How to Apply for Health Insurance Under 65

May 12, 2025

doctor examining man with stethoscope on chest

*Updated January 7th, 2026

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

This guide breaks down common options for health insurance, when and how to enroll, and the steps to apply. Whether you’re considering employer-sponsored coverage, an ACA health health insurance marketplace marketplace plan, Medicaid, COBRA, or private health medical insurance, this article will help you find health insurance efficiently, especially if you plan to retire early or are retiring before 65.

Why Health Insurance Matters for Individuals Under 65 (Including an Early Retiree)

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 helps manage these expenses and supports access to ongoing care. This is important for anyone, but especially for an early retiree navigating retirement health insurance options before becoming eligible for Medicare.

Key Benefits of Health Insurance

  • Access to Preventive Care: Many insurance plans cover preventive services such as vaccinations, screenings, and annual check-ups at no additional cost.

  • Financial Protection: Health insurance helps cover costs associated with emergency care, hospitalizations, prescriptions, and chronic conditions, reducing out-of-pocket costs.

  • Legal Compliance: Under the Affordable Care Act, most individuals should maintain qualifying insurance coverage (rules vary and change over time).

  • Access to a Wide Network of Providers: A health plan can connect you to doctors, specialists, and hospitals, helping you get care when needed.

  • Lower Prescription Costs: Many insurance plans include prescription benefits that can reduce ongoing medication costs.

Health Insurance Options for Individuals Under 65

Health insurance options depend on employment status, household income, and your situation—like whether you’re a working professional, a retiree who left the workforce, or an early retiree who plans to retire before age 65. Here are common ways to get health care coverage:

1. Employer-Sponsored Health Insurance

Most full-time employees get health insurance through work, where employers often share the premium cost.

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 may qualify for a special enrollment period and can enroll outside open enrollment.

If you’re planning early retirement, confirm when your employer coverage ends. Losing a group health plan can trigger a special enrollment period for other coverage.

2. Health Insurance Marketplace (Marketplace) Plans (ACA Health)

The Affordable Care Act created the Health Insurance Marketplace, where you can compare plan options available and purchase a compliant health insurance marketplace plan.

The federal health insurance marketplace on HealthCare.gov lets you compare a plan through the marketplace that covers essential health benefits, such as:

  • Hospitalization, maternity, and emergency care

  • Mental health services

  • Prescription medications

  • Preventive care and chronic disease management

Financial Assistance

  • Premium tax credits: Many people qualify based on income, which can reduce monthly premium costs.

  • Cost-sharing reductions (CSRs): May lower deductibles and copays depending on income and eligibility.

For an early retiree, an enroll in a marketplace plan option is often one of the most practical retirement health insurance options when you’re yet eligible for Medicare.

3. Medicaid & CHIP

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

  • Medicaid: Covers low-income adults and people with disabilities. Eligibility varies by state.

  • CHIP: Offers low-cost coverage for children and pregnant people in families that earn too much for Medicaid.

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

4. Private Health Insurance Plans

If you don’t qualify for employer coverage or an ACA plan, private health medical plans may be an option through an insurance company (often via an insurance agent or broker). Common plan types include:

  • HMO (Health Maintenance Organization): Requires members to use a designated network.

  • PPO (Preferred Provider Organization): Offers flexibility to see out-of-network providers at a higher cost.

  • Short-Term Health Plans: Temporary coverage, but may not cover pre-existing conditions and typically provides more limited insurance coverage.

5. COBRA Coverage

COBRA allows people who lose employer coverage to keep the same group health plan for up to 18–36 months, but you usually pay the full premium plus a 2% administrative fee.

This can be useful for a retiree or early retiree who needs short-term continuity of care while planning the next step—like switching to a marketplace option or preparing to sign up for Medicare when you turn 65.

When Can You Apply for Health Insurance?

Understanding enrollment timing is essential to avoid gaps in health coverage—especially if you’re retiring before 65 and transitioning away from a group health benefit.

1. Open Enrollment Periods

  • ACA Marketplace Plans: The annual open enrollment period typically runs from November 1 to January 15 (dates can vary by year/state). Coverage often starts January 1 if enrolled by mid-December.

  • Employer Plans: Employers set their own enrollment windows, usually once per year.

2. Special Enrollment Periods

A typical 60-day window may apply if you experience qualifying events, such as:

  • Losing health coverage (including employer coverage or COBRA ending)

  • Marriage, divorce, birth/adoption

  • Moving to a new coverage area

  • Changes in household income impacting subsidies

If you’re retiring before 65, losing employer coverage is one of the most common reasons you may qualify for a special enrollment and can enroll in a marketplace plan outside open enrollment.

3. Medicaid & CHIP Enrollment

These programs usually allow you to apply anytime if you qualify.

How to Apply for Health Insurance

Applying for online health insurance can feel overwhelming, but breaking it down into steps helps—whether you’re applying through HealthCare.gov, your employer, Medicaid, or a private insurance plan.

1. Gather Required Information

Before you apply for coverage, collect:

  • Social Security numbers and personal details

  • Income verification (pay stubs, tax returns)

  • Employer coverage details (if applicable)

  • A list of prescriptions and preferred doctors

2. Compare Plans & Costs

  • Consider the cost of health coverage beyond the monthly premium: review deductibles, copays, and out-of-pocket maximums.

  • Provider networks: confirm your doctors and hospitals are in-network.

  • Prescription coverage: verify key medications are included.

3. Submit an Application

  • Health Insurance Marketplace: Apply at HealthCare.gov or your state exchange to enroll online.

  • Employer coverage: follow HR instructions.

  • Medicaid/CHIP: apply via your state Medicaid office or through HealthCare.gov where available.

  • Private plans: contact insurers directly or work with a broker/agent.

4. Pay Your First Premium

Coverage typically doesn’t start until you pay your first premium. Set up auto-pay if possible to prevent coverage lapses.

Tips for Choosing the Right Health Insurance Plan

Selecting the right health insurance plan involves more than comparing monthly premium amounts. The best plan depends on your needs, budget, and provider preferences—especially if you’re an early retiree managing a multi-year runway to Medicare.

  • Evaluate total costs: premiums + deductibles + copays + out-of-pocket costs

  • Check coverage for chronic conditions & medications

  • Confirm provider networks to avoid surprise charges

  • Review extra benefits (telehealth, wellness, vision/dental options)

Conclusion: Retirement Health Insurance Options and Preparing for Medicare at Age 65

Finding the right health insurance can feel overwhelming, but it’s an important step in protecting your health and finances. Whether you’re getting coverage through your job, the health insurance marketplace, Medicaid, COBRA, or private insurance, the goal is choosing a plan that fits your situation.

As you approach age 65, your focus may shift to Medicare eligibility. Many people sign up for Medicare during their initial enrollment period around when they turn 65, often involving Medicare Part A and Part B (including Part B) depending on your circumstances and other coverage.

To explore coverage, speak with a licensed insurance agent to compare options and choose the right health plan for your needs, now and as you plan for retirement and Medicare.