Most Americans obtain health insurance through their employer. However, individual health insurance is a way to get coverage if you are not eligible for an employer-sponsored plan or if your company's plan is too expensive or too limited.
Individual plans offer benefits similar to most employer plans. Depending on your income, you may even pay less for a single health insurance plan than a single plan through your employer.
Individual health plans are available through the Affordable Care Act (ACA) exchanges and directly through exchanges through insurance companies. You cannot reject an ACA plan. Health law requires insurance companies to cover anyone who submits the request.
Now, let's take a look at when and how to buy individual health insurance and the types of plans and other options.
When to buy an individual health plan
You can purchase or make changes to individual health insurance during the open registration period. Open enrollment for most states is from November 1 to December 15 of each year. Countries with their exchanges generally offer open registry expansion.
For example, states had these extended open records for 2020 plans:
- California - October 15 to January 15
- Colorado - November 1 to January 15
- Capital - from November 1 to January 31
- Massachusetts - November 1 - January 23
- Minnesota: November 1 to December 23
- New York - November 1 to January 31
- Rhode Island - November 1 to December 23
The only other time you can get an individual health insurance plan is if you have a qualifying event that triggers a special registration period. These events can cause you to lose health coverage. The special registration period lasts 60 days.
Eligible special enrollment events include:
- marriage
- Have a child, adopt or place it for adoption or custody
- Moving
- Becoming a U.S. citizen
- Get out of prison
- Loss of other health coverage due to job loss, divorce, cobra expiration, or aging outside of parent's plan
- Disqualification for Medicaid or CHIP
- People who already have a market plan may be eligible for a special registration period if there is a change in income or family situation that affects eligibility for premium tax credits or cost-sharing support
- Gain status as a member of an Indian tribe
What do individual health plans cover?
Before the ACA, the coverage of individual health plans varied widely. Insurance companies can deny your insurance application or set prohibitive premiums if you have a medical condition.
Now, insurance companies must cover it regardless of your health history. You are eligible for individual health insurance even if you are pregnant or have a long-term condition, such as diabetes or a serious illness, such as cancer.
Insurance companies also cannot charge you too much due to medical conditions. Also, health plans cannot determine the amount of benefits you receive. You are also limited by the amount of costs you have to pay.
Additionally, all individual health plans must cover a standard set of 10 essential health benefits:
- Outpatient care, including visits to the doctor.
- Visits to the emergency room
- Hospital treatment
- Pregnancy and motherhood.
- Mental health and drug treatment.
- Prescribed medication
- Services and equipment for recovery after injury, or due to a disability or chronic condition.
- Laboratory analysis
- Preventive services, including health checks, immunizations, and birth control. Don't pay anything out of pocket for preventive care when you see health care providers in the health plan's network.
- Pediatric services, including dental and optical care for children.
Types of individual health plans
Individual health insurance plans do not differ in terms of benefits. However, plans differ on costs, how they are structured, the doctors who accept them, and the drugs they cover.
Health plans in the Affordable Care Act market are divided into four classes of minerals for ease of comparison. The categories are based on the percentage of the health care costs paid by the plans and their out-of-pocket share. Out-of-pocket costs include discounts, joint payments, and joint insurance.
Percentages are estimates based on the amount of health care that the average person will use per year.
- Bronze: The plan pays 60% of your health care costs. You pay 40%
- Silver: The plan pays 70% of your health care costs. You pay 30%
- Gold: The plan pays 80% of your health care costs. You pay 20%
- Platinum: The plan pays 90% of your health care costs. You pay 10%
In general, the less you spend in your pocket for deductions, copays and coinsurance, the more you will spend on insurance premiums. So in this case, Platinum Platinum imposes higher premiums than the other three plans, but you won't pay much if you need health care services. Meanwhile, bronze has lower premiums but higher costs than the pocket.
When deciding on a level, think about the health care services you used in the past year and what you expect next year. For example, if you plan to start a family, consider how much you would pay out of pocket if you opted for a bronze plan.
EHealth reported average monthly premiums based on metal level:
- Bronze - $ 440
- Silver - $ 481
- Gold - $ 596
- Platinum - $ 706
Bronze and silver are the most popular plans. Not many people have platinum plans.
When choosing an individual health plan, you should also think about what type of plan design. HMO plans are the most common plan design on the individual market. E-health estimated that 56% of individual plans are patient funds.
Patient funds include restricted provider networks. HMO members can only see doctors and get care at those network facilities. Also, you must refer a primary care provider to see a specialist.
PPO plans are the most common type of plan in an employer-sponsored health insurance market. Forty-four percent of PPO members have their PPO. However, only 15% of individual health insurance plans are PPOs.
