What You Need to Know About Individual Health Insurance

Many of us are used to having health insurance through our employer and we don’t give it much thought until we’re changing jobs, changing plans, or going on vacation. But what if you are self-employed or unemployed? What if you can’t get insurance from your employer? What if your company doesn’t offer health insurance? Many people in the United States have no other option but to buy health insurance on their own.

What is individual health insurance?

An individual health insurance policy is an insurance plan that covers only you and is not tied to a group or employer. There are different types of individual policies available, including short-term plans and catastrophic coverage. Most people will need comprehensive coverage that includes prescription drugs and preventive care. Also known as non-group or non-employer based coverage, these policies are regulated by each state’s insurance department.

What are qualified health benefits under the ACA?

The Affordable Care Act (ACA) requires individual and small group health plans to cover ten essential health benefits. These benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices. Vision and dental are no longer required in all states but some plans may still offer it.

How can I get an Individual Heath plan through Healthcare.gov?

There are 2 types of plans available: Bronze and Silver. When determining which plan is best for you, consider how much you’re willing to pay in order to lower your monthly premiums. While a Silver plan typically has a higher monthly premium than a Bronze plan, it also comes with higher out-of-pocket costs for doctor visits and other medical services.

How do I choose my individual health plan ?

Choose your individual health plan based on how much you expect to spend on out-of-pocket medical expenses in a given year. (You can also get an idea of what that number might be by looking at last year’s tax return.) There are two main categories of coverage: high deductible health plans (HDHPs) and low deductible health plans (LDHPs). HDHPs generally have lower monthly premiums, but require members to pay a higher share of their medical costs up front.

What’s the metal level all about, anyway?

The metal levels found in all ACA-compliant plans are bronze, silver, gold and platinum. Bronze plans have higher deductibles and co-pays than silver or gold plans, but they also have lower premiums. Silver plans sit right in between bronze and gold with a balance of premium and deductible (in most cases). Gold is more expensive but also has lower deductibles than silver or bronze.

Where can I get more information about individual health insurance plans?

One of the best ways to get information about what you’re buying and whether it’s a good deal for you is by speaking with an independent insurance agent. Agents are an unbiased source of information and can help ensure that you’re choosing plans and companies that are right for your situation. If you choose an individual health insurance plan, your coverage is guaranteed issue, meaning no one can reject your application because of pre-existing conditions.


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