UPDATED: JULY 21, 2023 | 3 MIN READ
Open Enrollment begins soon. Don’t go into it uninformed if you want to sign up for an insurance plan. Learn how it works, the cost, and what you need to know about individual health insurance coverage.
What is individual health insurance?
Individual health insurance is a health care plan you purchase directly through the marketplace or a carrier. Unlike an employer-provided plan, you can choose your plan and its coverage options.
If you’re self-employed, this is the only way to purchase health insurance because you aren’t eligible for group health insurance (employer-provided).
The Affordable Care Act (ACA) streamlined the process of buying health insurance for individuals and families by creating marketplaces. If you browse through several healthcare plans on the marketplace, you can select a plan based on your need and desired coverage.
Marketplace individual health insurance plans use a metal tier system to rank price, coverage options, and what you’ll pay. These are Bronze, Gold, Silver, and Platinum.
Bronze plans will be the cheapest and most affordable health plans but will have a high deductible. Some areas may also have an Expanded Bronze plan.
Health insurance marketplaces have specific enrollment times known as Open Enrollment. If you go through a private provider and not the marketplace, your health plan care typically starts the next month.
How much does individual health insurance cost?
The average cost for individual health insurance is around $430 a month. However, rates vary based on age, location, gender, coverage options, and chosen health plan.
If you’re eligible for financial assistance and don’t have access to employer-provided healthcare, you may pay less with a premium tax credit from the ACA. In 2022, the U.S. government increased subsidy sizes and expanded healthcare access to more people.
A premium is an amount you pay monthly to your insurance company. When you sign up for a health insurance plan, your carrier will outline your premium and the due date.
Premium costs differ by health benefits and carrier. The ACA prevents your insurance company from charging you a higher premium for a pre-existing condition, which makes it easier to afford a good healthcare plan.
Deductibles are one of the most important considerations when you sign up for health insurance. It’s the amount you must pay before your health insurance company starts to cover your medical expenses. Each plan has a deductible.
A copay is the amount you pay for a medical service, such as a doctor’s visit. It’s a set amount with each plan. Once you meet your deductible, you have a lower copay. Coinsurance works the same way, as it’s a percentage amount you pay for service after you complete the deductible.
Health insurance helps save on healthcare costs, especially if you anticipate regularly visiting the doctor. Out-of-pocket expenses are costs you pay without reimbursement.
The term also applies to deductibles, coinsurance, copays, and premiums. Each plan has a maximum out-of-pocket amount. After you reach your out-of-pocket max, your insurance company pays 100% of your covered services.
How to save money on individual health insurance plans
Start browsing the health insurance Marketplace to save money on your health insurance plan. You may use a state-run or the federal Marketplace, depending on your location.
The Open Enrollment period begins November 1 for 2023 coverage in the marketplace. During Open Enrollment, you can sign up for health insurance with one of your state’s carriers.
If your income is low or moderate, you may be eligible for tax credits, which can help you save each month on your healthcare plan. This also helps offset any tax penalties for no health insurance that your state may impose.
Another way to save money on your health insurance is to compare a plan that’s right for you carefully. You may want a plan with a low deductible because you anticipate needing a lot of care, and it won’t take long to reach the deductible.
If most of your medical needs are for general wellness, such as immunizations or wellness checkups, a low premium with a high deductible may be a better match.
Browse through the metal tier plans and compare premium amounts, deductibles, and out-of-pocket maximums to find the best plan for your needs.
How much is health insurance a month for a single person in the U.S.?
Without tax subsidies, the average health insurance premium cost for a single person is $438 for 2022 on the ACA. Your insurance premium may vary. This is just an average.
Can an individual get health insurance?
An individual can get health insurance. If you can’t get health insurance through your employer, using the health insurance marketplace is a great way to get health coverage. Sign up during Open Enrollment, or if you have unique circumstances, you may be eligible for Special Enrollment.
What’s the difference between individual health insurance and group health insurance?
Individual health insurance is insurance you purchase on your own from a carrier of your choice. Group health insurance is health insurance provided by your company or your spouse’s company. You don’t choose the carrier or coverage options of group health insurance; it’s yours.
What are the three basic types of health insurance for an individual?
There are three health insurance types. You may encounter them when you browse through the marketplace:
- Health Maintenance Organization (HMO): An HMO has a network of doctors and medical providers it covers. Care within the provider network is cheaper than out-of-network, with out-of-network care not covered except in emergencies. Specialist visits require a referral from your primary care provider (PCP).
- Preferred Provider Organization (PPO): With a PPO plan, you can access healthcare from providers within a network. Care costs less when you stay in the network, just like an HMO, except you don’t need referrals for specialist visits.
- Point of Service Plan (POS): A combination of a PPO and an HMO, POS plans have a network for providers. You may also go outside the network for care. If your PCP gives you a referral, your plan will help pay for the services.
Why is health insurance so expensive?
U.S. health insurance is expensive because it uses a pay-per-service design that’s exceedingly complex with several parts. Multiple factors determine your health insurance rates, including age and pre-existing conditions.
Finding individual health insurance
Individual health insurance is a great way to maintain your health and get treatment. Not only does it save you from expensive healthcare costs over time, but it also ensures you get affordable preventative care.
Thanks to the ACA, it’s easier than ever to sign up. If you’re interested in individual health insurance, you can browse and compare health insurance rates from providers in your area today using our tools.