How To Buy An Individual Health Insurance Plan
Heres your guide to when and how to buy individual health insurance and how to find health insurance quotes and information.
Most Americans get health insurance through their employer. However, individual health insurance is another way to get coverage if youre not eligible for an employer-sponsored plan or if your companys plan is too expensive or limited.
These plans let you buy individual health insurance on your own. provide similar benefits as most employer plans. Depending on your income, individuals and families may pay even less for individual health coverage than one through an employer.
You can buy an individual health insurance plan through the Affordable Care Act exchanges and outside the exchanges directly through insurance companies. You cant get denied for an ACA plan. The health law requires that insurance companies cover anyone who applies.
- You can buy individual or family coverage from the Affordable Care Act marketplace or directly from a health insurance company.
- ACA plans qualify for government subsidies that can reduce the cost of health insurance. No other plans qualify for those subsidies.
- Individual health plans offer comprehensive coverage, including emergency room and doctor visits, maternity care, prescription drug benefits and mental health care.
- You can enroll in an ACA plan during open enrollment or during a special enrollment period if you face a qualifying event.
The American Rescue Plan Act And Advanced Premium Tax Credit
For 2021 and 2022, the American Rescue Plan Act of 2021 changed how the advance premium tax credit is applied. The law increases premium tax credits for all income brackets for these years.
Here’s how it works. Previously, households with incomes that are more than 400% of the federal poverty level were not eligible for such tax credits. The new law allows families making more than 400% of the poverty level to claim premium tax credits.
There is still a limit to the program, but it works differently. Now, no family will pay more than 8.5% of their household income towards the cost of the benchmark plan or a less expensive plan. This means that many consumers will be eligible for higher tax credit amounts to help cover their Marketplace health plan premiums.
In practice, people across all household income levels will see lower premiums as a result of receiving more tax credits to reduce plan prices. Many low-income families and individuals will now have $0 premium plans to choose from.
This extension was automatically applied to all plans available through HealthCare.gov starting on April 1, 2021. This means that new consumers and current enrollees who submit an application and select a plan on or after April 1 will receive the increased premium tax credits for 2021 Marketplace coverage.
I Am Enrolled In A Va Health Care Program Would I Be Eligible For Assistance To Pay Health Insurance Premiums On The Marketplace If I Choose To Purchase Health Care Outside Of Va
Since VA care meets the standard for health care coverage, you wouldnt be eligible for assistance to lower your cost of health insurance premiums if you chose to purchase additional health care coverage outside of VA. However, you may still purchase private health insurance on or off the Marketplace to complement your VA health care coverage.
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More Providers In The Network
Another reason to shop for your health insurance off-exchange is the network of health care providers included in the plan. In some cases, health insurance companies are controlling their costs by limiting the provider networks for exchange plans.
So, you might have trouble finding a preferred provider organization plan on the exchanges. Instead, you might be limited to health maintenence organization and exclusive provider organization plans, which have restricted provider networks.
But if you shop off-exchange and ask an agent to review all options available, you would have many different plans from which to choose at that metal level, Freska says.
Your preferred doctor or hospital may not be included in the plan that looks best to you on the exchange. Some health plans, such as EPOs and HMOs, wont provide coverage if you go outside of their networks for care others provide only limited coverage, certainly less than you would get if you go to providers in network.
Buying off-exchange can give you access to larger provider networks.
If youre someone who has a chronic condition or specialist that you appreciate, it would be important to you to make sure that doctor or hospital is part of the network of any health plan you choose, says Kevin Coleman, head of research and data for HealthPocket, Inc. of Sunnyvale, CA.
Who Is Eligible For Health Insurance Marketplace
There are only a few requirements to be able to shop in the marketplace:
- You must live in the United States
- You must be a U.S. citizen, U.S. national or considered lawfully present
- You cant be incarcerated
- You cant be currently enrolled in Medicare
If you pass all four, youre OK to shop and enroll. But, when it comes to whether the health insurance marketplace is right for what you need, thats a different question.
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How To Get Individual Health Insurance
How can you buy an individual health plan? The health insurance marketplace, run by the U.S. Department of Health and Human Services and about a dozen states, is the ACA exchanges website that offers you a menu of your coverage options. The site lets you compare individual health insurance plans and find the best health insurance to buy for individual.
You simply enter your information, including your income, and the site provides your coverage options, including estimated costs. Thats the place to start when looking for your insurance options.
