhs.ri.gov or 1-855-697-4347.

RIte Care/RIte Share (CHIP)
Description: Health insurance for children and families.
Who Qualifies: Children up to 250% FPL, working parents.
Intake Process: Apply via HealthSource RI.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: eohhs.ri.gov or 1-855-697-4347.

HealthSource RI
Description: State ACA marketplace for private plans.
Who Qualifies: Uninsured residents not on Medicaid/Medicare.
Intake Process: Apply online or get help from an assister.
Hours of Operation: Mon–Fri 8am–6pm.
Contact Info: healthsourceri.com or 1-855-840-4774.

Rhode Island SHIP
Description: Medicare counseling and enrollment help.
Who Qualifies: Medicare recipients and caregivers.
Intake Process: Call or visit Office of Healthy Aging.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: oha.ri.gov or 1-888-884-8721.

South Carolina

South Carolina Healthy Connections (Medicaid)
Description: State Medicaid program for eligible residents.
Who Qualifies: Low-income individuals, children, pregnant people, elderly, disabled.
Intake Process: Apply online or through local DSS office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: scdhhs.gov or 1-888-549-0820.

South Carolina CHIP
Description: Health coverage for children and teens.
Who Qualifies: Children in low-income households not eligible for Medicaid.
Intake Process: Apply through Healthy Connections.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: scdhhs.gov or 1-888-549-0820.

HealthCare.gov (ACA Marketplace)
Description: Federal platform for purchasing health plans.
Who Qualifies: Anyone not covered by Medicaid, Medicare, or employer.
Intake Process: Apply through HealthCare.gov.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

South Carolina SHIP
Description: Medicare information and support.
Who Qualifies: Medicare beneficiaries and caregivers.
Intake Process: Contact local SHIP via Lt. Governor’s Office on Aging.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: aging.sc.gov or 1-800-868-9095.

South Dakota

South Dakota Medicaid
Description: Health coverage for eligible South Dakota residents.
Who Qualifies: Low-income individuals, children, seniors, pregnant people, disabled.
Intake Process: Apply online or at local DSS office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dss.sd.gov or 1-800-305-3064.

South Dakota CHIP
Description: Health insurance for children and teens.
Who Qualifies: Children under 19 in families with income up to 200% FPL.
Intake Process: Apply through South Dakota Medicaid.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dss.sd.gov or 1-877-999-5612.

HealthCare.gov (ACA Marketplace)
Description: Private plan enrollment platform.
Who Qualifies: Anyone not covered by Medicaid, Medicare, or employer.
Intake Process: Apply online or through local assister.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

South Dakota SHIINE (SHIP)
Description: Medicare counseling and support.
Who Qualifies: Medicare beneficiaries, caregivers.
Intake Process: Contact regional SHIINE office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: shiine.net or 1-800-536-8197.

Tennessee

TennCare (Medicaid)
Description: Tennessee’s Medicaid program.
Who Qualifies: Low-income adults, children, pregnant individuals, disabled.
Intake Process: Apply online via TennCare Connect.
Hours of Operation: Mon–Fri 7am–7pm.
Contact Info: tn.gov/tenncare or 1-855-259-0701.

CoverKids (CHIP)
Description: Free or low-cost health insurance for children.
Who Qualifies: Children under 19; pregnant women.
Intake Process: Apply through TennCare Connect.
Hours of Operation: Mon–Fri 7am–7pm.
Contact Info: tn.gov/tenncare or 1-855-259-0701.

HealthCare.gov (ACA Marketplace)
Description: Federal insurance marketplace for private plans.
Who Qualifies: Individuals not eligible for Medicaid, Medicare, or employer insurance.
Intake Process: Online application or in-person assister.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Tennessee SHIP
Description: Free help with Medicare questions.
Who Qualifies: Medicare recipients, caregivers.
Intake Process: Call or contact local Area Agency on Aging.
Hours of Operation: Mon–Fri 8am–4:30pm.
Contact Info: tn.gov/aging or 1-877-801-0044.

Texas

Texas Medicaid
Description: Medicaid coverage for qualifying Texans.
Who Qualifies: Low-income adults, children, pregnant individuals, seniors, disabled.
Intake Process: Apply online at YourTexasBenefits.com.
Hours of Operation: Mon–Fri 8am–6pm.
Contact Info: hhs.texas.gov or 2-1-1.

