Where to Start on the Health Insurance Exchange

by Nancy Metcalf Health Writer

Q. Please help. I’ve lost my health insurance and know I can get new coverage right away, but have I no idea where to start.

A. If you lose your health insurance coverage for pretty much any reason other than voluntarily canceling the policy or not paying your premium, you are entitled to a Special Enrollment Period at any time of the year. The Affordable Care Act remains in full effect and nothing has been repealed so far.

Where to start?

Everything you need to get started is at the Local Help page of HealthCare.gov. Enter your ZIP code or city. If you live in a state that runs its own health insurance exchange, you’ll be transferred to that site, where you’ll want to look for a link that says something like “get help” or an 800 number you can call.

If you stay with HealthCare.gov, you’ll be connected with a list of enrollment counselors and insurance brokers in your area, any of whom can help you enroll in private health insurance and guide you through the process of getting whatever financial help you are entitled to.

The state-run portals will lead you to similar lists. The major difference between the two types of assisters is that counselors aren’t allowed to recommend one plan over another, whereas brokers are. The good news: There is no charge for either type of help.

Could you qualify for Medicaid or CHIP?

If you need health insurance because of a job loss and your income has dropped considerably, it’s worth checking to see if you are eligible for Medicaid or if your children are eligible for the Children’s Health Insurance Program (CHIP).

Both of those types of insurance are free or very low cost, but availability and eligibility vary from state to state. In general, in states that have taken advantage of the ACA’s Medicaid expansion, you are eligible if your income this year is likely to be less than about $17,000 for a single person or $22,000 for a couple. CHIP income limits are somewhat higher, so your children could be eligible for that even if you can’t get Medicaid.

Figuring out your income can get complex, however. HealthCare.gov has a calculator that can give you some idea of your eligibility, but if you are in any doubt, check with an enrollment counselor or directly with your state’s Medicaid agency.

Nancy Metcalf
Meet Our Writer
Nancy Metcalf

Nancy Metcalf is an award-winning independent journalist specializing in health topics. A senior writer and editor for Consumer Reports for more than 25 years, she is a nationally recognized expert on health insurance and health reform.