Individual Health Plans

When exploring Individual ACA health plans, you’ll find they offer:

Essential Health Benefits: All plans must cover services like preventive care, maternity care, mental health services, and prescription drugs.

Pre-existing Condition Protections: Insurers cannot deny coverage or charge higher premiums based on your health history.

Subsidies & Tax Credits: Many individuals and families qualify for financial assistance to lower their premiums and out-of-pocket costs.

Metal Tiers: Plans are categorized into four metal levels based on how costs are shared between you and the insurer:

Bronze: Lowest premiums, highest out-of-pocket costs.

Silver: Moderate premiums and cost-sharing; eligible for cost-sharing reductions, if you qualify.

Gold: Higher premiums, lower out-of-pocket costs.

Platinum: Highest premiums, lowest out-of-pocket costs.

Anyone can purchase a plan through the Marketplace, but it’s especially beneficial for:

Individuals who don’t have employer-sponsored insurance

Self-employed workers

Part-time employees

Individuals whose income qualifies them for Medicaid expansion 
(in participating states)

Understanding the different terms you’ll run across with individual health insurance plans is important to determining costs. Here are the top three terms to know:

Copayments & Coinsurance: Your share of the cost of medical services after meeting your deductible

Deductibles: The amount you pay out of pocket before insurance starts covering expenses

Premiums: The amount you pay each month for coverage

Additionally, there are financial assistance programs in place that can lessen the burden of healthcare costs for individuals. Many people qualify for subsidies to reduce premiums and other costs. Assistance is based on your household income and size:

Premium Tax Credits: Available to individuals and families with incomes between 100% and 400% of the federal poverty level (FPL)

Cost-Sharing Reductions: Lower out-of-pocket costs for Silver plan enrollees with incomes between 100% and 250% of the FPL

Speak with someone from our team to estimate your eligibility for subsidies.

Note: If your income falls below certain thresholds, you may qualify for Medicaid or the Children’s Health Insurance Program (CHIP). Both of these programs provide free or low-cost coverage. Eligibility varies by state.

Open Enrollment Period (OEP)

The Open Enrollment Period typically runs from November 1st to December 15th each year. However, exact dates may vary by state, so it’s crucial to check your state’s Marketplace or connect with a licensed health insurance agent to confirm your deadlines.

During OEP, you can:

Enroll in a new health plan

Renew or change your existing plan

Special Enrollment Period (SEP)

If you experience a qualifying life event, you may be eligible for a Special Enrollment Period. Common qualifying events include:

Losing other health coverage

Getting married or divorced

Having a baby or adopting a child

Moving to a new coverage area

The SEP generally lasts 60 days from the date of the qualifying event.