How to Apply for Health Insurance Under 65

May 12, 2025

doctor examining man with stethoscope on chest

Healthcare can be expensive, but having the right insurance plan can make all the difference. Whether it’s a simple check-up or an unexpected emergency, health insurance ensures you get the care you need without facing overwhelming bills. If you’re under 65 and looking for coverage, understanding your options is the first step.

This guide breaks down the different health insurance options, when and how to enroll, and the steps to apply. Whether you’re considering employer-sponsored insurance, an ACA Marketplace plan, Medicaid, or private coverage, this article will help you navigate the process efficiently.

Why Health Insurance Matters for Individuals Under 65

According to the Kaiser Family Foundation (KFF), medical bills are a leading cause of personal bankruptcy in the U.S. In 2023, the average hospital stay cost exceeded $12,000 without insurance. Health coverage not only helps manage these expenses but also ensures access to essential medical care.

Key Benefits of Health Insurance

  1. Access to Preventive Care: Many insurance plans cover preventive services such as vaccinations, screenings, and annual check-ups at no additional cost.
  2. Financial Protection: Health insurance helps cover costs associated with emergency care, hospitalizations, prescriptions, and chronic conditions.
  3. Legal Compliance: Under the ACA, most individuals must have minimum essential coverage to avoid potential penalties.
  4. Access to a Wide Network of Providers: Insurance plans allow access to doctors, specialists, and hospitals, ensuring you receive care when needed.
  5. Lower Prescription Costs: Many plans offer coverage for prescription medications, reducing the financial burden of essential drugs.

Health Insurance Options for Individuals Under 65

Health insurance availability depends on employment status, income level, and personal needs. Here are the primary coverage options:

1. Employer-Sponsored Health Insurance

Most full-time employees receive health insurance through their jobs, where employers cover 75%-85% of the premium costs on average.

Enrollment Process:

  • Open Enrollment Period: Occurs once a year and typically lasts 2-4 weeks.
  • Special Enrollment Period (SEP): If you experience a qualifying life event (job loss, marriage, childbirth), you can enroll outside of open enrollment.

2. ACA Marketplace (Obamacare) Plans

The Affordable Care Act (ACA) established the Health Insurance Marketplace, where individuals can compare and purchase health plans that meet ACA coverage standards.

The Health Insurance Marketplace at HealthCare.gov allows individuals to compare and purchase insurance plans covering essential health benefits such as:

  • Hospitalization, maternity, and emergency care
  • Mental health services
  • Prescription medications
  • Preventive and chronic disease management

Financial Assistance

  • Premium Tax Credits: Available for individuals earning 100%–400% of the Federal Poverty Level (FPL), reducing monthly costs.
  • Cost-Sharing Reductions (CSRs): Help lower deductibles and copayments for those earning 100%–250% of the FPL.

3. Medicaid & CHIP

Medicaid and CHIP provide low-cost or free health coverage to eligible individuals and families. These programs are state-run, with specific eligibility requirements based on income, household size, and other factors.

  • Medicaid: Covers low-income adults, seniors, and people with disabilities. Eligibility varies by state, but the 2024 income limit for a single adult is $20,120 per year.
  • CHIP (Children’s Health Insurance Program): Offers low-cost coverage for children and pregnant women in families that earn too much for Medicaid.

Applications for Medicaid and CHIP are open year-round and can be completed through HealthCare.gov or state agencies.

4. Private Health Insurance Plans

For those who don’t qualify for employer-based or ACA coverage, private health insurance offers alternatives, including:

  • HMO (Health Maintenance Organization): Requires members to use a designated network of doctors and hospitals.
  • PPO (Preferred Provider Organization): Offers flexibility to see out-of-network doctors at a higher cost.
  • Short-Term Health Plans: Temporary coverage for 30 days to 12 months but often excludes pre-existing conditions.

5. COBRA Coverage

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), individuals who lose employer-sponsored coverage can continue the same health plan for up to 18-36 months, but must pay the full premium plus a 2% fee.

When Can You Apply for Health Insurance?

Understanding the enrollment periods for different types of health insurance is essential to avoid coverage gaps. Missing the enrollment window can leave you uninsured for months or force you to rely on limited options like short-term health plans.

1. Open Enrollment Periods

  • ACA Marketplace Plans: Open Enrollment runs from November 1 to January 15. Coverage begins January 1 if enrolled by December 15.
  • Employer-Sponsored Plans: Companies set their own enrollment windows, usually once per year.

2. Special Enrollment Periods (SEP)

A 60-day enrollment window is available for individuals who experience:

  • Loss of previous health coverage
  • Marriage, divorce, or birth/adoption of a child
  • Relocation to a new coverage area
  • Changes in household income affecting subsidy eligibility

3. Medicaid & CHIP Enrollment

These programs do not have restricted enrollment periods—you can apply anytime if you qualify.

How to Apply for Health Insurance

Applying for health insurance can feel overwhelming, but breaking it down into clear steps makes the process easier. Whether you’re enrolling in an ACA Marketplace plan, employer-sponsored coverage, Medicaid, or a private plan, the following guide will help ensure a smooth application.

1. Gather Required Information

Before applying, collect:

  • Social Security numbers (SSN) & personal details
  • Income verification (pay stubs, tax returns)
  • Employer-sponsored insurance details (if applicable)
  • List of current prescriptions and doctors

2. Compare Plans & Costs

  • Premium vs. Deductible Trade-Off: Higher premiums mean lower out-of-pocket costs, while lower premiums increase deductibles and copays.
  • Provider Networks: Check if your preferred doctors and hospitals are in-network.
  • Prescription Drug Coverage: Verify if necessary medications are covered.

3. Submit an Application

  • ACA Marketplace: Apply at HealthCare.gov or a state exchange.
  • Employer Insurance: Follow your HR department’s instructions.
  • Medicaid/CHIP: Apply via your state’s Medicaid office.
  • Private Plans: Contact insurers directly or use a licensed broker.

4. Pay Your First Premium

Your coverage does not start until you pay your first premium. Insurers typically send a payment notice with instructions after enrollment.

To avoid coverage lapses, consider setting up automatic payments. If you miss your first premium deadline, your coverage may be canceled before it starts.

 

Tips for Choosing the Right Health Insurance Plan

Selecting the right health insurance plan involves more than just comparing monthly premiums. The best plan for you depends on your healthcare needs, budget, and provider preferences. Here are key factors to consider before making a final decision.

  1. Evaluate Total Costs: Look beyond premiums—consider deductibles, copays, and out-of-pocket maximums.
  2. Check Coverage for Chronic Conditions & Medications: Make sure prescriptions and specialist care are included.
  3. Confirm Provider Networks: Avoid out-of-network costs by ensuring your doctors accept the plan.
  4. Assess Additional Benefits: Look for perks like telehealth, wellness programs, and vision/dental coverage.

Conclusion

Finding the right health insurance plan can feel overwhelming, but it’s an important step in protecting both your health and finances. Whether you’re getting coverage through your job, the ACA Marketplace, Medicaid, or a private insurer, the key is choosing a plan that meets your needs.

Taking the time to compare plans and understand enrollment deadlines ensures you won’t face unexpected medical expenses without coverage. The right plan gives you peace of mind, knowing that you’ll have access to care when you need it most.

Visit Healthcare.gov or speak with a licensed insurance agent to find the best plan for your needs.