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Health Insurance Glossary

Definitions for common health insurance terms

individual health insurance

DEFINITION: Individual health insurance is coverage that you purchase on your own, on an individual or family basis, as opposed to obtaining via an employer.

Individual health insurance can be purchased through the exchange, or off-exchange (directly from the health insurance carrier). Brokers and navigators are available in every state to help you enroll. There’s an annual open enrollment window for individual coverage. For 2017 and 2018 coverage, it runs from November 1 to January 31. Outside of open enrollment, you need a qualifying event to trigger a special enrollment period.

Individual health insurance was historically less expensive than group coverage (although employers usually pay a significant portion of the premiums for group coverage). This was because individual plans were medically underwritten in nearly every state prior to 2014, making pre-existing conditions an obstacle to getting coverage. In addition, the level of coverage was traditionally less than what group plans offered (for example, most group plans covered maternity, while individual plans typically excluded this benefit before the ACA mandated it).

All of this changed in 2014 though, when the bulk of the ACA’s reforms took effect. Individual plans became more benefit-rich with the introduction of the ACA’s essential health benefits, and also became guaranteed issue (although enrollment is limited to open enrollment and special enrollment periods). Subsidies are available to help millions of people pay a portion of the premiums, as long as they purchase through the exchanges.