Not all insurers sell plans through the government-run health insurance marketplace. You can find more individual and family options by shopping directly through health insurance companies that offer plans outside the exchanges. That will take more work to compare the insurers, but you may also find a plan that better fits your needs outside of the exchanges.
Now, lets take a look at when you can buy individual health insurance and the types of plans and other options.
Part B: Information About Health Coverage Offered By Your Employer
Note, you will need to take the document, that is available via the link at the end of this paragraph, to your benefits/payroll/personnel office for completion if you choose to apply for coverage through the Marketplace. This document contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. .
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Whos Eligible To Use The Health Insurance Marketplaces
With the exception of people who are enrolled in Medicare coverage, virtually all Americans are eligible to use the health insurance marketplace.
But practically speaking, the marketplaces were designed to provide coverage for individuals and families who were either uninsured or already buying their own health insurance. This includes people who are self-employed, people who are employed by a small business that doesnt offer health benefits, and people who have retired before age 65 and are thus too young to be covered by Medicare.
The majority of non-elderly Americans get their coverage from an employer, which means they dont need to use the marketplace. They can choose to decline their employers coverage and select a plan in the marketplace instead, but they wont be eligible for financial assistance unless the employers coverage wouldnt be considered affordable and/or wouldnt provide minimum value.
Most non-elderly Americans who are eligible for Medicaid can use the marketplace to enroll in Medicaid, or at least to determine their eligibility for Medicaid. In some states, the Medicaid enrollment process is completed via the marketplace, while in other states, the marketplace sends the consumers information to the state Medicaid agency to finalize the eligibility and/or enrollment process.
Choosing A Health Insurance Plan
Reading the fine print is important when choosing health care plans. These questions may help:
- Can I go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? This is the amount you must pay each year before your insurance company will begin paying claims.
- Are there any co-payments? This is the amount of money you pay each time you receive medical services or a prescription.
- If there is a dispute about a bill or service, how is it handled?
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The Health Insurance Marketplace
If you don’t have health insurance through a job, Medicare, Medicaid, the Childrens Health Insurance Program , or another source, you can buy a plan on the Health Insurance Marketplace.
To be eligible to enroll in health coverage through the Marketplace, you:
- Must live in the United States
- Must be a U.S. citizen or national
- Must not be incarcerated
If you have Medicare coverage, youre not eligible to use the Marketplace to buy a health or dental plan.
The Marketplace was created as part of the Affordable Care Act of 2010, colloquially known as Obamacare. Most people can use the federal government’s marketplace to apply for and to enroll in health insurance, but 17 states, plus Washington D.C., have set up their own exchanges.
You’ll use a state health marketplace to enroll if you live in:
- Obesity screening
How Healthcaregov Works
Healthcare.gov is the health insurance marketplace operated by the federal government. It launched in 2013 as part of the Affordable Care Act. The marketplace allows you compare and apply for private health insurance policies.
Unless a state creates its own marketplace, its citizens will default to using the federal exchange. For residents in one of the 13 states with its own health insurance marketplace, healthcare.gov will redirect them to the appropriate state marketplace.
You need to create a free healthcare.gov account in order to search and enroll in a marketplace plan online. You can also sign up without an account by calling the insurance company, going through an agent or broker, using an enrollment partner website, or completing a paper application.
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In states using the federal exchange, you can also use healthcare.gov to see if you qualify for public health insurance programs like Medicaid or the Children’s Health Insurance Program .
For other types of insurance, such as life insurance, you may need to go through a broker .
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The Bottom Line On Off
In summary shopping around for quotes on health plans is a smart move every open enrollment. The more you understand what the private insurance market offers, the better your chances of finding the best plan for you. That being said, if you qualify for cost assistance your best choice will almost always be a subsidized marketplace plan.
Can I Still Enroll Through The Health Insurance Marketplace Even When Were Not In An Open Enrollment Period
Individuals with a qualifying life event can enroll in health coverage or change their coverage outside of the open enrollment period and have it be effective for that coverage year. This is called the Special Enrollment period. Qualifying life events include having a baby or getting married. Visit www.healthcare.gov/coverage-outside-open-enrollment to learn more about these qualifying life events and other circumstances for special enrollment.