CHIP Texas
Description: Health insurance for uninsured children.
Who Qualifies: Children under 19 whose families earn too much for Medicaid.
Intake Process: Apply online at YourTexasBenefits.com.
Hours of Operation: Mon–Fri 8am–6pm.
Contact Info: hhs.texas.gov or 1-877-543-7669.

HealthCare.gov (ACA Marketplace)
Description: Private plan marketplace.
Who Qualifies: Individuals not eligible for Medicaid, Medicare, or employer plans.
Intake Process: Apply online or call.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Texas SHIP
Description: Help understanding Medicare benefits.
Who Qualifies: Medicare beneficiaries and caregivers.
Intake Process: Call 2-1-1 or your Area Agency on Aging.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: hhs.texas.gov or 1-800-252-9240.

Utah

Utah Medicaid
Description: Medical coverage for low-income Utahns.
Who Qualifies: Adults, children, pregnant women, seniors, people with disabilities.
Intake Process: Apply online via myCase or in person.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: medicaid.utah.gov or 1-866-435-7414.

CHIP Utah
Description: Health insurance for kids in working families.
Who Qualifies: Uninsured children under 19.
Intake Process: Apply online or call for application.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: chip.utah.gov or 1-877-543-7669.

HealthCare.gov (ACA Marketplace)
Description: Federal marketplace for private plans.
Who Qualifies: Anyone not eligible for Medicaid or Medicare.
Intake Process: Apply online or through a navigator.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Utah SHIP
Description: Counseling for Medicare recipients.
Who Qualifies: Medicare recipients and caregivers.
Intake Process: Contact SHIP via Utah Insurance Department.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: insurance.utah.gov or 1-800-541-7735.

Vermont

Green Mountain Care (Medicaid)
Description: Vermont’s public health coverage programs.
Who Qualifies: Low-income individuals and families.
Intake Process: Apply online or through Department of Vermont Health Access.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dvha.vermont.gov or 1-800-250-8427.

Dr. Dynasaur (CHIP)
Description: Health insurance for children and pregnant people.
Who Qualifies: Children under 19 and pregnant Vermonters.
Intake Process: Apply through Green Mountain Care.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dvha.vermont.gov or 1-800-250-8427.

Vermont Health Connect
Description: ACA marketplace for Vermont residents.
Who Qualifies: Individuals not covered by Medicaid, Medicare, or employer plans.
Intake Process: Apply online or through a navigator.
Hours of Operation: Mon–Fri 8am–4:30pm.
Contact Info: healthconnect.vermont.gov or 1-855-899-9600.

Vermont SHIP
Description: Medicare counseling services.
Who Qualifies: Medicare-eligible individuals.
Intake Process: Call Area Agencies on Aging.
Hours of Operation: Mon–Fri 8am–4:30pm.
Contact Info: vermont4a.org or 1-800-642-5119.

Virginia

Virginia Medicaid (Cardinal Care)
Description: Medicaid program for low-income Virginians.
Who Qualifies: Children, pregnant people, parents, disabled, low-income adults.
Intake Process: Apply online at CoverVA.
Hours of Operation: Mon–Fri 8am–7pm, Sat 9am–noon.
Contact Info: coverva.org or 1-855-242-8282.

FAMIS (CHIP)
Description: Health coverage for children and teens.
Who Qualifies: Uninsured children under 19.
Intake Process: Apply online or by calling CoverVA.
Hours of Operation: Mon–Fri 8am–7pm, Sat 9am–noon.
Contact Info: coverva.org or 1-855-242-8282.

HealthCare.gov (ACA Marketplace)
Description: Purchase health plans online.
Who Qualifies: Residents not eligible for Medicaid, Medicare, or employer plans.
Intake Process: Apply online or with navigator help.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Virginia SHIP
Description: Medicare counseling and assistance.
Who Qualifies: Medicare recipients and caregivers.
Intake Process: Call Virginia Insurance Counseling & Assistance Program (VICAP).
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: vda.virginia.gov or 1-800-552-3402.

Washington

Washington Apple Health (Medicaid)
Description: Free or low-cost health coverage for eligible residents.
Who Qualifies: Low-income adults, children, pregnant individuals, seniors, and those with disabilities.
Intake Process: Apply online via Washington Healthplanfinder.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: hca.wa.gov or 1-800-562-3022.

