Individual Health Insurance

Individual vs. group insurance

Individual health insurance policies are for people that cannot receive health insurance through their work. Some people refer to these plans as private health insurance.

• A policy through an employer is called Group health insurance.

A 2023 survey conducted by the Kaiser Family Foundation found that 93% of companies, with 50 ore more employees, offered health insurance.

The number fell to less than 47% for smaller companies with less than 50 employees.

The survey shows there are a lot of people who must find insurance on their own.

Individual

Individual health insurance may be purchased for an individual or for a family.

Family health insurance has been traditionally thought of as husband and wife plus children. Today, single parent families make up an ever increasing percentage of family health insurance plans.

♦ Historically individual health insurance plans with benefits similar to group plans have been more expensive.

Part of the reason being that group plans are often times partly paid for by the employer as a form of employee benefit. Larger employers can also negotiate better pricing.

Prior to the Affordable Care Act

A person was not guaranteed acceptance into an individual plan.

If there were any preexisting health issues a person was often times refused or forced to pay higher than normal premiums.

Many people even with minor health issues found themselves trapped in older benefit skimpy plans with rapidly rising premiums.

Insurance companies had the power and some abused it.

The ACA changed everything

Insurance companies now have to accept anyone regardless of health problems.

Their plans also have to meet minimum requirements when it comes to what they cover and what they pay.

Plans sold at the Marketplace must also be certified as being a Qualified Health Plan.

Subsidies in the form of premium tax credits make it possible for many people to now afford more benefit-rich plans.

When to buy

So that people would not wait until the day they became sick to purchase health insurance, the law sets limits as to certain times when an individual can enroll in coverage.

This period when everyone can enroll in a new plan or change their plan is called Open Enrollment.

A person may enroll in any plan during open enrollment. The main open enrollment occurs at the end of the year and is for coverage starting the new year.

There are times during the year that it is possible to enroll. These times are called Special Enrollment Periods and they are usually triggered by a life changing event like loss of employer-base health insurance or marriage.

Where to buy

Individual health insurance may be purchased through the Marketplace also known as the Exchange.

They may be purchased through an agent or even directly from most insurance companies.

If purchased through the Marketplace there is the possibility of qualifying for a premium tax credit to help subsidize and lower the premium cost.