Cost and Payments

Costs for both job-based and individual insurance vary. Beginning in 2014, many Americans, including American Indians and Alaska Natives, will be eligible for new tax credits to help them afford the cost of insurance purchased through Affordable Insurance Exchanges.

It depends. Policies that cover more tend to cost more. In addition, in most states, premiums for individual health insurance depend on your health status, age, gender, and other characteristics.

Under the Affordable Care Act, this will change. Starting in 2014, new individual insurance policies (and job-based plans) won’t be allowed to charge you more based on your health status, pregnancy, or disability. Also, insurers won’t be allowed to charge you more based on your gender, and there will be limits on how much premiums can vary based on age.

For job-based health plans, it’s up to tribal governments or other employers to decide how much of the premium to pay on behalf of you and your family. Your employer will tell you how much of the premium for health coverage you must pay.

You may be able to qualify for Medicaid coverage during your pregnancy. If so, Medicaid can help you pay for the premiums and other cost sharing under your job-based health plan. Medicaid income eligibility rules vary by state. In all states pregnant women are eligible if their income is below about $20,000 a year, and in most states women with higher incomes can qualify.

Starting in 2014, if your job doesn’t offer health coverage, or your job-based plan costs more than 9.5% of your income, you can apply for a tax credit to help pay for insurance coverage purchased through an Affordable Insurance Exchange. An Exchange is a new transparent, competitive marketplace where individuals and small businesses can buy affordable health benefit plans. Exchanges will offer you a choice of plans that meet certain benefits and cost standards.

Under the Affordable Care Act, American Indians and Alaska Natives who are below 300% of the Federal Poverty Line and are enrolled in any qualified health plan through an Exchange, are exempted from cost sharing.

For more information on the insurance marketplace, including costs, see Insurance Basics.