How much does it cost to buy health insurance on your own?
Generally, the less you will have to pay out-of-pocket for deductibles, copays and coinsurance, (Copays and coinsurance are out-of-pocket costs for which you are responsible before your insurance company pays the rest of the bill. ) the more you'll pay in premiums. Platinum plans charge higher premiums than the other three plans but have lower deductibles. Bronze, meanwhile, has the lowest premiums but the highest out-of-pocket cost. copays and, the more you'll pay in premiums.
When deciding on the level, consider the medical services you used over the past year and what you expect next year. Our website has a calculator (Subsidy Calculator | Tailored BenefitsLLC) to help you determine the cost associated with each metal level and well as the subsidy that will be provided to reduce your monthly premium.
Bronze and Silver are the most popular plans -- 32% of insureds have silver plans and 56% have Bronze plans. Only 10% have Gold plans and 1% have Platinum plans.
What’s the cheapest health insurance?
The cheapest premiums in the ACA marketplace are bronze plans. If you are eligible for subsidies, your premium cost for silver and bronze plans may be similar. Non-ACA-compliant plans may be less expensive, but the benefits are limited. Be sure to compare them to the ACA plans before you decide.There are also very cheap plans called catastrophic plans. These have very specific eligibility requirements and have low monthly costs but very high deductibles.
When can you buy an individual health plan?
You can purchase or make changes to individual health insurance during the open enrollment period. (Open enrollment for plans through the Affordable Care Act runs between Nov. 1 and Jan. 15 in most states. During that time, you can choose a new health plan or make changes to your current one)
States with slightly different open enrollment periods include California, the District of Columbia, Idaho, Maryland, New Jersey and New York, and Rhode Island.
The only other time you can get individual health insurance coverage is if you have a qualifying event (A qualifying life event launches a special health insurance enrollment period. Getting married or having a baby are examples of qualifying events that allow you to make changes to your health insurance plan outside of open enrollment.) that launches a special enrollment period. These events may have caused you to lose your health insurance coverage. The special enrollment period lasts 60 days.
Special enrollment qualifying events include:
• Getting married
• Having a baby, adopting a child or placing a child for adoption or foster care
• Moving
• Becoming a U.S. citizen
• Leaving incarceration
• Losing other health coverage due in the past 60 days to job loss, divorce, COBRA expiration or aging off a parent’s plan
• Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
• Change in income or household status that affects eligibility for premium tax credits (A premium tax credit is a federal credit that you can claim to help decrease your monthly costs for health insurance.) or cost-sharing subsidies
• Gaining status as a member of an Indian tribe
People with income up to 150% of federal poverty level ($19,320 for a single person, $32,940 for a family of three) are eligible for a special enrollment period each month. The Centers for Medicare and Medicaid Services estimates that about one-third of marketplace plan members qualify.
Do you need individual health insurance?
If you aren’t eligible for employer-sponsored health insurance, Medicare, Medicaid, veteran’s benefits or any other government program, you should buy individual health insurance. You can buy individual health insurance through the ACA marketplace, as well as non-ACA policies through brokers and directly from insurance companies.
What do individual health plans cover?
ACA marketplace Individual health insurance plans offer comprehensive coverage. ACA marketplace plans have to offer coverage to you regardless of your health history. You qualify for individual health insurance even if you’re pregnant or have a long-term condition like diabetes or a serious illness, such as cancer. ACA marketplace health plans can’t cap the amount of benefits you receive and limit out-of-pocket costs you have to pay in a year.
In addition, all ACA marketplace individual health plans must cover a standard set of 10 essential health benefits:
· Outpatient care, including doctor’s visits
· Emergency room visits
· Hospitalizations
· Pregnancy and maternity care
· Mental health and substance abuse treatment
· Prescription drugs
· Services and devices for recovery after an injury or due to a disability or chronic condition
· Lab tests
· Preventive services, including health screenings, immunizations, and birth control. You pay nothing out of pocket for preventive care when you see health care providers in your plan’s network.
· Pediatric services, including dental and vision care for kids.
Plans that are not ACA-compliant are available directly from insurance companies. They’re generally less expensive, have limited benefits, and can decline to offer coverage based on your health history.
How to choose an individual health plan
There are different types of individual health plans. Plans in the ACA marketplace are divided into four metal tiers to make comparing them easier. The tiers are based on the percentage of medical costs the plans pay and the portion you pay out of pocket. Out-of-pocket costs include deductibles, copayments, and coinsurance.
Plan Pays You Pay
Bronze 60% of healthcare costs 40% of healthcare costs
Silver 70% of healthcare costs 30% of healthcare costs
Gold 80% of healthcare costs 20% of healthcare costs
Platinum 90% of healthcare costs 10% of healthcare costs
The percentages are estimates based on the amount of medical care an average person would use in a year. Platinum plans, which pay 90% of healthcare costs, are more expensive than silver plans that pay 70% of healthcare costs. Not all providers accept every plan.
Individual health insurance subsidies
People who buy an individual health plan through the ACA exchanges may be eligible for subsidies that reduce the cost of premiums.
The ACA allows tax credits and subsidies. Only people with household income below 400% of the federal poverty level are eligible for subsidies.
The Inflation Reduction Act of 2023 expanded subsidies through 2025. When you search for a plan through the ACA exchanges, the site provides cost estimates that include subsidies.
Reminder: People with an individual health plan outside of the exchanges aren’t eligible for subsidies.
Important criteria to consider when deciding on a plan
When shopping for an individual health insurance plan, the most important things to consider are your health care needs and budget.
· How much flexibility do you need?
You want to consider the type of benefit design. They include the following:
Health maintenance organization (HMO) plans are the most common plan design in the individual market. HMOs include restricted provider networks. HMO members can only see doctors and get care from facilities in those networks. Also, you need a primary care provider referral to see a specialist.
Exclusive provider organization (EPO) plans don’t allow you to get care outside of the network, but you also don’t need a referral to see a specialist.
Preferred provider organization (PPO) plans are more flexible. You can see doctors both in your network and outside the network. You don’t have to get referrals to see specialists. However, PPOs have much higher premiums than HMOs, so you pay more for that flexibility.
· Are your providers in network?
Check the health plan's network to make sure it has a good selection of hospitals, doctors and specialists. Look for your providers in the plan’s network.
This is especially true if you get an HMO. HMOs have a restricted network and won’t pay for the care you receive outside of the network.
If you get a PPO, you’ll likely be able to get out-of-network care, but it can come at a higher price tag.
· What does private health insurance cover?
Check to see if the prescription drugs you take are included in the plan's list of covered medications. Compare other benefits. Some plans may go above and beyond coverage mandated by law.
In conclusion, selecting the appropriate plan that suits your requirements may seem daunting. However, our extensive knowledge, proficiency, and advice are here to assist you in making a decision. Entrust the guesswork to us, and rest assured that you will receive a health plan customized to your needs.