Individual Health Insurance Plans
What is an Individual Health Insurance Plan?
An individual health insurance plan, also known as a personal health plan, is a health policy that a person or family can purchase on their own. It’s different from employer-sponsored health insurance and government-run programs like Medicare and Medicaid.
Who Should Consider an Individual Health Insurance Plan?
People who may consider an individual health insurance plan include:
- Part-time workers who don’t qualify for employer-sponsored coverage
- Self-employed individuals
- Early retirees
- College students and recent graduates
- Individuals who work for a small business that doesn’t offer healthcare benefits
What to Know About The Affordable Care Act
The Affordable Care Act (ACA)* has provided some protections for consumers in the individual health insurance market, such as preventing insurers from denying coverage for pre-existing conditions or charging more based on health status. The federal government also offers subsidies to lower premiums for people who meet certain income criteria.
What to Look For in a Health Insurance Plan
Individual health insurance plans are available in every state through the exchange or marketplace.
When shopping for a plan, it’s important to consider the following factors:
Plan Categories
Health insurance plans are categorized as Bronze, Silver, Gold, or Platinum, which indicate how costs are shared between the plan and the policyholder.
Monthly Premium
Policyholders pay monthly to their insurance company, even if they don’t use medical services that month. This is different from out-of-pocket costs.
Out-of-Pocket Costs
These include deductibles, which are the amount the policyholder pays for covered healthcare services before the insurance plan starts to pay.
Health Plan Categories
Health insurance plans are categorized as Bronze, Silver, Gold, or Platinum, which indicate how costs are shared between the plan and the policyholder. These categories don’t affect the quality of care.
Bronze
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles — the amount you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.
Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
Silver
- Moderate monthly premium
- Moderate costs when you need care
- Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of Bronze plans.
Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
Gold
- High monthly premium
- Low costs when you need care
- Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.
Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.
Platinum
- Highest monthly premium
- Lowest costs when you get care
- Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.
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