Apple Health for Kids (CHIP)
Description: Health coverage for children and teens.
Who Qualifies: Children under 19 in households up to 317% FPL.
Intake Process: Apply through Washington Healthplanfinder.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: wahealthplanfinder.org or 1-855-923-4633.

Washington Healthplanfinder
Description: State-run ACA insurance marketplace.
Who Qualifies: Residents not eligible for Medicaid, Medicare, or employer coverage.
Intake Process: Apply online or with in-person assistance.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: wahealthplanfinder.org or 1-855-923-4633.

Washington SHIBA (SHIP)
Description: Free, unbiased Medicare help.
Who Qualifies: Medicare recipients and caregivers.
Intake Process: Call SHIBA or visit a local partner site.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: insurance.wa.gov or 1-800-562-6900.

West Virginia

West Virginia Medicaid
Description: Medical coverage for eligible West Virginians.
Who Qualifies: Low-income individuals, pregnant people, seniors, people with disabilities.
Intake Process: Apply through WV PATH or local DHHR office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhhr.wv.gov or 1-877-716-1212.

West Virginia CHIP
Description: Health insurance for children under 19.
Who Qualifies: Children in households up to 300% FPL.
Intake Process: Apply online or by mail.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: chip.wv.gov or 1-877-982-2447.

HealthCare.gov – West Virginia
Description: Federal ACA marketplace for private plans.
Who Qualifies: Uninsured residents not eligible for Medicaid or employer plans.
Intake Process: Apply online or by phone.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

West Virginia SHIP
Description: Medicare assistance and counseling.
Who Qualifies: Medicare-eligible individuals and caregivers.
Intake Process: Contact SHIP through Bureau of Senior Services.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: aging.wv.gov or 1-877-987-4463.

Wisconsin

Wisconsin Medicaid
Description: Public health coverage for low-income residents.
Who Qualifies: Children, pregnant individuals, seniors, adults, and people with disabilities.
Intake Process: Apply through ACCESS Wisconsin.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhs.wisconsin.gov or 1-800-362-3002.

BadgerCare Plus (Medicaid & CHIP)
Description: Combined Medicaid and CHIP program for children and working families.
Who Qualifies: Children, parents, and some low-income adults.
Intake Process: Apply online via ACCESS Wisconsin.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhs.wisconsin.gov or 1-800-362-3002.

HealthCare.gov – Wisconsin
Description: Marketplace for ACA-compliant insurance.
Who Qualifies: Anyone not eligible for Medicaid, Medicare, or employer coverage.
Intake Process: Apply online or with a navigator.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Wisconsin SHIP
Description: Medicare assistance via Elder Benefit Specialists.
Who Qualifies: Medicare recipients and their caregivers.
Intake Process: Connect through your county’s Aging & Disability Resource Center.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: dhs.wisconsin.gov or 1-800-242-1060.

Wyoming

Wyoming Medicaid
Description: Health coverage for eligible low-income residents.
Who Qualifies: Low-income children, adults, seniors, pregnant individuals, disabled.
Intake Process: Apply through WES or local DFS office.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: health.wyo.gov or 1-855-294-2127.

Kid Care CHIP (Wyoming)
Description: Health insurance for children and teens.
Who Qualifies: Children under 19 in families up to 200% FPL.
Intake Process: Apply online or request paper application.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: health.wyo.gov or 1-855-294-2127.

HealthCare.gov – Wyoming
Description: ACA marketplace for individual/family health plans.
Who Qualifies: Uninsured residents not eligible for Medicaid or Medicare.
Intake Process: Enroll online or by phone.
Hours of Operation: Mon–Fri 8am–8pm.
Contact Info: healthcare.gov or 1-800-318-2596.

Wyoming SHIP
Description: Medicare counseling and navigation help.
Who Qualifies: Medicare-eligible residents and caregivers.
Intake Process: Call SHIP via Aging Division.
Hours of Operation: Mon–Fri 8am–5pm.
Contact Info: health.wyo.gov or 1-800-856-4398.

California – Covered California State Subsidies

Program: Covered California Enhanced Silver Plans & State Subsidies
What it is:
California offers additional state-funded subsidies for low- and middle-income residents to lower premiums and out-of-pocket costs beyond what the federal government provides.

