Health Insurance: Everything You Need to Know

American health insurance, a dynamic and often debated sector, encapsulates a wide array of plans, providers, and regulatory frameworks. It encompasses private insurance plans offered by employers, government-sponsored programs like Medicare and Medicaid, and individual policies purchased on the open market. This diversity in insurance options reflects the complex interplay between public and private interests in the American healthcare system.

Furthermore, American health insurance is marked by its unique features, including cost-sharing mechanisms, such as deductibles, copayments, and coinsurance, which influence the financial responsibilities of policyholders. The debate over healthcare reform in the United States frequently centers around issues like affordability, coverage adequacy, and the role of government in ensuring healthcare access for all.

As we delve deeper into the intricacies of American health insurance, we will explore the historical evolution of this system, the key stakeholders involved, the benefits it offers, and the challenges it poses for both individuals and policymakers. By doing so, we aim to shed light on this crucial aspect of the American healthcare landscape and foster a better understanding of the ongoing discourse surrounding healthcare access, quality, and affordability in the United States.

See who can use health insurance in the U.S.:

Here are five possible options of people who can use American health insurance.

1- A U.S. citizen who lives in the United States and does not have Medicare coverage. This person is eligible to enroll in health coverage through the Marketplace¹.

This is the first step to apply and enroll on HealthCare.gov ¹. Here are some more details about this step:

To create a Marketplace account, you need to enter some basic information, such as your name, address, and email address. You also need to choose a username and password, and set up security questions and answers ¹.
If your state runs its own Marketplace, you will be redirected to their website after you enter your state of residence. You can also find your state’s Marketplace website by using this tool.
Creating a Marketplace account does not mean you are enrolled in a health plan. You still need to complete the other steps, such as submitting your application, getting your eligibility results, and choosing a plan ¹.
You can get help creating your account by calling the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325. You can also find local help in your area by using this tool.

A U.S. national who lives in the United States and does not have Medicare coverage. This person is also eligible to enroll in health coverage through the Marketplace¹ ².

2- A lawfully present immigrant who lives in the United States and does not have Medicare coverage. This person can also enroll in health coverage through the Marketplace, depending on their immigration status¹ ².

his is a rare and special status that applies to some people who have ties with certain U.S. territories or who have U.S. national parents. Here are some more details about this status:

A U.S. national is a person who owes their sole allegiance to the United States, but does not have all the rights and privileges of a U.S. citizen ¹.
The only U.S. territories that currently produce non-citizen U.S. nationals are American Samoa and Swains Island ². People born in these territories are U.S. nationals by birth, unless they acquire U.S. citizenship by other means ².
People born outside of U.S. territory can also be U.S. nationals if they have two U.S. national parents, or one alien parent and one U.S. national parent ². However, there are some residency requirements for the parents before the birth of the child to transmit U.S. nationality ².
In the past, people born in Guam, Puerto Rico, the U.S. Virgin Islands, or the Philippines were also U.S. nationals, but not U.S. citizens ². However, these territories have changed their status over time, and now most of them grant U.S. citizenship to their residents ². The Philippines became an independent country in 1946 and never granted U.S. citizenship to its people ².
The main difference between a U.S. citizen and a non-citizen U.S. national is that a non-citizen U.S. national cannot vote in federal elections or hold any federal elected office ¹ ². They also cannot serve on a jury or claim any right or benefit that is reserved for U.S. citizens only ¹.
On the other hand, a non-citizen U.S. national has the same rights to live and work in the United States as a U.S. citizen does, and this right is irrevocable, unlike a lawful permanent resident (LPR) status ¹ ². A non-citizen U.S. national can also apply for a U.S. passport, which will indicate their nationality as “USA” but not their citizenship ¹ ². They can also receive consular protection from the U.S. government when abroad, and apply for U.S. citizenship through naturalization after just three months of residency ¹ ².

3- A person who works for an employer that offers health insurance as part of their benefits package. This person can choose to enroll in their employer-sponsored health plan, or shop for a different plan on the Marketplace³.

This is a broad category that includes many different types of immigrants who have permission to live or work in the United States, such as green card holders, refugees, asylees, visa holders, and more. Here are some more details about this category:

A lawfully present immigrant is a person who has a valid immigration status that allows them to reside in the United States legally¹. This term covers a wide range of immigration statuses, such as:
1. Lawful permanent residents (LPRs) or green card holders
2. Refugees and asylees
3. Temporary Protected Status (TPS) recipients
4. Special Immigrant Juveniles (SIJs)
5. Asylum applicants
6. Convention Against Torture (CAT) applicants or beneficiaries
7. Victims of trafficking and their derivatives
8. Valid non-immigrant visa holders, such as students, tourists, workers, etc.
9. Legal status conferred by other laws, such as the LIFE Act, Family Unity Program, etc.

A lawfully present immigrant can enroll in health coverage through the Health Insurance Marketplace®, which is a website where people can compare and buy health insurance plans¹ ².

To enroll in health coverage through the Marketplace, a lawfully present immigrant needs to:

Create a Marketplace account on HealthCare.gov ³. This requires entering some basic information, such as name, address, email address, username, password, and security questions. If the state has its own Marketplace website, the person will be redirected there after entering their state of residence ³.
Get ready to apply by gathering some documents and information, such as immigration status, income, household size, current health coverage, etc ³.
Submit an application online, by phone, by mail, or in person with the help of a trained assister³ ⁴. The application will ask for personal and financial information to determine the eligibility for health coverage and savings on monthly premiums and out-of-pocket costs ³.

