Health insurance before Medicare, explained in plain language
Buying your own coverage, self-employed, between jobs, or offering benefits to your employees? Here's where coverage comes from, what the common terms mean, and the dates that matter for 2027.
Where coverage comes from
Most people under 65 get health insurance in one of these ways. The right fit depends on your job, your income, your health, and how long you need coverage.
Employer coverage
A group plan through your job or a spouse's job. When it's offered, it's often the most affordable choice because the employer pays part of the premium.
Individual plans
Plans you buy yourself, through the Health Insurance Marketplace (HealthCare.gov) or directly from an insurance company. They must cover pre-existing conditions and essential health benefits. Financial help is only available through the Marketplace.
COBRA
Keeps your former employer's plan after you leave a job, usually for up to 18 months. You typically pay the full premium plus a small fee, so it can be expensive.
Short-term medical
Temporary coverage for a gap, such as between jobs. Premiums are usually lower, but these plans can exclude pre-existing conditions and don't have to cover every essential benefit.
Medicaid
Free or low-cost coverage for people with lower incomes. In Ohio, many adults qualify with household income up to 138% of the federal poverty level.
Coverage for your business
Group health plans for employers, or reimbursing employees for individual coverage through an arrangement called an ICHRA. Good benefits help you attract and keep employees.
Key terms
- Premium
- What you pay each month to keep your coverage, whether or not you use it.
- Deductible
- What you pay for covered care each year before the plan starts paying its share.
- Copay
- A flat fee for a service, such as $30 for a doctor visit.
- Coinsurance
- Your percentage of a bill after the deductible, such as 20%.
- Out-of-pocket maximum
- The most you'll pay for covered care in a year. After that, the plan pays 100%.
- Network
- The doctors and hospitals a plan works with. HMO, PPO, and EPO plans handle networks differently.
Individual plans vs. short-term medical
Both can cover you when you don't have a job-based plan, but they work very differently.
| Individual (ACA) plan | Short-term medical | |
|---|---|---|
| Pre-existing conditions | Covered. You can't be turned down. | Can be excluded, or you can be declined |
| Essential benefits | Required, including preventive care, prescriptions, maternity, and mental health | Not required. Benefits vary by plan. |
| When you can enroll | Open Enrollment, or within 60 days of a qualifying life event | Usually any time of year |
| Financial help | Premium tax credits through the Marketplace, if you qualify | None |
| Out-of-pocket costs | Capped each year by law | Limits vary by plan |
| How long it lasts | A full year, renewable | Temporary, with limits set by federal and state rules |
Key dates and deadlines
- Nov 1, 2026 – Jan 15, 2027
Open Enrollment for 2027
The yearly window to buy or change an individual plan. Enroll by December 15 for coverage that starts January 1.
- Within 60 days
Special Enrollment Period
Losing other coverage, moving, getting married, or having or adopting a baby can open a 60-day window to enroll outside Open Enrollment. You may need to show proof.
- Within 60 days
Electing COBRA
After leaving a job, you generally have 60 days from your COBRA notice to decide whether to keep your employer plan.
- Set by your employer
Employer open enrollment
Usually in the fall. It's your yearly chance to join, change, or drop a job-based plan.
- Turning 65
Moving to Medicare
Your Medicare enrollment window opens 3 months before your 65th birthday month. See our Medicare 101 guide.
What's different next year
Income range, as a share of the federal poverty level, that can qualify for Marketplace premium tax credits. For one person that's about $15,960 to $63,840. The extra subsidies of recent years have expired, so the 400% cutoff is back.
2027 Health Savings Account (HSA) limits for self-only and family coverage, plus $1,000 more if you're 55 or older.
Marketplace Bronze and catastrophic plans can now be paired with an HSA, so more people can save pre-tax for medical costs.
Many people will see higher premiums in 2027, and some insurers have changed their plan options. If you were automatically renewed, check that your plan still fits your doctors, prescriptions, and budget.
Filling the gaps
Health plans don't cover everything, and high deductibles can leave you exposed. These add-on policies can help.
- Dental and vision for checkups, cleanings, glasses, and contacts
- Hospital indemnity pays cash if you're hospitalized
- Accident coverage for injuries like sprains, fractures, and ER visits
- Critical illness pays a lump sum for a diagnosis such as cancer, heart attack, or stroke
- Life insurance to protect the people who depend on you
What to have on hand
- Your best estimate of your 2027 household income
- Names and birthdates of everyone who needs coverage
- A list of your doctors, hospitals, and prescriptions
- Details of your current coverage, or any job-based plan you've been offered
- For business owners: how many employees you have and what benefits you offer today
Have questions? Let's talk.
We'll walk you through your options one-on-one, at no cost and with no obligation. Whether you're buying your own coverage, between jobs, self-employed, or setting up benefits for your business, we'll help you compare plans and find the right fit.
This page is general information, not tax or legal advice. Income figures are estimates based on the 2026 federal poverty guidelines used for 2027 coverage; your actual eligibility is determined when you apply. Plan availability, prices, and rules vary and can change. For official Marketplace information, visit HealthCare.gov.