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Frequently asked questions about
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.
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).
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 runs from November 1 through January 15. But DC and 17 states run their own enrollment platforms, and some of them have different deadlines.
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.
To get a clearer picture of your potential plan costs, it’s worth seeking personal assistance from a navigator or broker. (You can call one of healthinsurance.org’s partners at (866) 686-8071 to talk with a licensed, exchange-certified broker who can enroll you in an ACA-compliant plan.)
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.
During the open enrollment period for 2022 coverage, more than 14.5 million people signed up for coverage through the marketplaces (health insurance exchanges) nationwide. Most of those enrollees — more than 10.2 million — used the federally-run exchange (HealthCare.gov). Across those enrollees, total premiums averaged $594/month. But 92% of those enrollees were eligible for premium subsidies (premium tax credits) that averaged $524/month, covering the large majority of the total premium.
For 2021 and 2022, the American Rescue Plan significantly boosted subsidies and made them available to more people. So the subsidies available during the open enrollment period for 2022 coverage were larger than subsidies had 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 recently, you might be pleasantly surprised to see how affordable coverage for 2022 can be.
Finding affordable health insurance has become easier in recent years. The Affordable Care Act was designed to improve the quality of health insurance but also put a heavy emphasis on affordability. As of early 2022, nearly 13 million Americans were receiving income-based premium subsidies that offset the cost of premiums.
The American Rescue Plan – passed in 2021 – provided further financial relief through several health insurance provisions that made coverage even cheaper than it was under the ACA alone. The ARP enhanced the ACA’s premium subsidies and eliminated the upper income cap for subsidy eligibility, making subsidies available to more enrollees.
Another form of health insurance considered “cheap” is short-term health insurance, which can provide an affordable safety net for consumers while they’re in transition from one life event to another without a comprehensive health plan.
These temporary health plans offer lower premiums and a wide range of deductibles – but also offer many buyers immediate enrollment, and a degree of flexibility when it comes to providers, services, and plan duration. However, they are not suitable to serve as a long-term replacement for ACA-compliant major medical coverage.
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I really appreciate you taking the time to help out and explain things to people who need it the most.
Thank you, Louise! This is extremely helpful and makes me feel better prepared to navigate my transition.
Louise, Thank you so much for the clear and very helpful response. I’ve learned a lot from you on the subject.
Thank you, Louise for your detailed answer. Your first paragraph is exactly what we were looking for!
Thank you so much … this is one of the clearest articles on the income limits and subsidy amounts.
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Learn about health insurance coverage options in your state.
Our state guides offer up-to-date information about ACA-compliant individual and family plans and marketplace enrollment; Medicaid expansion status and Medicaid eligibility; short-term health insurance regulations and short-term plan availability; and Medicare plan options.
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