Get eligibility results right away after submitting the application. The results will show if the person qualifies for:

A health insurance plan with savings based on income. The savings can lower the monthly premium and out-of-pocket costs for deductibles, copayments, and coinsurance ³.
Medicaid or the Children’s Health Insurance Program (CHIP), which are public health insurance programs for low-income people and children ³.

Enroll in a health plan of their choice by comparing the available options and selecting the one that best suits their needs and budget ³. The enrollment must be completed by the deadline to get coverage that starts on the first day of the next month ³.

4- A person who has a disability or a long-term nursing or custodial care need. This person may qualify for health insurance through social insurance programs such as Medicare or Medicaid, depending on their income and eligibility criteria³.

This is a common way for many Americans to get health insurance coverage, as employers often offer health benefits to their employees as part of their compensation package. Here are some more details about this option:

An employer-sponsored health plan is a healthcare plan that employers provide for the company’s workforce and their dependents ¹. The employer is responsible for choosing the plan and determining exactly what it covers. Employers and employees typically share the cost of health insurance premiums ¹.
To enroll in an employer-sponsored health plan, an employee must first become eligible for the coverage. Eligibility rules vary by employer, but usually depend on factors such as the employee’s job status, hours worked, length of service, etc². Some employers may require a waiting period before new hires can enroll in the plan ².

Once an employee is eligible for the coverage, they can enroll in the plan during one of the following periods:

The initial enrollment period, which is when the employee first becomes eligible for the plan. The employee usually has a limited time window to enroll, such as 30 or 60 days from the date of eligibility ².
The annual open enrollment period, which is when the employee can make changes to their existing coverage or enroll for the first time if they missed the initial enrollment period. Open enrollment for small employers usually is the month prior to renewal date of the policy and lasts about one or two weeks ². During this time employees receive plan materials, have a chance to ask questions about plan choices and enroll in a plan ².
The special enrollment period, which is when the employee can enroll or make changes to their coverage due to certain qualifying life events, such as marriage, divorce, birth, adoption, loss of other coverage, etc. The employee must request a special enrollment period within 30 days of the qualifying event and provide proof of the event³.

To enroll in an employer-sponsored health plan, an employee must complete an enrollment form and submit it to their employer or the plan administrator. The form may be paper-based or online, depending on the employer’s preference. The form will ask for personal information, such as name, address, date of birth, social security number, etc., as well as information about the employee’s dependents and plan selection ².
After enrolling in an employer-sponsored health plan, an employee will receive a confirmation notice and an identification card from the plan. The employee should review the notice and card carefully and contact the plan or the employer if there are any errors or questions. The employee should also keep the card handy and present it when seeking medical services covered by the plan².

To apply for American health insurance step by step, you can follow these general guidelines:

First, you need to determine if you are eligible for health coverage through the Health Insurance Marketplace®, which is a website where you can compare and buy health insurance plans. You can use this tool to check your eligibility based on your income, household size, and other factors ¹.
Second, you need to create a Marketplace account on HealthCare.gov ². This requires entering some basic information, such as your name, address, email address, username, password, and security questions. If your state runs its own Marketplace, you will be redirected to their website after entering your state of residence ².
Third, you need to submit an application online, by phone, by mail, or in person with the help of a trained assister ² ³. The application will ask for personal and financial information to determine your eligibility for health coverage and savings on monthly premiums and out-of-pocket costs ².
Fourth, you need to get your eligibility results right away after submitting the application. The results will show if you qualify for a health insurance plan with savings based on your income, or for Medicaid or the Children’s Health Insurance Program (CHIP), which are public health insurance programs for low-income people and children ².
Fifth, you need to enroll in a health plan of your choice by comparing the available options and selecting the one that best suits your needs and budget ² ³. You must enroll by the deadline to get coverage that starts on the first day of the next month ².
Sixth, you need to pay your first premium to activate your coverage. You can pay online, by phone, by mail, or in person depending on your plan and payment method ³ ⁴. You should also review your confirmation notice and identification card from the plan and contact them if there are any errors or questions ³ ⁴.

I hope this helps you understand how to apply for American health insurance step by step. If you have any questions or need more information, please visit HealthCare.gov or call 1-800-318-2596. TTY users can call 1-855-889-4325. You can also find local help in your area by using this tool.

Related articles

1- A U.S. citizen who lives in the United States and does not have Medicare coverage. This person is eligible to enroll in health coverage through the Marketplace1.

2- A lawfully present immigrant who lives in the United States and does not have Medicare coverage. This person can also enroll in health coverage through the Marketplace, depending on their immigration status12.

3- A person who works for an employer that offers health insurance as part of their benefits package. This person can choose to enroll in their employer-sponsored health plan, or shop for a different plan on the Marketplace3.

4- A person who has a disability or a long-term nursing or custodial care need. This person may qualify for health insurance through social insurance programs such as Medicare or Medicaid, depending on their income and eligibility criteria3.

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1- A U.S. citizen who lives in the United States and does not have Medicare coverage. This person is eligible to enroll in health coverage through the Marketplace¹.

2- A lawfully present immigrant who lives in the United States and does not have Medicare coverage. This person can also enroll in health coverage through the Marketplace, depending on their immigration status¹ ².

3- A person who works for an employer that offers health insurance as part of their benefits package. This person can choose to enroll in their employer-sponsored health plan, or shop for a different plan on the Marketplace³.

4- A person who has a disability or a long-term nursing or custodial care need. This person may qualify for health insurance through social insurance programs such as Medicare or Medicaid, depending on their income and eligibility criteria³.