If your employer doesn’t offer health insurance, you’re not stuck going without coverage. Most employers in the U.S. are not legally required to provide it, and millions of workers get coverage through other channels. Your best options depend on your income, your household size, and whether you recently lost coverage or are starting fresh.
Most Employers Aren’t Required to Offer Coverage
Only companies with 50 or more full-time equivalent employees are legally required to offer health insurance under the Affordable Care Act’s employer mandate. The IRS calculates this by averaging total full-time and full-time equivalent employees across each month of the prior year. If the average hits 50, the company must offer coverage to full-time workers or face a penalty.
That penalty is roughly $2,000 per full-time employee per year (adjusted for inflation), minus the first 30 employees. If the company offers coverage but it’s unaffordable or doesn’t meet minimum standards, the penalty jumps to about $3,000 per employee who ends up getting subsidized Marketplace coverage instead. These penalties only apply to the employer, not to you. There is no federal penalty for individuals who go without insurance.
If your employer has fewer than 50 full-time equivalent employees, they have no obligation to offer you anything. That’s the reality for a huge portion of the American workforce, especially people at small businesses, startups, restaurants, and retail shops. The good news: you have several solid alternatives.
The Health Insurance Marketplace
The federal Marketplace (HealthCare.gov) and state-run exchanges are the most common path for people whose employers don’t offer coverage. Plans are organized into four tiers based on how much of your costs the plan covers versus what you pay out of pocket:
- Bronze: The plan covers about 60% of costs. You pay 40%. Deductibles are high, but monthly premiums are the lowest.
- Silver: The plan covers about 70%. Moderate deductibles and premiums.
- Gold: The plan covers about 80%. Lower deductibles, higher premiums.
- Platinum: The plan covers about 90%. Lowest out-of-pocket costs, highest premiums.
If you’re mostly healthy and want protection against a catastrophic event, Bronze may work. If you use healthcare regularly, Gold or Platinum will cost more each month but save you money when you actually need care. Silver plans have a unique advantage worth understanding, which is covered below.
Subsidies That Lower Your Costs
If your household income falls between 100% and 400% of the federal poverty level, you qualify for premium tax credits that directly reduce your monthly payment. For a single person in 2024, 100% of the poverty level is roughly $15,060, and 400% is about $60,240. These thresholds shift each year and change based on family size. Thanks to temporary expansions that Congress has repeatedly extended, people earning above 400% of the poverty level can also get some help, though the amount shrinks as income rises.
You can take the credit in advance (so your monthly premium drops immediately) or claim it when you file taxes. If your income changes during the year and you received too much in advance credits, you may need to repay some at tax time.
On top of premium credits, lower-income households can qualify for cost-sharing reductions that lower deductibles, copays, and coinsurance. There’s one catch: you only get these extra savings if you pick a Silver plan. If you enroll in Bronze, Gold, or Platinum, you can still use premium tax credits, but the cost-sharing reductions disappear. This is why financial advisors often recommend Silver plans for people with modest incomes, even if a Bronze plan looks cheaper at first glance.
Medicaid and CHIP
If your income is low enough, Medicaid may cover you at little to no cost. In the 40 states (plus Washington, D.C.) that have expanded Medicaid under the ACA, adults generally qualify with household incomes up to 133% of the federal poverty level. A handful of states, like Minnesota and New York, cover adults up to 200% through supplemental programs.
In the 10 states that haven’t expanded Medicaid (including Texas, Florida, Georgia, and Mississippi), eligibility for adults is far more limited. Parents and caretaker relatives may qualify, but income limits in some of these states are as low as 12% of the poverty level. Childless adults in non-expansion states often fall into a coverage gap: they earn too much for Medicaid but too little to qualify for Marketplace subsidies. If you’re in one of these states, it’s still worth applying through HealthCare.gov, because the system will check both Medicaid and Marketplace eligibility for you.
Children in low-income families are covered more broadly through the Children’s Health Insurance Program (CHIP), which extends to higher income levels than adult Medicaid in every state.
When You Can Enroll
Marketplace open enrollment typically runs from November 1 through mid-January for coverage starting the following year. Outside that window, you can only enroll if you experience a qualifying life event that triggers a special enrollment period. Common qualifying events include:
- Losing existing coverage: This includes losing employer-sponsored insurance (your own or a family member’s), aging off a parent’s plan, losing Medicaid or CHIP eligibility, or having an individual plan discontinued.
- Moving: Relocating to a new ZIP code or county, moving to the U.S. from abroad, or moving to or from the place you attend school or do seasonal work.
- Household changes: Getting married, having or adopting a baby, getting divorced and losing coverage, or a death in the household that causes you to lose your current plan.
- Income changes: If your household income drops and you newly qualify for Marketplace savings, that can also open a special enrollment window.
You generally have 60 days from the qualifying event to enroll. For Medicaid or CHIP losses, you get 90 days. Don’t wait until the deadline, because processing delays can leave you with a gap in coverage.
COBRA: Continuing Your Old Plan
If you recently left a job that did offer insurance, COBRA lets you stay on that same plan for up to 18 months (sometimes 36 months in certain situations). The downside is cost. While your employer likely paid a large share of the premium when you were employed, under COBRA you pay the full amount: both the employer’s portion and the employee’s portion, plus a 2% administrative fee. That means you could owe up to 102% of the total plan cost.
For many people, COBRA costs $500 to $700 or more per month for individual coverage. Compare that to a subsidized Marketplace plan before defaulting to COBRA. If you qualify for premium tax credits, the Marketplace will almost always be cheaper. COBRA makes the most sense when you’re mid-treatment with a provider who isn’t in any Marketplace plan’s network, or when you’ve already hit your deductible for the year.
Short-Term Health Insurance
Short-term plans are designed as temporary stopgaps, not long-term coverage. Under federal rules that took effect September 1, 2024, these plans can last no longer than 3 months, with total duration (including renewals from the same insurer) capped at 4 months within a 12-month period. Some states impose even tighter limits or ban short-term plans entirely.
These plans are typically cheaper than Marketplace coverage, but they come with serious trade-offs. They can deny coverage for pre-existing conditions, impose annual or lifetime benefit caps, and exclude categories of care like mental health or maternity. They also don’t count as qualifying coverage under state individual mandates where those exist. Short-term insurance works best as a bridge, for instance, if you’re between jobs and waiting for new employer coverage to kick in within a month or two.
State Individual Mandates
The federal individual mandate penalty was eliminated in 2019, so you won’t owe anything to the IRS for going uninsured. However, a few states and Washington, D.C. have their own mandates that carry tax penalties if you don’t maintain coverage. Massachusetts has had an individual mandate since before the ACA. California, New Jersey, Rhode Island, and D.C. also impose penalties. If you live in one of these places, going without insurance costs you at tax time on top of the obvious risk of uninsured medical bills.
Practical Steps to Get Covered
Start at HealthCare.gov (or your state’s exchange if your state runs its own). The application will determine whether you qualify for Medicaid, CHIP, or Marketplace coverage with subsidies, all in one process. You’ll need your Social Security number, income information (pay stubs or tax returns), and the ages and household details of everyone who needs coverage.
If your income is very low and you’re in a non-expansion state, also check with your state Medicaid office directly, because some categories of eligibility (pregnant women, people with disabilities, parents of young children) have different rules than the standard adult category. Community health centers offer care on a sliding fee scale regardless of insurance status, which can fill gaps while you sort out coverage.