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How do I know if I qualify for health insurance?

The lowdown...
  • The Affordable Care Act was partially designed to ensure that every American has some access to care
  • Once, the main reason that you wouldn’t qualify for health insurance was because you were “too sick”
  • Qualifications for different health care programs are based on the kind of insurance that you are looking for
  • Qualifications for employer-based, Medicare, Medicaid and State Exchange (Obamacare) insurance is listed below

If you are looking to qualify for health care, there is some good news. The most common reason that people were unable to qualify for health care, pre-existing conditions, was no longer legally allowed when the Affordable Care Act was passed.

As long as this is the law of the land, pre-existing conditions cannot be used to disqualify anyone from obtaining insurance.

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However, the additional qualifications needed to get insurance will vary based on the kind of insurance that you get. Read on to discover the major forms of health care and the basic qualifications for each:

Employer-Based Insurance


This is the most common kind of insurance that Americans use. According to the Kaiser Family Foundation, employer-based insurance accounts for 49 percent of all kinds of health insurance.

This percentage is more than twice any other form of insurance.

Employer-based insurance is typically provided as a benefit that comes with many full-time jobs.

The ACA requires most employers of full-time workers to provide health care. Qualifications for this health care depend on the employer, but typically include:

  • A full-time position (or a position over a certain number of hours per week)
  • Good standing at work and the completion of a probationary period
  • The payment of the required portion of the premium

Job-based health care can include an employee and be extended to their family and dependents.


Medicare is provided to two basic kinds of people: seniors and those with disabilities. To qualify for disability-based medicare, you must first apply for Social Security. You can do this if you meet four qualifications:

  • 18 or older
  • Cannot work for at least a year
  • Not already receiving social security benefits
  • Have not had a denied application for at least 60 days

To receive medicare as a senior, you must meet a different set of qualifications:

  • You are 65 or older
  • You are no longer working and receiving other insurance
  • You are eligible for Social Security
  • You or your spouse worked in a job that contributed to Medicare for at least 10 years (you can still get medicare without this qualification, but you cannot get it premium-free)



Medicaid is a federal and state-based insurance program that is designed to help low-income individuals. Unlike Medicare, which has the same rules in every state, Medicaid rules vary by state.

This variation means you should look into your own state’s qualification rules if you are interested in applying for Medicaid. In some cases, you may qualify, but policies may be limited and you may be waitlisted.

You can discover if you qualify for Medicaid in two different ways.

  1. First, you can go to your state’s website and apply directly.
  2. Second, you can choose to go to the insurance exchange (Obamacare) and enter your information.

If you are qualified for Medicaid based on your personal information, then it will be presented to you as one of your choices.

Dependent Care

If you are under 26 and your parents have job-based health insurance, you can continue to remain on their health care plan if you do not have a job that offers health care.

This benefit has very few requirements outside of having a parent who qualifies for health insurance and pays any premiums required for you to remain on their plan.

Obamacare (Health Care Exchange)


For those who are not in jobs that provide insurance or qualified for the other forms of insurance, the final choice is the website. Here, you can enter your personal and financial information and your address.

This information will let the system know several different things:

  • Your income level
  • Your geographic region
  • Your family size
  • Any pre-existing conditions
  • Medical care that you currently need

This information can help the program to assess what plans are available and offer you your options. Higher deductible plans can be offset by tax credits for many people.

Eligibility Windows

While you may qualify for one or more of these insurance types, you may only enroll in two different situations.

Open enrollment situations occur once per year and allow you to make any changes you wish to your plans.

Special enrollment periods allow you to add someone to the plan mid-year, but you must meet certain requirements, some of which include:

  • Adding or dropping someone due to birth or death
  • A dependent turning 26 and leaving your health plan
  • New employment or termination
  • Marriage or divorce
  • Incarceration or release

The good news about qualifying for insurance is that it’s not a matter of if, just which plan you qualify for. This guarantee will remain true as long as the Affordable Care Act is in place and that requirement is in the laws.

To learn more about which plans are best for you, visit the Health Care Exchange, look at your state requirements, or speak with your HR administrator.

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