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What Is A Non
Non-ACA Plan is a very generalized term that people use to describe anything that is not compliant with the ACA. The problem is that a lot of plans that arent actual insurance get lumped in like faith-based cost-sharing plans which are not insurance. There are also a lot of new plans from carriers that no one has ever heard of pushing plans that sound like the greatest thing since sliced bread. None of these have passed our sniff test and as a result, the only non-ACA plan that we recommend is Short Term Medical Insurance . Due to recent changes in the law, these plans are now able to be purchased for 12-36 months at a time.
What Are State Healthcare Exchanges
State healthcare exchanges, also known as state healthcare marketplaces, allow individuals and small businesses to compare and purchase health insurance options. Though offered by private insurers, these policies follow the coverage guidelines and criteria outlined in the Affordable Care Act. In 17 states and the District of Columbia, residents seeking such policies go through these state exchanges. Americans in other states purchase health insurance through the federal government’s marketplace.
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Individual And Family Health Plan Guide
This guide will help compare differences between ACA compliant plans and Non-ACA plans. Non-ACA plans can save you a great deal of money and offer greater access to providers. Having said that, Non-ACA plans arent for everyone. If you have significant health issues and very specific needs you may need to stay in an ACA plan. Keep reading for more information.
Non-ACA Short Term Medical plans
Cost* Those whose incomes are within the sweet spot can obtain sizable subsidies making their ACA plan little to no money.
Which Option Is Cheaper: Individual Health Insurance Or Group Health Insurance
Cost is a deciding factor for many when it comes to health insurance. The cost for both an employer-sponsored health insurance plan and an individual health insurance plan can vary greatly depending on several factors.
If you are an individual with access to employer-sponsored group health, the primary factors that may influence the monthly cost of your health insurance are income, location, size of family, and the percentage of your premium your employer pays, if any portion of it. According to the Kaiser Family Foundation , employers in the U.S. paid on average 72% of their employees family health insurance premiums in 2019. Proportionately, employees paid a relatively small amount of the family coverage premium, or, on average, $5,726 annually.
In a 2020 eHealth study, unsubsidized individuals paid onaverage $1,152 in monthly premiums for families , afigure essentially unchanged from 2019.
Depending on the percentage of the Federal Poverty Line you earn, you may be eligible for Affordable Care Act also known as Obamacare subsidies to help pay your monthly premium for an individual health insurance plan. Generally, if your household income is above 400% of the FPL you will not qualify for a tax credit subsidy. According to the KFF, the average monthly advanced premium tax credit received by marketplace enrollees in 2019 was $512.
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How Much Does It Cost To Buy Health Insurance On Your Own
Generally, the less you pay out of pocket for the deductible, copays and coinsurance, the more you spend on premiums.
Platinum plans charge harmer premiums than the other three plans, but you wont pay as much if you need health care services. Bronze, meanwhile, has the lowest premiums but the highest out-of-pocket costs.
When deciding on the level, consider the medical services you used over the past year and what you expect next year. For instance, if you plan on starting a family, consider how much out-of-pocket costs youll have to pay if you go with a Bronze plan.
eHealth reported the average monthly premium by metal level:
- Bronze — $448
- Gold — $569
- Platinum — $732
Bronze and Silver are the most popular plans — 39% have Silver plans and 36% have Bronze plans. Only 17% have Gold plans and 1% have Platinum plans.
Do I Have To Buy Health Insurance Through The Marketplace
You are not required to buy coverage through the marketplace. There is no longer a federal penalty for not having health coverage . And even when there was a federal penalty, people could choose to purchase their coverage off-exchange instead of buying a plan through the marketplace .
But if you dont buy your coverage through the exchange, you cannot obtain premium tax credits or cost-sharing reductions, even if youd otherwise be eligible for them. This is one of the primary reasons people shop in the marketplace, as full-price individual health insurance premiums would simply be too costly for most people.
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Where Do I Shop For Individual Health Insurance
If you decide not to buy health insurance through your employer, you can shop through the state or federal marketplace, directly from an insurance company, or through a broker like eHealth.While eHealth is not a government marketplace, you can compare a large range of coverage options and you can still qualify for premium tax credits if you buy an ACA-compliant plan.
If you decide not to buy health insurance through your employer, you can shop through the state or federal marketplace, directly from an insurance company, or through a broker like eHealth.
While eHealth is not a government marketplace, you can compare a large range of coverage options and still qualify for premium tax credits if you buy an ACA-compliant plan. eHealth also allows you to effortlessly compare all of your options so that you know youre getting the best plan. To start looking into your health insurance options, visit our website page, Individual and Family Health Insurance.