Health Coverage Basics: Marketplace, Medicaid, CHIP and Job Plans

Health coverage can feel confusing, with lots of programs, plan names and dates to keep track of. Understanding the basics makes it much easier to know where to look and what questions to ask. This guide gives you a plain-language overview of the main ways people in the United States get health coverage. It is for learning only. EverydayBenefitGuide does not sell insurance or take applications, so we point you to the official sources for those steps.

The main ways people get coverage

Most people get health coverage in one of these ways:

• Through a job — an employer plan for you and often your family.
• Through the Health Insurance Marketplace — plans you buy on your own at HealthCare.gov or a state-run site.
• Through Medicaid or CHIP — public programs run by states with federal support.
• Through Medicare — a federal program mainly for people 65 and older and some younger people with disabilities.

Some people also get coverage through the military, veterans’ programs or tribal health services. Let’s look at the most common options in more detail.

Employer plans

Many employers offer health plans to their workers. The employer usually pays part of the monthly cost, and you pay the rest through your paycheck.

What to know

• Enrollment timing. You can usually sign up when you are hired and during your employer’s yearly enrollment period.
• Family coverage. Many plans let you add a spouse and children. Young adults can often stay on a parent’s plan until age 26.
• Plan choices. Some employers offer several plan types. Compare the monthly cost, the deductible and which doctors are in the network.

Your human resources or benefits office can answer questions about your specific plan. Our guide on insurance terms explained can help you read the plan details.

If you leave a job

When you leave a job, you may be able to keep your employer plan for a while through a program called COBRA. You usually pay the full cost yourself. Leaving a job also often opens a special enrollment period for Marketplace coverage, which may cost less depending on your household.

The Health Insurance Marketplace

The Marketplace is where individuals and families can shop for health plans on their own. HealthCare.gov serves many states. Some states run their own marketplace websites, and HealthCare.gov can direct you to the right one.

How it works

1. Create an account on HealthCare.gov or your state’s site.
2. Fill out an application about your household and expected income.
3. See which plans are available and whether you can get help with costs.
4. Compare plans and choose one.
5. Pay your first monthly payment to start coverage.

Help with costs

Depending on your household size and income, you may be able to get a tax credit that reduces your monthly payment. Some people may also get help with deductibles and copays on certain plans. The application will show what is available to you. Rules and amounts change, so always check the current details on HealthCare.gov.

Plan categories

Marketplace plans are grouped into “metal” levels: Bronze, Silver, Gold and Platinum. These show how you and the plan share costs, not the quality of care. In general, Bronze plans have lower monthly costs and higher costs when you get care, while Platinum plans are the reverse.

Medicaid and CHIP

Medicaid provides health coverage to many people with limited income, as well as some older adults, pregnant people and people with disabilities. States run their own Medicaid programs within federal guidelines, so eligibility rules and program names vary by state.

CHIP, the Children’s Health Insurance Program, covers children in families who earn too much for Medicaid but may find private coverage hard to afford. In some states it also covers pregnant people.

Applying

You can apply for Medicaid and CHIP at any time of year. There are two main ways:

• Through your state Medicaid agency.
• Through HealthCare.gov, which will send your information to your state if it looks like someone in your household may be eligible.

Check the eligibility rules on your state’s official Medicaid website. InsureKidsNow.gov has information about children’s coverage in each state. Once enrolled, watch your mail for renewal notices. Our guide on renewals and reporting changes explains why they matter.

Enrollment periods

Timing matters for most private health plans.

Open enrollment

Open enrollment is the yearly window when anyone can sign up for or change a Marketplace plan. It usually runs from late fall into winter, though dates can differ in states with their own marketplaces. Employer plans have their own open enrollment periods, often in the fall. Read our post on what to review during open enrollment for a simple checklist.

Special enrollment periods

Outside open enrollment, certain life events can open a special enrollment period, often for 60 days. Common examples include:

• Losing other health coverage, such as a job-based plan.
• Getting married.
• Having or adopting a baby.
• Moving to a new area with different plans.

You may need to show documents about the event. Check HealthCare.gov for the current list of events and time limits.

Medicare in brief

Medicare is a federal program mainly for people 65 and older. It has several parts covering hospital care, doctor visits and prescriptions. Medicare has its own enrollment periods, and signing up late can sometimes lead to added costs. Medicare.gov is the official place to learn more.

Getting free, trustworthy help

You do not have to sort through health coverage alone. Trained, unbiased helpers called navigators and assisters can help you apply for Marketplace coverage, Medicaid or CHIP at no cost. You can find local help through HealthCare.gov. Be cautious of anyone who charges you to apply or pressures you to pick a plan quickly.

The bottom line

Most people get health coverage through a job, the Marketplace, Medicaid or CHIP, or Medicare. Learn the open enrollment dates, keep an eye out for life events that open a special enrollment period, and use official sites like HealthCare.gov and your state Medicaid agency to apply and confirm details. Free local helpers are available if you want support along the way.