Getting health care in the United States comes down to figuring out which coverage path fits your situation: your age, income, employment status, and where you live. Most people qualify for at least one affordable option, whether that’s employer coverage, a government program, or a subsidized marketplace plan. Here’s how to find the right one.
Check if You Qualify for Medicaid
Medicaid is free or very low-cost health coverage for people with limited income. In states that have expanded Medicaid under the Affordable Care Act, adults earning up to 138% of the federal poverty level qualify. For a single person, that’s roughly $21,600 per year. For a family of four, the cutoff is about $44,400. Children, pregnant individuals, and people with disabilities often qualify at higher income levels.
Eligibility rules vary by state, so your first step is checking your state’s Medicaid website or calling your local Department of Human Services. There’s no limited enrollment window for Medicaid. You can apply any time of year, and coverage can start as soon as the month you apply.
Use the Marketplace if You Don’t Have Employer Coverage
If you don’t get insurance through a job and earn too much for Medicaid, the health insurance marketplace is your main option. Most states use the federal site, HealthCare.gov. However, 21 states and the District of Columbia run their own enrollment platforms, including California, New York, Colorado, Massachusetts, Georgia, Virginia, and others. If you’re in one of those states, you’ll apply through your state’s website instead.
Open enrollment for 2026 plans started on November 1, 2025, and nearly 22.8 million people signed up during the most recent enrollment period. If you missed open enrollment, you can still get a plan through a special enrollment period triggered by a qualifying life event: losing other coverage, getting married or divorced, having a baby, or moving to a new area. You typically have 60 days from the event to enroll.
Financial Help With Premiums
Most marketplace shoppers qualify for premium tax credits that lower monthly costs. For the 2026 tax year, households earning between 100% and 400% of the federal poverty level are eligible for these credits, which are applied directly to your monthly bill so you pay less upfront. If your income is at or below 250% of the poverty level, you may also qualify for cost-sharing reductions that lower your deductibles and copays.
When you apply, you’ll need your most recent tax return or W-2s to verify income. If your income has changed since you last filed taxes, bring recent pay stubs or documentation of your current earnings. You’ll also need to verify your identity, citizenship, or immigration status.
Employer-Sponsored Insurance
If your employer offers health insurance, that’s often the most straightforward path. Most companies hold an annual open enrollment period, usually in the fall, when you can sign up or change plans. Outside of that window, you need a qualifying life event to enroll: losing other coverage, getting married, having a child, or your spouse losing their job-based plan. A reduction in work hours that makes you ineligible also counts.
Employers typically pay a significant share of the premium, making this one of the more affordable options. If you were offered coverage when you were hired and declined it, you’ll generally need to wait for the next open enrollment or experience a qualifying event to get back in.
Medicare for People 65 and Older
Medicare covers people aged 65 and older, as well as younger people with certain disabilities or who need regular dialysis or a kidney transplant. If you’ve been receiving Social Security benefits for at least four months before turning 65, you’re automatically enrolled in both hospital coverage (Part A) and outpatient coverage (Part B).
Part A is free for most people, as long as you or a spouse paid into the system through payroll taxes during your working years. Part B carries a monthly premium. If you aren’t automatically enrolled, you’ll need to sign up during your initial enrollment period, which is the seven-month window surrounding your 65th birthday. Missing this window can result in late-enrollment penalties that permanently increase your premiums.
Bridging a Gap Between Plans
If you recently left a job that provided insurance, COBRA lets you temporarily continue your employer’s plan for 18 to 36 months depending on your situation. The catch is cost: you pay the full premium yourself, plus a 2% administrative fee. That often means paying several hundred dollars more per month than you were paying as an employee. COBRA can be worth it if you’re mid-treatment or close to qualifying for another plan, but for many people a marketplace plan with premium tax credits is cheaper.
Short-term health plans are another stopgap, but they come with serious limitations. Federal rules cap these plans at three months, with a maximum total coverage period of four months including renewals. They typically don’t cover preexisting conditions, prescription drugs, or mental health care, and they don’t count as comprehensive coverage under the ACA.
Care Without Insurance
If you don’t have coverage right now, community health centers (also called Federally Qualified Health Centers) provide primary care, dental services, mental health care, and prescriptions on a sliding fee scale based on your income. If you earn at or below the federal poverty level, you receive a full discount and may pay nothing or only a small nominal fee. Partial discounts apply up to 200% of the poverty level, with at least three discount tiers in between. Above 200%, you pay the standard rate.
There are roughly 1,400 community health center organizations operating across the country with thousands of individual sites. You can find one near you at findahealthcenter.hrsa.gov. These centers are required to see you regardless of your ability to pay or insurance status, making them one of the most reliable options for anyone who is currently uninsured.
How to Start Right Now
Your fastest path depends on your income and situation:
- Income below 138% of the poverty level: Apply for Medicaid through your state’s website. No enrollment deadline.
- Income above 138% of the poverty level, no employer plan: Apply at HealthCare.gov or your state’s marketplace during open enrollment or after a qualifying life event.
- Employer offers coverage: Enroll during open enrollment or within 30 to 60 days of a qualifying event like a new job or loss of other coverage.
- Age 65 or older: Enroll in Medicare during your initial enrollment period around your 65th birthday.
- No coverage and need care now: Visit a community health center, where fees are based on what you can afford.
Gather your income documents, Social Security number, and any notices about lost coverage before you start the application. Most applications, whether for Medicaid, Medicare, or a marketplace plan, can be completed online in under an hour.