not through an employer
What Is Individual Health Insurance?
Individual health insurance is coverage purchased for yourself or your family rather than provided through an employer. Plans may be available through the Health Insurance Marketplace or directly from an insurance carrier.
Depending on your eligibility and household income, you may qualify for financial assistance that lowers your monthly premium or other out-of-pocket costs.
categories
What Can Individual Health Insurance Cover?
Coverage varies by plan, but comprehensive health plans may include:
- Primary care and specialist visits
- Preventive care and wellness services
- Emergency and urgent care
- Hospitalization and surgery
- Prescription medications
- Laboratory services and diagnostic testing
- Maternity and newborn care
- Mental health and substance-use services
- Rehabilitative services
- Pediatric care
Before enrolling, it is important to review the plan's provider network, prescription drug formulary, deductible, copays, coinsurance, and out-of-pocket maximum.
between jobs, pre-65
Who May Need Individual Health Insurance?
Individual health insurance may be appropriate if you:
- Are self-employed or own a small business
- Work for an employer that does not offer health benefits
- Are between jobs or recently lost employer coverage
- Are no longer eligible for a parent's health plan
- Retired before becoming eligible for Medicare
- Need coverage for yourself or your family
- Do not qualify for Medicare or another government health program
to compare
Understanding Your Plan Options
Health insurance plans vary in cost, provider access, and how expenses are shared. When comparing plans, consider:
Monthly premium
The amount you pay each month to keep your coverage active.
Deductible
The amount you may need to pay for covered healthcare services before the plan begins paying its share.
Copays and coinsurance
Your portion of the cost when you receive covered services or prescriptions.
Provider network
The doctors, hospitals, pharmacies, and other healthcare providers that participate in the plan.
Prescription coverage
The medications covered by the plan and the amount you may pay for each prescription.
Maximum out-of-pocket cost
The most you may be required to pay during the plan year for covered, in-network services, excluding your monthly premiums.
Gold or Platinum
Marketplace Health Insurance and Financial Assistance
Marketplace plans are categorized as Bronze, Silver, Gold, or Platinum. These categories describe how you and the insurance company generally share healthcare costs — they do not indicate the quality of care.
You may qualify for a premium tax credit based on factors such as your household income and family size. Some eligible individuals may also qualify for additional savings on deductibles, copays, and coinsurance when enrolled in a qualifying Silver plan.
or a qualifying event
When Can I Enroll?
You can generally enroll in Marketplace coverage during the annual Open Enrollment Period.
You may be able to enroll at another time if you qualify for a Special Enrollment Period following certain life events, such as:
- Losing qualifying health coverage
- Getting married
- Having or adopting a child
- Moving to a new coverage area
- Turning 26 and losing coverage through a parent
- Experiencing another qualifying change in your household or eligibility
Enrollment periods, deadlines, and eligibility requirements may vary.
we can help
Guidance with a Human Touch
Choosing health insurance involves more than finding the lowest monthly premium. The right plan should also account for your healthcare needs, doctors, medications, anticipated expenses, and financial situation.
We will help you:
- Review available health plan options
- Compare premiums and out-of-pocket costs
- Check provider and hospital networks
- Review prescription drug coverage
- Explore potential financial assistance
- Understand important plan benefits and limitations
Our goal is to provide clear, personal guidance so you can make an informed decision for yourself and your family.