How Health Benefits Work Show
Where can I sign up for health coverage?How you sign up depends on the type of coverage you get:
If my job offers me health coverage, can I still qualify for Medicaid or get subsidies for an individual plan on Healthcare.gov?You can qualify for Medicaid if your family’s income qualifies, even if your job offers insurance. You cannot get subsidies for purchasing an individual health plan through Healthcare.gov if your job offers you affordable insurance. Does it matter how I qualify for Medicaid?In most cases, no. The actual medical coverage you get from Medicaid is the same, no matter how you qualify. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and, if you have a disability and start working, you can earn a lot more while still getting Medicaid coverage through Freedom to Work. What is the most money I can make and still get Medicaid?For income-based Medicaid, the main income rules are:
Income-based Medicaid is based on your Modified Adjusted Gross Income (MAGI), which includes most of your earned and unearned income. (That's why some people call it "MAGI Medicaid.") MAGI doesn't include some types of income, like Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility. If you have a disability, you may be able to get Medicaid coverage if your income is a lot higher than this, thanks to the Freedom to Work program. Once you have Freedom to Work coverage, you can keep your coverage no matter how much you earn. Learn more about Freedom to Work. Health Coverage Income Limits for Your Family
I’m an immigrant. Can I get Medicaid?It depends on your situation:
What happens to my Medicaid coverage if I go back to work?There are different health coverage options as your income goes up:
The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage. Who qualifies for Freedom to Work?To qualify for Medicaid's Freedom to Work program, you must:
You have to pay a monthly premium to get Freedom to Work coverage in any month where your income is higher than $1,563 (if you are single). The more income you have, the higher your premium. To learn how much your premium might be, try DB101's Freedom to Work Estimator. How many programs does Medicare offer?Medicare has three main parts:
Medicare Advantage (also called Medicare Part C) is a way to get a single combined plan including Parts A, B, and D through a private company. With Medicare Advantage plans, you may have less flexibility, but your costs could be lower. How do I become eligible for Medicare?If you or your spouse worked enough time while paying Medicare taxes, you qualify for Medicare Parts A and B:
Note: If your disability began before you turned 22 years old and you get Disabled Adult Child (DAC) benefits for two years based on a parent’s work record, you start getting Medicare. Does Medicare pay for all of my medical expenses?No. Medicare only helps pay for care that it considers reasonable and necessary. If you need a service that Medicare doesn’t cover, you have to pay for it yourself, unless you have other coverage, such as Medicaid, employer-sponsored coverage, or a Medicare supplement (Medigap) policy. For certain services, you pay a deductible, copayment, or co-insurance before Medicare begins to help pay for that service. For Medicare Part B or Part D, or for Medicare Advantage, you may have to pay a monthly premium. You may qualify to get help paying for your Medicare premiums, copayments, and deductibles if you have low income. Medicare Savings Programs help pay for Part B coverage and the Low Income Subsidy (LIS) helps pay for Part D coverage. How much does employer-sponsored health coverage cost and who pays for it?You may pay nothing, a percentage of the cost, or whatever amount your employer doesn't pay. Employers are supposed to offer plans that cost the employee, for the employee’s policy alone, less than 9.61% of the employee’s family income for the monthly premium. Also, that coverage must meet bronze-level standards for copayment, co-insurance, and deductible expenses. If your employer offers a plan that does not meet these standards, you may qualify for government help through tax subsidies to reduce the premium on an individual plan. Note: The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan. Even so, anybody who can get employer-sponsored coverage, even if it is not affordable for the family member, does not qualify for tax subsidies to buy an individual plan on Healthcare.gov. Can I get coverage through my parent’s employer-sponsored insurance?Yes, if you are under 26 and cannot get health coverage through your own employer. Employers who offer coverage to their employees must also offer it to their children under the age of 26. Employers do not have to offer coverage to the spouses of employees, but many do. Note: While employers must offer this coverage to children, the employee may be required to pay for all of it. I have a disability. Can I really get insurance that covers my medical problems?Yes. Plans cannot deny people coverage. When you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability. Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer comprehensive coverage, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few. How does the government help people pay for individual coverage?Depending on your situation, you may qualify to have the government help pay for your individual health plan through tax credits. Here's how it works:
Do I have to get a silver level plan on Healthcare.gov if I want government help paying for my insurance?No, but depending on your income, you may get more help from the government if you get a silver-level plan:
When Healthcare.gov looks at your income, they count most of your earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage. Health Coverage Income Limits for Your Family
What happens if I sign up for an individual plan and then my income changes and I can no longer afford it?Usually, when you sign up for a plan through Healthcare.gov, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2022, then you can’t leave that plan until 2023. However, in certain situations you may be able to change plans mid-year:
The first one is the key. If your income goes down and you can’t afford your plan anymore, report your change in income to Healthcare.gov. You may qualify to get Medicaid or to have the government increase how much it pays for your current insurance (meaning that you have to pay less). Note: American Indians do not have these restrictions and can change up to once a month. Learn moreWhat is the highest income to qualify for Medicaid?Federal Poverty Level thresholds to qualify for Medicaid
The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.
What are some disadvantages of employer sponsored health insurance?Because group insurance is chosen by the employer, employees don't have a say in what network they'll be on, the deductible they'll need to meet, or the premium they'll have to pay. The lack of control and customization of group health plans doesn't make it as appealing to many individuals.
What is the income limit for Michigan Medicaid?Have income at or below 133% of the federal poverty level* ($16,000 for a single person or $33,000 for a family of four) Do not qualify for or are not enrolled in Medicare. Do not qualify for or are not enrolled in other Medicaid programs. Are not pregnant at the time of application.
What are the income limits for Colorado Medicaid?Who is eligible for Colorado Medicaid?. |