Health plans

Individual & Family Health Insurance

Family and individual health insurance plans are policies people can purchase from health insurance marketplaces. In most cases, these purchases occur during the open enrollment period, but there are special circumstances that can trigger a special enrollment period. People who choose insurance plans from the marketplace are usually eligible for subsidies, which can significantly reduce the final payment amount.
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Who Is Eligible for Individual or Family Health Insurance Plans?

Virtually all adult, U.S. residents can purchase plans through the marketplace if they are not covered under other plans. Other health insurance sources might include coverage from employment or a spouse’s or parent’s insurance plan. Medicaid and Medicare are also viable options for people who qualify.

While Obamacare is a federal program, it is administered at the state level, so each state determines eligibility and the level of additional subsidies provided. These states tend to set income limits, which could vary based on the individual’s zip code and the size of their families

What Essential Health Benefits
Do These Plans Cover?

The marketplace and its policies are products of the Affordable Care Act, which is commonly called Obamacare. The ACA requires that marketplace insurance plans provide 10 primary benefits to qualify.

This refers to medical procedures that do not require an overnight stay in a health facility, especially a hospital. Examples include getting stitches or seeing a counselor.

If you suffer a serious and unexpected health incident, then you may get rushed to the ER. Examples include injuries sustained after a car crash or during a chemistry lab mishap.

Hospitalization describes a situation where someone becomes admitted to a hospital to receive treatment, which is usually lifesaving. Examples include brain surgery and chemotherapy.

When people suffer serious injuries that could lead to disabilities, rehabilitative services can help them cope, improve or even make full recoveries. Examples include learning to walk after a car crash.

Not all services related to substance abuse and mental health are covered by ACA plans, so be sure to check that the program complies before signing up. General examples include sessions with a shrink or checking into rehab.

There are medical services provided specifically for children that health insurance policies should cover. Examples include immunization and treating chickenpox.

Not all lab services are covered under the ACA. The primary ones you can usually count on include diagnostic imaging and X-rays, as well as blood and fluid tests.

As the name implies, this includes treatments for the birth of a child, care of a newborn and care of the mother. This may also include follow-up services.

If your doctor prescribes medication for any purpose, ACA insurance plans should cover or subsidize the cost. Examples include prescription meds for heart conditions or diabetes.

Regular checkups are the best way to maintain good health, so the ACA generally covers this too. These services include physical exams, stress reduction and weight management.

What Triggers Special Enrollment?

A sitting president or another authorized government official may re-open enrollment for special reasons, such as an ongoing pandemic. When this happens, it applies nationwide. There are also some individual events that could lead to special enrolment periods for you or your family. These include the following life events:

When you experience a life event that triggers special enrolment, you generally need to apply for insurance within 60 days. If the order comes from the sitting U.S. president, he or she determines how long the SEP lasts.

Gold and Platinum

These plans have high premiums, but lead to the lowest out-of-pocket costs. Seniors and people with pre-existing conditions tend to choose this plan.

Silver

These plans are sometimes eligible for cost-sharing reduction discounts for out-of-pocket costs. Premiums are average. They work well for most families and individuals on a budget.

Catastrophic and Bronze

This is the cheapest category of plans, but they have a high deductible. These plans are most suitable for young, healthy persons with no pre-existing conditions.

What Are the Different Tiers of Plans?

The government-run marketplaces tend to provide plans in several tiers. Here is some basic information to help you decide which one is right for you in virtually any state:

How Do People Enroll in Plans on the Marketplace?

To begin, you must find the relevant website for your state, such as HealthPlans.com. Most states use the existing Healthcare.gov website, but there are several that created separate state-based exchanges. For example, Georgia uses the federal website, but Nevada has Nevada Health Link. From there, the instructions will differ based on how each state structures the sign-up process. 

In most cases, you will need to wait for open enrolment or qualify for special enrollment. Then, the state may request information regarding age, sex, household size and income. From there, the state will tell you how many credits you qualify for — if any. You can then move forward with shopping for plans. Note that you may need to provide proof of the information submitted at a later date. For immigrants, this usually includes proof of residency.

At healthplans.com, we make it easy for people just like you to find family or individual plans that meet their needs.