PPOs are more flexible. You can see doctors in and out of your network. You do not need references to see specialists. However, PPOs have much higher premiums than health funds, so they pay more for this flexibility.
Individual health insurance benefits
People who purchase an individual health plan through ACA exchanges may be eligible for benefits that lower the cost of premiums.
The ACA allows tax credits for anyone with a disbursement plan whose income is less than 400% of the federal poverty level and subsidies to offset premiums for people whose income is less than 250% of the federal poverty level.
For 2020 health plans, the 400% threshold is $ 49,960 per person. Here are more examples:
- Family of 2 - Income less than $ 67,640
- Family of 3 - Income less than $ 85,320
- A family of 4 - Income less than $ 103,000
- A family of 5 - Income less than $ 120,680
The 250% threshold is $ 31,225 for one person and $ 64,375 for a family of four.
When searching for a plan through exchanges, the site will provide cost estimates for plans with benefits in mind.
Reminder: People with an individual health plan outside of the stock exchanges are not eligible to receive benefits.
Other options for people seeking health coverage.
Individual health insurance is an option, but there are other ways for a person to get coverage:
- Short-term plans: These plans do not offer the same benefits as a regular health insurance plan. Insurance companies are not required to provide comprehensive benefits. Most short-term health plans do not cover maternity, prescription, and mental health. Instead, you will have to pay for this care yourself. Short-term plans are not intended to be a long-term health insurance solution. You can only get it for one year and you can request two extensions. These plans are low cost, but have limited benefits. A handful of countries do not allow short-term plans, while others limit them to shorter terms.
- Medicaid: Medicaid is available to qualified people. Thirty-six states have expanded Medicaid, allowing people who represent 138% of the federal poverty level to be eligible for Medicaid. This level is $ 17,609 for one person, $ 23,791 for two people and $ 36,156 for a family of four. Medicaid plan costs depend on your income, but you will pay less for Medicaid from an employer or individual plan, if you qualify. Medicaid offers comprehensive health insurance despite low costs.
- Catastrophic Health Plans - If you are under age 30 or meet income requirements, you may qualify for a disastrous health plan. These plans offer lower premiums, but come with much higher discounts and out-of-pocket costs. The plans cover low-income youth and people who cannot afford a regular health insurance plan. The idea behind catastrophic plans is to cover them to avoid financial devastation if they have urgent health care needs. Unlike short-term health plans, which don't cover many services, disastrous plans generally pay for preventive services. However, catastrophic plans may not cover some preventive services and may limit doctor visits.
How to buy individual health insurance
The health insurance marketplace is the ACA exchange site, making it easy for people to compare individual health plans. Simply enter your information, including your income, and the site will provide you with your health plan options, including estimated costs and support factors. This is the place to start when researching your options.
Not all insurance companies sell plans through the government-run market. You can find more options by buying directly through health insurance companies that offer OTC plans. This will take a lot more work to compare insurance companies, but you can also find a plan that works best for you outside of the stock market.
When shopping for an individual health insurance plan, you should consider your healthcare needs and budget.
These are the questions to consider:
How is the plan built?
When choosing an individual plan on ACA exchanges, you will likely have multiple options that include different types of plans (bronze, silver, gold, and platinum). The plans are divided into out-of-pocket and premium costs.
Find out if you want a plan with lower premiums and higher costs than out-of-pocket or vice versa. Here is who can benefit from each type of mineral:
- Bronze - You want the lowest possible premiums and don't expect to need many health care services.
- Silver - You want low premiums, but you don't want to pay exorbitant money costs when you get care.
- Gold: You don't mind paying higher premiums, knowing you'll pay less than your pocket.
- Platinum - You want to cut your out-of-pocket costs as much as possible and don't mind paying higher premiums knowing that you will pay less for health care services.
Who on the net?
Check the Health Plan Network to make sure you have a good selection of hospitals, doctors, and professionals. Find your providers in the plan's network.
This is especially true if you get sick. Health funds have a restricted network and will not pay for the commercial care they receive.
If you get PPO, you can probably get care out-of-network, but it may be priced higher.
What is covered?
Check to see if prescription drugs are on the plan's list for covered drugs. Compare other benefits. Some plans may exceed or exceed the coverage imposed by law.
What is the reputation of insurance companies?
You will also need to verify consumer opinions and the company's financial position. You can check Insure.com's top health insurance companies for customer satisfaction reviews and A.M. The best financial strength ratings.
Choosing smart individual health insurance takes time and effort, but the task you do now will pay off later when you and your family need care.
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