Individual Health Insurance

Individual health insurance policies are those that you buy on your own. They are not part of employer health plans. These plans can cover a single person or an entire family.

The landscape of Individual health insurance policies changed in 2014 with the passing of the Affordable Health Care Act (ACA). The ACA standardized and increased the benefits provided by these policies and offered Americans more policy options. This law also guaranteed coverage for individuals and offered subsidies to help people afford the insurance coverage they deserve.

Types of Individual Health Insurance Plans

There are various types of plans, including preferred provider organization (PPO), health maintenance organization (HMO), point of service (POS) plans, and high-deductible health plans with a health savings account.

The PPO plans give you greater flexibility than other individual health insurance options. Visits to medical specialists do not require referrals from primary care physicians. But these plans do provide a greater percentage of coverage if you visit doctors in the plan network.

For HMO plans, you pick your primary care physician that manages your health care. But generally, you must choose from a network of hospitals and doctors. Typically, you bear a low copayment for office visits, but the plan generally doesn’t cover care from outside their network.

POS plans combine a little bit of the PPO and HMO options. These plans act like an HMO when you visit hospitals and doctors with their network but provides the option of using doctors outside their network as well. Note that POS plans normally require a referral to cover doctor visits outside their network.

The high-deductible health plans paired with a health savings account (HSA) feature a high deductible. So anything above this amount is available for coverage. But you are able to use funds from the HAS to cover medical expenses. And the contributions you make to the HAS are tax-deductible.

Who Is Eligible?

All individuals are guaranteed coverage through reputable health insurance companies. You cannot be refused coverage or be charged high premiums due to being sick or having a severe health condition like diabetes or heart disease. Prior to the introduction of the ACA, approval and coverage rates were not guaranteed, and many individuals did not qualify for individual health plans.

What Is Covered by Individual Health Insurance?

The introduction of the ACA required individual health insurance policies to provide coverage in ten areas, including prescription drugs, outpatient expenses, prenatal and maternity care, mental health care, and hospitalization costs.

What Is the Amount of Coverage Available?

There is no cap on the benefits you receive. This lack of restriction applies to both annual benefits as well as benefits over the life of the policy. There is, however, a cap to the amount of out-of-pocket expenses the policyholder pays.

Another advantage is that subsidies are available for people that qualify. Tax credits or subsidies are available to lower your costs.

What Is the Enrollment Period?

There is a limited enrollment period for individual health insurance policies. For example, the enrollment period in 2017 and 2018 ran from November 1 until December 15, though individual states offered varying extensions. Only during the enrollment period can individuals apply, unless you have exceptional circumstances such as getting married, becoming unemployed, or giving birth to a child.

Who Can Benefit from Individual Health Insurance?

Individual health insurance provides coverage for both individuals and families. And if your earnings qualify for discounts and lower out-of-pocket costs, individual health insurance provides you and your loved ones with additional security for all health care expenses at a reduced cost.

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