Health insurance can help you cover medical bills & provides routine medical care that may help you catch & treat diseases before they get worse.

It’s a good investment in your health & it helps pay your medical bills.

Walmart offers full, comprehensive benefits that meet the requirements of the Affordable Care Act (ACA). You may also see these plans referred to as major medical policies or marketplace plans.

Marketplace plans cover 10 essential health benefits, coverage for people with pre-existing conditions & offer subsidies to help offset the cost of premiums. Medicare is available for those 65 & older.

Yes, there are other kinds of health insurance besides major medical or marketplace plans.

Short-term, limited-duration plans exist to help people bridge gaps in comprehensive coverage. There's also Medicare for those 65 & older & younger people with certain disabilities. For people with low incomes & who meet state guidelines for eligibility, there’s also Medicaid. Military members may qualify for other types of coverage as well, such as care through the VA or TRICARE.

On this page, we’re referring to major medical coverage that you have to buy yourself (i.e., you don’t get it through a job or another source).

The Affordable Care Act (ACA) is a healthcare law in the United States that requires major medical plans to cover 10 essential health benefits, ensuring that modern health plans are robust & comprehensive. It also protects people with pre-existing conditions by preventing health insurance companies from denying them coverage or charging higher rates based on medical history. The law also created subsidies, a form of tax credit that can bring down the cost of insurance for most people.

This is a very brief summary of the ACA, which radically changed healthcare in America.

Yes, & that’s thanks to the protections afforded by the Affordable Care Act. Under current healthcare law, major medical plans have to cover people with pre-existing conditions in order to be compliant with the law. Not only that, but you can’t be charged higher rates for the same coverage if you do have a pre-existing condition.

Other than tobacco use, your health history is not taken into account when you apply for a marketplace health insurance plan.

The ACA requires marketplace plans to cover 10 essential health benefits. They are:

• Preventive care

• Hospitalization

• Emergency care

• Outpatient care

• Prescription drugs

• Mental health care

• Pediatric care, including dental & vision for children

• Maternal care before, during & after labor

• Lab services

•Rehabilitative care & equipment

Health insurance companies still have leeway in the degree to which they cover these services & what that care looks like from a coverage point. But all ACA-compliant health plans have to cover these essential benefits.

Health insurance costs vary. How much you pay for a plan depends on different factors, including the company you buy the plan from, where you live & the kind of plan you get. For ACA plans, there are different tiers, too, that can affect your costs.

• Bronze: These plans cover about 60% of your medical costs. You can expect lower premiums but higher out-of-pocket costs with bronze plans.

• Silver plans cover about 70% of medical costs. This level is also the benchmark used for determining subsidies (tax credits that lower premium costs).

• Gold: Gold plans cover about 80% of medical costs. These plans tend to be more generous with coverage but cost more as a result.

• Platinum: The highest tier, platinum plans cover about 90% of your medical costs but are also the most expensive plans. When we say a plan covers a certain percentage of your healthcare costs, that’s not a literal percentage for every service.

A $100 doctor’s visit may still only cost $15 out of pocket regardless of your plan type. These percentages are based on actuarial values. It just means that overall, these are the plan values, covering about that much of your costs as a whole.

The Affordable Care Act made health insurance more affordable for more people.

Subsidies are based on income. The less you earn, the higher your tax credit. People who earn between 100% & 250% of the federal poverty level may also qualify for extra help in reducing out-of-pocket costs, not just premiums.

But even if you qualify for subsidies, you may not find the coverage affordable. It happens. If that’s the case, you can explore other options, like short-term health plans or a government program if you qualify for one (such as Medicaid or CHIP for your kids).

Health insurance plans typically include networks. These networks are filled with providers—hospitals, doctors, therapists, pharmacies, etc.—who contract with the health plan to charge lower rates to people with that plan.

Technically, you can see any provider you want regardless of your health plan. But if you want your plan to pay its share of your medical costs, you’ll need to stick to the network. Your plan may not cover out-of-network providers at all, & even if it does, the coverage will be less.

At the federal level, there is not a penalty if you don’t have health insurance.

But some states do have their own requirements, known as individual mandates. As of 2023, there are five states (plus the District of Columbia) with individual mandates to have health insurance: California, Massachusetts, New Jersey, Rhode Island & Vermont.¹

Unless you live in one of those states or D.C., you’re not required to have health insurance & won’t pay a penalty fee for going uninsured.

¹Forbes, “Does Your State Require You to Have Health Insurance?” August 18, 2022.

Major medical insurance is only available during the annual open enrollment period, which runs from November 1 through January 15 at the federal level (i.e., most states). Some states have different enrollment periods. But regardless of where you live, you’ll need to enroll in health insurance during the open enrollment period unless you meet the guidelines for a special enrollment period.

Special enrollment periods allow you to sign up for or change your health insurance due to significant life events, such as a job change, certain moves, marriage or the birth of a child.

If you’re outside of open enrollment & you don’t qualify for a special signup period, you may have to wait for the next open enrollment window to get coverage for the following year. In the meantime, you could consider short-term health insurance, which is available year-round. Medicaid & CHIP are also available anytime, but eligibility for these programs varies by state.

You can get major medical insurance from the federal marketplace, your state’s marketplace if it has one, through private insurance companies directly or through private marketplaces that represent different carriers.

You can also visit https://walmart.allstatehealth.com/ 24/7 to browse & compare local health insurance plans from nationwide carriers.

Or call 833-672-1911 (TTY 711), Monday through Friday, 8am to 8pm EST to speak with a licensed health insurance agent about your coverage options.