Features:

• Expanded eligibility for premium subsidies (up to ~600% FPL)
• Enhanced Silver Plans offer stronger cost-sharing reductions
• Undocumented immigrants can enroll in Medi-Cal (Medicaid equivalent) as of 2024

Helpful Link:

• Covered California

New York – Essential Plan & Child Health Plus

Program 1: Essential Plan
What it is:
A low-cost health insurance option for adults earning up to 200% FPL who don’t qualify for Medicaid.

Features:

• $0–$20 monthly premiums
• No deductibles
• Dental and vision included

Program 2: Child Health Plus

• Available to all children under 19 regardless of immigration status
• Sliding-scale premiums based on income

Helpful Link:

• NY State of Health – Essential Plan
• Child Health Plus Info

Massachusetts – ConnectorCare

Program: ConnectorCare Plans through MA Health Connector
What it is:
Health insurance with low premiums, low copays, and no deductibles for residents earning up to 300% FPL.

Features:

• Additional cost-sharing help beyond federal ACA support
• Special rules for young adults and part-time workers
• Coverage includes behavioral health and prescription drugs

Helpful Link:

• Massachusetts Health Connector

Minnesota – MinnesotaCare

Program: MinnesotaCare
What it is:
A public health insurance program for low- to middle-income residents who don’t qualify for Medicaid, including many immigrants.

Features:

• Low monthly premiums
• Broad eligibility (including undocumented youth under 21)
• Funded jointly by the state and federal government

Helpful Link:

• MinnesotaCare Info

Washington – Cascade Care & Cascade Select

Program: Cascade Care Public Option Plans
What it is:
State-standardized health plans offered on the Marketplace with a public-option model. Includes Cascade Select, the public-run version.

Features:

• Lower deductibles and more upfront services
• Income-based subsidies and premium assistance
• Available on WA Healthplanfinder

Helpful Link:

• Cascade Care Overview

Colorado – Colorado Option

Program: Colorado Option Plans
What it is:
Standardized health insurance plans offered by private carriers with required benefits and lower cost structures.

Features:

• Required to reduce premiums by 15% over 3 years
• Same essential benefits as ACA plans
• Available through Connect for Health Colorado

New Jersey – NJ FamilyCare & Expanded Subsidies

Programs:

• NJ FamilyCare: Covers Medicaid and CHIP for families, undocumented pregnant women, and some adults
• State subsidies supplement federal Marketplace subsidies to lower premiums even further

Helpful Link:

• NJ FamilyCare
• Get Covered NJ

Oregon – Cover All People Program (Coming Soon)

What it is:
Oregon is launching a program to provide full coverage to all low-income residents, including undocumented immigrants.

Expected Features:

• Modeled after Medicaid
• Rolling out in phases through 2025

Helpful Link:

• Oregon Health Plan

Marketplace (ACA) Plans

What it is:
Marketplace plans are health insurance options offered under the Affordable Care Act (ACA) through federal or state exchanges. These plans are available to individuals and families who do not get coverage through a job, Medicare, or Medicaid.

Key Features:

• Four metal tiers: Bronze, Silver, Gold, Platinum (differ by premium & cost-sharing)
• All plans cover essential health benefits
• Subsidies and tax credits are available based on income

Where to Enroll:

• Healthcare.gov (used by most states)
• Or your state’s exchange

Enrollment Periods:

• Open Enrollment: Usually Nov 1 – Jan 15
• Special Enrollment for life events like losing coverage, marriage, or having a child

Off-Exchange Plans

What it is:
These are health insurance plans purchased directly from private insurers, without using the government Marketplace.

Key Differences:

• No ACA subsidies or cost-sharing reductions
• Still may cover essential benefits, but benefits can vary
• Often available through health insurance companies or brokers

When to Consider:

• You earn too much for subsidies
• You want a wider provider network or specific insurer

Helpful Links:

• National Association of Insurance Commissioners (NAIC) Consumer Guide
• Licensed Insurance Brokers Directory

Short-Term Health Insurance

What it is:
Short-term health insurance offers temporary coverage — often for a few months — with limited benefits and lower premiums.

Key Points:

• Not required to follow ACA rules
• Often excludes preexisting conditions and many essential benefits
• Can be denied based on health history

When to Consider:

• You’re between jobs and need temporary coverage
• You missed Open Enrollment and don’t qualify for Special Enrollment
• You want emergency-only or low-cost coverage temporarily

Compare Plans:

• eHealth Short-Term Plans (note: private broker site)
• Pivot Health (note: private insurer)

Important: Check if your state allows or restricts short-term plans — state laws vary widely.

