Common Pitfalls

Almost everyone has a health coverage option, even if you have a disability. The exact coverage that’s right for you depends on things like your family’s income, whether you can get employer-sponsored coverage, your age, where you live, and whether you have a disability.

If you can get employer-sponsored coverage or public health coverage, like Medicare or Medicaid, they are probably your best options.

If you cannot get health coverage from any of the above options and your family’s income is at or below 400% of the Federal Poverty Guidelines (FPG), which is $62,600 for an individual ($128,600 for a family of four), the government may help you pay your monthly premium via a tax credit. Note: From 2021 through 2025, there was no income limit for getting subsidies that help pay individual coverage premiums. However, a 400% of FPG income limit is set to return for 2026. DB101 will be updated if there are any changes.

kynect is the best way to get an individual plan. There are four big reasons it is best to use kynect:

1. It’s the only place where you can get government help paying for your premiums and other health expenses. To get this help, your family’s income has to be between 138% and 400% of the Federal Poverty Guidelines ($62,600 for an individual; $128,600 for a family of four).
2. It will automatically check if you or your family might qualify for a public health coverage program like Medicaid and will let you know how to apply for it instead of an individual plan.
3. kynect has customer services representatives available over the phone at 1-855-459-6328, 1-855-306-8959, or 1-800-627-4720 (TTY). You can also get local help.
4. It’s totally free – there are no commissions and no hidden fees.

When making decisions about health coverage and comparing different plans, make sure you understand all of a plan’s costs, which can include:

• Premiums, a monthly amount that has to be paid whether or not you use medical services. If you have employer-sponsored coverage, your employer pays part or all of the premium and you pay whatever the employer doesn’t pay. If you have individual coverage, you pay the entire premium, though the government may help you pay through tax subsidies if your income is low enough.
• Copayments, a set amount you have to pay for a medical visit or service. The exact amount of the copayment depends on the service you get: Medications, visits to specialists, lab tests, X-rays, emergency room visits, and other services can all have different copayment amounts.
• Co-insurance, a set percentage of the cost of a visit or service that you must pay.
• A deductible, a set amount of money that you pay out of your own pocket each year before the insurance company will begin to pay for certain services, including hospital care, emergency room visits, and brand-name prescription drugs. Once you have paid the deductible, you do not have to pay it again until the next calendar year.

Medicaid used to be mainly for people with disabilities, seniors, children, and pregnant women. Now, it is for anybody with low income (at or below 138% of the Federal Poverty Guidelines (FPG), $21,597 for an individual; $44,367 for a family of four). No matter how much money you have in the bank or what your health situation is, you could qualify.

A quick online pre-screening process lets you see if you might qualify for Medicaid, or other programs.

In the past, people feared that if they got a job while they were on Medicaid, they’d lose their coverage, because they would no longer have low enough income to qualify.

Now, if you lose one health coverage option, there should be another one you can get. If you lose your Medicaid coverage, you should be able to get employer-sponsored coverage or private individual coverage. And, if you can’t afford individual coverage, the government may help you pay for it.

The bottom line: There is a coverage option for most people. Do not worry that getting a job will leave you without health coverage.