Frequently asked questions about individual health insurance
Updated: Jan 17
What is individual health insurance?
Individual health insurance refers to health insurance coverage in the United States that’s purchased by individuals who don’t have coverage through an employer-sponsored health plan or through government health plan such as Medicare, Medicaid, CHIP or Tricare.
Individual health insurance is also referred to as individual/family coverage, because the plans can also be used to cover family members.
How can I buy affordable individual and family health coverage?
Americans who purchase individual health insurance that’s ACA-compliant through the marketplace in each state can in many cases achieve substantial cost savings through the Affordable Care Act’s premium subsidies (premium tax credits) and cost-sharing reductions.
In fact, many consumers shopping for ACA / Obamacare plans in 2022 will be able to tap into these subsidies for the first time because the American Rescue Plan increased ACA premium subsidy availability at all income levels.
Consumers can also purchase ACA-compliant health insurance outside the marketplace (ie, “off-exchange“) nationwide, except in the District of Columbia, where individual health insurance can only be purchased through the marketplace. However, the premium subsidies and cost-sharing reductions are only available if a plan is purchased through the marketplace (this includes enrollments completed via a direct enrollment or enhanced direct enrollment entity).
When can I buy health insurance with ACA subsidies?
Regardless of whether you purchase individual health insurance on-exchange or off-exchange, your enrollment in ACA-compliant coverage is limited to the annual open enrollment period or to a special enrollment period triggered by a qualifying event.
In most states, the annual open enrollment period for 2022 health plans will run from November 1, 2021 to January 15, 2022. But DC and 17 states run their own enrollment platforms; several of them have opted for a January 15 end date, but there are also some with earlier or later deadlines.
How can I choose the best individual health insurance plan for my needs?
This article is a detailed overview of how to choose a health insurance plan that will best fit your needs. A common way to compare individual health insurance plans is by the total cost – the total annual premiums plus the maximum out-of-pocket – that you’d incur with each plan. If you qualify for a premium subsidy, be sure to use the after-subsidy premium for each plan when you’re calculating how much the coverage will cost. You can determine your after-subsidy premium by using your exchange’s plan browsing tool. It only takes a minute or two and doesn’t require any identifying data. You can also use our subsidy calculator to get a close estimate of how much you’d save on ACA-compliant coverage. If you are eligible for a premium subsidy, it’s also wise to consider additional cost savings through cost-sharing reductions (CSR) that are built into Silver plans. If your household income does not exceed 250% of federal poverty guidelines, you’re eligible for cost-sharing subsidies in addition to premium subsidies. CSR benefits are particularly strong if your household income doesn’t exceed 200% of the poverty level. If you’re in that range, a Silver plan will likely provide you with the best value. Plan availability and coverage options vary considerably from one area to another. Some parts of the country have only a single insurer that sells individual health insurance, while other areas have several different insurers and dozens or even hundreds of healthcare plans from which to choose.
How much does individual and family health insurance cost?
The overall cost of a health insurance policy includes premiums and cost sharing. Individual health insurance premiums vary greatly, depending on the applicant’s age, zip code, whether they use tobacco, and the health insurance company they choose. But unlike policies issued in most states pre-2014, premiums do not vary based on gender or an applicant’s medical history.
Across 11.3 million people who had effectuated coverage in the marketplace (health insurance exchange) as of early 2021, the average full-price premium was $575/month. But 86% of those enrollees were receiving premium subsidies, and the subsidies averaged $486/month — covering the majority of the average premium cost.
And that was before the American Rescue Plan significantly boosted subsidies and made them available to more people. Those subsidy improvements continue to be available for 2022. So the subsidies available during the open enrollment period for 2022 coverage are larger than subsidies have been during previous fall open enrollment periods.
And they’re also available to more Americans due to the elimination of the income cap for subsidy eligibility. If you haven’t shopped for health insurance since last fall — or a few falls ago — you might be pleasantly surprised to see how affordable coverage for 2022 can be.
For more understanding visit POLICY