Catastrophic Plans

What it is:
Low-cost, high-deductible plans that meet ACA standards but are intended primarily for emergency coverage.

Eligibility:

• Under 30 years old
• Or have a hardship exemption or affordability exemption

Key Features:

• Lower premiums
• High deductibles
• Coverage kicks in after large out-of-pocket spending
• Good for healthy individuals wanting financial protection against major illness or injury

How to Enroll:

• Apply through Healthcare.gov or your state’s marketplace

Group Health Insurance Plans

What it is:
Health coverage offered through an employer to employees and often their families. Employers typically pay part of the premium, and plans are regulated under the Employee Retirement Income Security Act (ERISA).

Key Features:

• Lower premiums due to group buying power
• Coverage may start after a waiting period (e.g., 30–90 days)
• Pre-tax premiums are often deducted from payroll
• Includes preventive services and usually prescription coverage

Helpful Link:

• U.S. Department of Labor – Group Health Plans Overview

COBRA Coverage

(Consolidated Omnibus Budget Reconciliation Act)

What it is:
COBRA lets you keep your employer-sponsored health plan temporarily after leaving a job, being laid off, or experiencing a qualifying life event (e.g., divorce).

Key Features:

• Coverage is identical to your employer plan
• You pay the full premium + 2% admin fee
• Lasts 18–36 months, depending on the situation

Who Qualifies:

• Former employees
• Spouses and dependent children under the plan

Helpful Link:

• COBRA Overview – DOL

HMO vs. PPO vs. EPO vs. POS Plans

What it is:
These are the types of plan networks that determine how you access care, which doctors you can see, and whether you need referrals.

Helpful Link:

• Healthcare.gov: Types of Health Insurance Plans

FSA vs. HSA vs. HRA Accounts

These accounts help pay for out-of-pocket medical expenses with pre-tax dollars, but they work differently depending on your health plan.

FSA (Flexible Spending Account)

• Set up by employers
• Use-it-or-lose-it rule (limited carryover)
• Available with most job-based plans
• Not tied to a specific plan type

HSA (Health Savings Account)

• For people with High-Deductible Health Plans (HDHPs) only
• Money rolls over year to year
• Can invest unused funds
• Portable — stays with you even if you change jobs

HRA (Health Reimbursement Arrangement)

• Funded entirely by employer
• Only employer can contribute
• Can be designed in various ways (e.g., to reimburse premiums)

Helpful Links:

• IRS Guide to FSAs, HSAs, HRAs
• HSA Eligibility Rules – Healthcare.gov

Veterans

Coverage Options:

• VA Health Care System for eligible veterans
• CHAMPVA for dependents/survivors of disabled or deceased veterans
• TRICARE for military retirees, active-duty families, and reservists

Key Features:

• Coverage includes hospital, outpatient, preventive, mental health, and prescription services
• VA benefits may be combined with other insurance (e.g., Medicare)

Helpful Links:

• VA Health Care Eligibility
• CHAMPVA Program
• TRICARE Overview

Native Americans & Alaska Natives

Coverage Options:

• Free care through Indian Health Service (IHS)
• Zero-cost or low-cost Marketplace plans with special protections
• Medicaid & CHIP eligibility often more flexible

Key Features:

• Exempt from Marketplace cost-sharing if eligible
• May enroll in a Marketplace plan any time (not limited to Open Enrollment)
• Can still use IHS facilities even with private or public insurance

Helpful Links:

• IHS Website
• Marketplace Info for Native Americans

People with Disabilities

Coverage Options:

• Medicare (after 24 months of SSDI eligibility)
• Medicaid (based on income and/or disability status)
• Dual Eligibility: Many qualify for both Medicare and Medicaid
• Marketplace Plans: May still qualify for subsidies if not on Medicare

Additional Services:

• Home- and community-based services
• Long-term care support through Medicaid waivers
• State disability health programs (varies by location)

Helpful Links:

• Medicare & SSDI Eligibility
• Dual Eligibility Overview

Refugees & Immigrants

Coverage Options:

• Refugee Medical Assistance (RMA): Up to 12 months of coverage for newly arrived refugees
• Medicaid & CHIP: Varies by immigration status and state
• Marketplace Coverage: Many lawfully present immigrants qualify for subsidies

