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Your guide to buying individual health insurance

Thanks to special enrollment periods, millions of Americans can still buy ACA-compliant plans.

2018 Obamacare enrollment

With all of the hype about December 15 being the “last day of open enrollment,” it’s easy to understand why many Americans believe their opportunity to enroll in ACA-compliant coverage has now passed. But for millions, that’s simply not the case.

Millions can buy outside of open enrollment

One obvious example: a special enrollment period – in more than 20 states – for consumers who had an individual market plan but lost it because their insurer is left the marketplace. Those policyholders are eligible for an SEP that ends March 1, 2018. (In states that run their own exchanges, this SEP may not be available for on-exchange plans if the exchange mapped the enrollees to a new plan for 2018.)

And that special enrollment period – when involuntary loss of coverage is the qualifying event – is just one of a fairly long list of opportunities to enroll in ACA-compliant coverage outside of open enrollment. So before you give up hope on compliant coverage – and coverage that may very well include a subsidy – you should review our Insider’s Guide to Obamacare’s Special Enrollment.

The list of qualifying events that could result in a special enrollment period for you at any point during the year including:


Your reasons to enroll haven’t changed

Katya Powder

Read: Enrolling like their lives depend on it

If you’re wondering whether it still makes sense to enroll, consider this:

Four Americans who are still enrolling – like their live depend on it

Subsidies can still greatly reduce your plan costs

Depending on your household income, you may still be eligible for premium tax credits (aka, premium subsidies) and possibly cost-sharing reductions (CSR, aka, cost-sharing subsidies).

  • Premiums subsidies are still available in the exchange for people with income up to 400 percent of the poverty level. (For 2018 coverage, a single person can earn up to $48,240 and be eligible for the premium tax credit, and a family of four can earn up to $98,400). Calculate your subsidy. In 2017, 84 percent of exchange enrollees received premium subsidies that covered an average of two-thirds of the total premiums.
  • The only thing that has changed about premium subsidies for 2018 is that they’re larger than they were in 2017 in most areas, since average premiums increased and the subsidies grow to keep up with premiums.
  • Cost-sharing subsidies are also still available in 2018, even though the Trump Administration has eliminated funding for cost-sharing reductions. People with income up to 250 percent of the federal poverty level still have access to Silver plans with reduced out-of-pocket costs.

A few reminders about affordable coverage

Given the premium increases that took effect in most areas for 2018, it’s essential for anyone who is eligible for premium tax credits – or who might be eligible with an income fluctuation later in the year – to enroll through the exchange if and when they have a special enrollment period. Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.

In general, the only people who should be enrolling off-exchange are those who are 100 percent certain that there is no way they will qualify for a premium tax credit during the year – keeping in mind that the premium tax credits are available well into the middle class and are larger in 2018 than they were in 2017 in order to offset the higher premiums. (A family of four earning $98,400 is eligible for premium subsidies in 2018.)

Remember that you have an option to either have the premium tax credit paid directly to your insurer each month to offset the amount you have to pay in premiums, or you can pay full price for your coverage each month and claim the full premium tax credit when you file your tax return.

But either way, it’s only available if you enroll in a plan through the exchange. If you buy your plan off-exchange, there’s no way to claim the tax credit at the end of the year, even if your income ultimately ends up at a level that would have been subsidy-eligible.

Short-term and other Obamacare alternatives

We’re big fans of the Affordable Care Act and what it’s done to improve access to affordable coverage. We know that the law has delivered health insurance for millions who were unable to find affordable coverage on the individual market in the past. And – if at all possible – we strongly encourage our readers to take advantage of the comprehensive ACA-compliant coverage the law has provided.

At the same time, we do recognize that there is a segment of the individual market population that is facing daunting rate increases. We realize that their coverage options may be limited – at least for 2018 coverage.

To those consumers facing high premiums – perhaps because they’re in the coverage gap or their incomes make them ineligible for subsidies – we still would emphasize that some health coverage is always better than no coverage. The good news: there’s a wide range of short-term health coverage available that could provide a temporary safety net until you can find less expensive comprehensive coverage.

A guide to individual and family health insurance

As much as we love the Affordable Care Act, we know as well as anyone that the individual health insurance market continues to be a source of confusion for many consumers.

Since 1994, this web site has been a guide for consumers seeking straightforward explanations about the workings of individual health insurance – also known as medical insurance. Within this site, you’ll find hundreds of articles loaded with straightforward explanations about health insurance – and the health law – all written by a team of respected health insurance experts.

Our most popular resources include:


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

healthinsurance.org, your trusted guide for 23 years

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