Health Insurance Information Center

Health insurance can be difficult to understand and sometimes frustrating to handle. We’ve built this page to help you navigate the ins and outs of health insurance options. Here, you’ll find our health insurance guide for people with lupus, tips for managing finances, strategies to reduce health care costs and more. 

Why Do I Need Health Insurance?

For people with lupus, attending regular medical appointments, including routine lab tests, and following a prescribed treatment plan is essential.

Having health insurance often makes it easier to see health care providers and access specialists, such as rheumatologists, because insurers typically have broad provider networks.

Insurance can also help lower the out-of-pocket costs for visits, services, and prescribed medications, which can vary in price depending on treatment.

Health insurance helps make health care more affordable and accessible. Easier access to care can improve health outcomes and reduce financial stress for individuals and families. When healthcare costs are manageable, it becomes simpler and more practical to get the care you need.

What is Open Enrollment?

Open enrollment is a window of time each year when anyone can find a new health insurance plan through the Affordable Care Act (sometimes called the ACA or Obamacare) health insurance marketplace or change the plan they already have through the marketplace. This period usually runs from November 1 to January 15, with a December 15 deadline for coverage starting January 1.

Keep in mind that these dates are limited and can vary slightly from year to year, so it’s important to check the official ACA marketplace website each year to confirm the exact enrollment period. If you miss the window, you may have to wait until the next open enrollment period to get a new plan or change your current plan, unless you qualify for a Special Enrollment Period.

A Special Enrollment Period allows you to enroll outside of the standard dates if you experience a life event such as losing coverage, getting married, moving or having a baby.

What Is the Health Insurance Marketplace?

The health insurance marketplace is a shopping and enrollment service for medical insurance created by the ACA in 2010. It includes information on programs that help people pay for coverage, ways to save on monthly premiums and out-of-pocket costs, and other financial assistance programs.

The marketplace is a vital health insurance option for people with lupus because it allows access to a variety of health insurance plans and tools to compare them side-by-side. You can also see if you qualify for help paying for health insurance through a tax credit or subsidy. You can apply for coverage online, by phone or with a paper application. You cannot be denied coverage because you have lupus.

In addition to marketplace plans, federal and state programs may provide coverage. Medicare offers insurance for people over 65 or with disabilities, including those affected by lupus. Medicaid provides coverage for people with low incomes or disabilities, with eligibility set by each state. These programs can be important options to explore if you qualify.

Some people with lupus may also get coverage through employer-sponsored insurance (ESI), COBRA continued coverage, or student health plans, depending on their situation. Understanding every option can help you find the most affordable and comprehensive coverage.

What Kind of Plan Should I Choose?

It’s important to choose a plan that covers the type of care you are likely to need. This may not be the plan that costs the least upfront. If the care you need isn’t covered, then you will be responsible for the cost, which could be more expensive in the long run. You can find helpful advice on how to choose a plan in our Health Insurance Guide for People with Lupus. Think carefully about what you will need for your lupus care and choose a plan based on that.

If you need health insurance, you can explore your options at www.healthcare.gov. You can see if you’re eligible to get health coverage now, compare plan details and prices, and find out if you qualify for financial assistance or other programs like Medicaid and Medicare. Health insurance is the best way to make sure that you get the care you need when you need it.

When comparing plans, pay close attention to prescription drug coverage, specialist visit, prior authorization rules and annual out-of-pocket maximums – all of which can significantly affect people living with lupus.

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