No one plans to get sick or injured. But if that happens, a health insurance policy can help you access care while avoiding unexpected, high medical costs. Health insurance also covers preventive services, such as vaccines and screenings, and allows for peace of mind even when you’re healthy. But do you know how to get health insurance?

Knowing where to begin can be confusing, but it boils down to a few common options: getting coverage on your own through an insurance company or an insurance marketplace, such as HealthCare.gov; receiving coverage through an employer or through a family member’s plan; or accessing coverage through a public program, like Medicaid or Medicare.

This guide will walk you through the basics of how to get health insurance, answering questions such as how long it takes to get health insurance, where to get health insurance and when to enroll for your new policy.

Main Takeaways

• There are a variety of options for accessing health insurance.

• While many people get health insurance through their employer, others purchase their own plan through the marketplace or participate in a public program.

• It’s important to note the “open enrollment” dates to sign up for a health insurance plan; outside of that period you may need to experience a “qualifying life event” to sign up for a plan. 

Where to Get Health Insurance? 6 Most Common Options

When considering where to get health insurance, there are a number of factors that come into play, including your employment status, your age and your financial resources. Read on to learn about the most common health insurance options and decide what makes sense for you. 

Employer-sponsored health insurance

Most people — 86% — work for an employer that offers health insurance to them and their family members. This is known as “employer-sponsored health insurance.” The insurance provider, cost and type of coverage will vary depending on what the employer selects as its group plan.

Marketplace insurance

Generally, individuals who don’t get health insurance through an employer can purchase it themselves, either through the federal marketplace (HealthCare.gov) or directly through an insurer, such as Blue Cross and Blue Shield of Alabama.

COBRA

If an employee loses their job, they — and their family — are often able to continue receiving their employer-sponsored health insurance for a limited period of time thanks to the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA generally covers individuals for 18 months, with the possibility of extending it to 36 months for spouses and dependent children under certain circumstances; usually, it’s paid for by the beneficiary. It’s important to note that COBRA is only available if the employer has 20 or more employees; the coverage isn’t available to everyone who loses their job.

Medicare

Medicare is the federal health insurance program for people 65 and older, as well as for certain individuals who are younger than 65 and live with certain health conditions (including kidney failure) and/or receive disability benefits. Across the US, more than 66 million adults are covered by Medicare. The four parts of Medicare are designed to meet different health needs and budgets.

• Part A is hospital insurance

• Part B is medical insurance

• Part C, known as Medicare Advantage, is an alternative to A and B and offered by private companies (it often bundles A, B and D coverage)

• Part D is prescription drug coverage

Medicaid

Medicaid is a government-funded health insurance program for people with limited income and resources. Each state has its own eligibility requirements for Medicaid, which could be based on age, income level, number of people in the family, and whether an individual is pregnant or has a disability. Learn more about how to qualify for Medicaid in Alabama.  

ALL Kids Insurance for Children

Funded by state and federal government programs, the Children’s Health Insurance Program, known a CHIP, provides health coverage to children who are eligible based on income. In Alabama, this program is called ALL Kids, and it uses Blue Cross and Blue Shield of Alabama to provide medical, mental health and substance abuse services to eligible children under age 19. Children who qualify for CHIP generally aren’t eligible for Medicaid but can’t afford private health coverage.   

When Can You Get Health Insurance?

With few exceptions, you have to sign up for your annual health insurance policy within a very specific time period each year. It’s called “open enrollment,” and it generally starts a couple of months before the policy begins. That’s true for employer-sponsored plans, marketplace and individual plans and Medicare plans. For Medicare Advantage plans, this period is called the Annual Enrollment Period (AEP) and it’s available each year from October 15 through December 7. Open enrollment for Medicare Advantage is a separate period when members may change to another plan if they are unsatisfied with the one they enrolled in during the AEP. 

For those who just turned 65, or are about to, and are signing up for Medicare for the first time, the initial enrollment period lasts seven months: it begins three months before you turn 65 and ends three months after the month you turn 65.

However, Medicaid and CHIP/ALL Kids do not have an open enrollment period; you can apply any time of the year.  

Be sure to mark open enrollment periods that apply to you and your family on your calendar so you don’t miss out. Otherwise, you may need to wait until the next open enrollment period to begin coverage, except in the case of a qualifying event.  

How long does it take to get health insurance?

The amount of it time it takes for a policy to begin depends on what type of insurance you’re using. After you sign up for insurance during an open enrollment period it could take anywhere from a couple of weeks to a couple of months for the policy to begin (many policies will start with the new calendar year). If you’re enrolling in Medicare for the first time, your policy will usually begin the first day of the month after you enroll. For Special Enrollment Periods (see next section), coverage start times vary depending on the qualifying event. For Medicaid, if an applicant is determined eligible, coverage is effective on the date of application or the first day of the month of application. For ALL Kids, if the child is approved, coverage begins the first day of the month after applying.

Can You Get Health Insurance Outside of the Open Enrollment Period?

Now that you know the rules, it’s important to point out that, of course, every rule has exceptions, including health insurance enrollment. A number of changes in situation will enable you to sign up for a policy outside of the traditional enrollment period.

• Qualifying Life Events (QLE):
  Specific changes in your life, called Qualifying Life Events, include events such as getting married, adding a new child to the family, losing previous coverage, moving to a new state, turning 26 or turning 65. 

• Special Enrollment Periods (SEP):
  Each qualifying life event has a special enrollment period that specifies the amount of time before and/or after the event that you can enroll. For example, the special enrollment period after a marriage might be 60 days, while losing previous coverage might allow you to sign up for a policy 60 days before the loss and 60 days after.

Can You Buy Your Own Health Insurance if You’re Not Covered by Your Employer?

While many people depend on employer-sponsored health insurance, there are an array of scenarios in which an individual would sign up for their own plan via the marketplace or directly with an insurer. Some examples include:

• Freelancers, gig workers, contractors or other self-employed individuals, part-time workers who don’t receive benefits, individuals who run a small business or work for a small business that don’t offer insurance, students, stay-at-home parents, young adults aging off a parent’s plan at 26, people who are not eligible for government programs, or prefer to not apply.

For people who identify with any of the above situations, there are plans that offer different levels of coverage at different price points to meet all needs.

What to Look for When Comparing Health Insurance Plans

Determining how to get insurance is the first step — and an important one. Once you’ve decided the path to take, you’ll still have a lot to consider. Here are things to compare as you start your research to select the right plan.

1. Do I want an EPO or a PPO?
   With an EPO, you choose a primary care physician (PCP) within your network and they can refer you to other health care providers. With some PPOs, you can make an appointment with any health care provider without a referral and your plan will help pay for it; other PPO plans require a PCP designation and referrals to specialists in order to cover the care. 

2. How much am I willing to pay for my health insurance?
   When comparing different plans you’ll want to consider a number of different costs, including the plan’s premium, copay, coinsurance and deductible. 

3. Are my doctors covered by the plan?
   Every plan has its own in-network providers, meaning they have a contract to provide care to members at an agreed upon rate. Generally speaking, PPOs tend to have a broader listing of in-network providers. Confirm that your providers are covered by your prospective plans. 

4. Are my medications covered?
   If you’re taking prescription drugs, be sure to see if they’re covered in the prospective plan’s formulary.