Key Features:

• No 5-year wait for Medicaid for certain groups (e.g., refugees, asylees)
• Undocumented immigrants generally not eligible for federal programs but may qualify for state or local programs

Helpful Links:

• Healthcare.gov for Immigrants
• ORR Refugee Medical Assistance

Pregnant People

Coverage Options:

• Medicaid for Pregnant Women: Available at higher income thresholds in many states
• CHIP Perinatal Programs: Some states offer prenatal care for those who don’t qualify for Medicaid
• Marketplace Plans: Must be purchased during open or special enrollment

Key Features:

• Pregnancy counts as a qualifying life event in some states (check state rules)
• Coverage may include prenatal, labor/delivery, postpartum, and newborn care
• Some states offer Medicaid Presumptive Eligibility for immediate coverage

Helpful Links:

• Medicaid & Pregnancy – Medicaid.gov
• MCHB Title V Resources

Dental and Vision Insurance

What it is:
Dental and vision plans typically aren’t included in standard health insurance for adults, though they are covered for children in ACA-compliant plans.

Key Features:

• Available as stand-alone plans or as add-ons to medical coverage
• Dental coverage may include preventive, basic, and major services (e.g., cleanings, fillings, root canals)
• Vision plans usually cover eye exams, glasses, and contacts

Where to Get It:

• Private insurers (e.g., Delta Dental, VSP)
• Employers or unions
• Marketplace dental coverage

Helpful Links:

• Dental and Vision Coverage on Healthcare.gov
• Find a Standalone Dental Plan – eHealth

Prescription Drug Plans (Medicare Part D)

What it is:
Medicare Part D provides prescription drug coverage for people with Medicare. Plans are sold by private insurers and vary by state.

Key Features:

• Monthly premiums and cost-sharing
• Formulary (list of covered drugs) varies by plan
• May have coverage gaps (“donut hole”)

Who Needs It:

• Medicare beneficiaries not already enrolled in a Medicare Advantage plan that includes drug coverage

Helpful Links:

• Medicare Part D Overview
• Find a Part D Plan

Medigap (Medicare Supplement Insurance)

What it is:
Medigap helps cover out-of-pocket costs that Medicare Parts A & B don’t cover (e.g., copays, coinsurance, deductibles). These are sold by private insurers.

Key Features:

• Standardized plans (A–N) across most states
• No networks — you can see any provider that accepts Medicare
• Doesn’t include drug coverage (must add Part D separately)

Helpful Links:

• What is Medigap? – Medicare.gov
• Compare Medigap Policies

Travel Health Insurance

What it is:
Temporary insurance that covers emergency medical care while traveling internationally or outside your coverage network.

Key Features:

• Typically includes emergency services, evacuation, and repatriation
• Some include COVID-19 coverage
• Doesn’t cover routine care or preexisting conditions in most cases

When to Consider:

• Studying or working abroad
• Traveling to countries where your domestic plan doesn’t provide coverage

Helpful Links:

• GeoBlue (BCBS Global)
• Allianz Travel Insurance
• InsureMyTrip.com

Critical Illness, Accident, or Hospital Indemnity Insurance

What it is:
These are cash-benefit insurance plans that pay you directly if you’re diagnosed with a covered illness, get injured, or are hospitalized.

Key Features:

• Critical Illness: Pays lump sum for conditions like cancer, heart attack, stroke
• Accident Plans: Help cover ER visits, broken bones, and recovery
• Hospital Indemnity: Pays a fixed daily benefit while hospitalized

When to Consider:

• If your primary insurance has a high deductible
• If you want income protection while recovering

Helpful Links:

• Aflac Supplemental Insurance
• UnitedHealthcare Critical Illness & Accident Plans

Long-Term Care Insurance

What it is:
Covers the cost of services like nursing homes, assisted living, or in-home care not typically covered by health insurance or Medicare.

Key Features:

• Best purchased before age 60 for affordability
• Premiums based on age, health, and coverage amount
• May help protect savings from being used for extended care needs

When to Consider:

• If you’re planning for aging needs and want more control over where/how you receive care
• If you don’t qualify for Medicaid long-term care and want to avoid spending down assets

Helpful Links:

• Long-Term Care Information – ACL.gov
• NAIC Consumer Guide to Long-Term Care