Individual Insurance Informational Page
Individual health insurance is a type of health coverage that a person purchases for themselves or their family, rather than getting it through an employer or group. It's designed to provide essential medical protection and financial security in the face of healthcare costs, from routine doctor visits to major emergencies.
Who Needs It?
Anyone who doesn’t have access to employer-sponsored or government-funded health insurance (like Medicare or Medicaid) may need an individual plan. This includes self-employed individuals, part-time workers, early retirees, students, and anyone between jobs. It’s also a good fit for those who want more control over their healthcare choices and plan options.
Where to Get Coverage
Individual health insurance plans are commonly purchased through the Health Insurance Marketplace (under the Affordable Care Act), directly from private insurers, or through insurance brokers. Depending on your income level, you may qualify for premium tax credits or cost-sharing reductions when enrolling through the Marketplace.
What Individual Plans Cover
Individual health insurance plans must comply with essential health benefit standards under the ACA. These include coverage for preventive care, prescription drugs, mental health services, hospitalization, maternity and newborn care, pediatric services, and more. Plans vary in network size, deductible amounts, and monthly premiums, so it’s important to compare options.
Why Individual Health Insurance Matters
Individual health insurance empowers you to protect yourself and your family with reliable access to medical care — without relying on an employer. Whether you’re self-employed, in a career transition, or simply want more control over your healthcare choices, individual coverage gives you the freedom and security to plan for your health on your own terms.
Customization and Flexibility
One of the biggest advantages of individual health insurance is the flexibility it offers. You can choose from different plan types (like HMO, PPO, or EPO) based on your budget, preferred doctors, and medical needs. Some plans even allow the addition of supplemental benefits like dental, vision, or accident insurance.
Cost and Premiums
Costs can vary significantly depending on age, location, health history, and the level of coverage selected. Plans are typically categorized into metal tiers (Bronze, Silver, Gold, Platinum), each offering a different balance between monthly premium and out-of-pocket costs. Bronze plans have the lowest premiums but highest deductibles, while Platinum plans offer the most coverage at the highest cost.
Tax Credits and Subsidies
If your household income falls within certain guidelines, you may be eligible for government subsidies that lower your monthly premium. These subsidies, known as Advanced Premium Tax Credits (APTC), are only available through the Health Insurance Marketplace. Cost-sharing reductions (CSR) may also lower out-of-pocket costs for eligible enrollees on Silver plans.
