What are individual health insurance plans?

Individual health insurance plans are purchased by people who don’t have major medical coverage through an employer-sponsored health plan or a government health plan such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP) or Tricare. Since 2014, all ACA-compliant individual health insurance plans have been required to cover essential health benefits (outpatient care, emergency services, hospitalization, mental health and substance use disorder services, prescription drugs, rehab services, lab services, preventive and wellness services, pregnancy, maternity and newborn care, and pediatric services) without annual or lifetime benefit caps, and they cover pre-existing conditions.[efn_note]“ Health insurance rights & protections ” HealthCare.gov, Accessed August 2023[/efn_note]

How much can I expect to pay for individual and family health insurance?

What you pay for coverage depends on your age, income, where you live and whether you use tobacco. Thanks to the Affordable Care Act, your medical history will not affect your premiums, and neither will your gender. Keep in mind that many people do qualify for income-based premium subsidies that offset a significant portion of their monthly costs.[efn_note]“ Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average ” CMS.gov, March 15, 2023[/efn_note] Across the more than 14 million people who received premium subsidies in 2023, the average after-subsidy premium was about $124/month.[efn_note]“ Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average ” CMS.gov, March 15, 2023[/efn_note]

Can health insurance that costs me less still provide comprehensive coverage?

Yes! The key is to understand that it’s income-based subsidies that keep the monthly premiums less expensive. You’re still buying ACA-compliant health coverage, but people who qualify for the subsidies do not have to pay the full premiums that go along with those plans. Instead, many Marketplace enrollees are eligible for subsidies that can cover a significant portion of the premium! Just know that even if your after-subsidy portion of the premium is less expensive, the coverage itself is still robust.

Do I qualify for ACA (Obamacare) subsidies?

Your eligibility for premium tax credits is based on the relationship between your household income and the federal poverty guidelines.[efn_note]“ Subsidized coverage ” HealthCare.gov, Accessed August, 2023[/efn_note] So your age, location, and income will all factor into determining your eligibility. But many Marketplace applicants will qualify for premium subsidies, and many also qualify for financial assistance to reduce their out-of-pocket costs.[efn_note]“ Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average ” CMS.gov, March 15, 2023[/efn_note] You can use our premium subsidy calculator to understand more about your subsidy eligibility. It only takes a few minutes and all you have to provide is your zip code, age, household size, and income.

When can I enroll in an ACA plan during the year?

You can enroll in an ACA-compliant individual or family health plan during open enrollment or during a special enrollment period . In most states, open enrollment runs from November 1 to January 15. Read our Guide to Open Enrollment. Special enrollment periods can be available at any time of the year, and are generally linked to a specific qualifying life event, such as losing health coverage, having a baby, moving to a new area, or getting married. Read our Guide to Special Enrollment Periods. But some people will find that they are eligible for enrollment year-round , simply due to their circumstances.

Do I qualify for Medicaid in my state?

Medicaid benefits and eligibility is different in every state. Click on your state on this map to learn more about eligibility rules where you live. Learn more about the federal poverty level and how it’s used to determine your eligibility for Medicaid. Use our federal poverty level calculator.

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Health insurance Marketplace

Looking for affordable health insurance? An ACA (Affordable Care Act) Marketplace plan might be a great option for anyone who doesn’t receive health benefits through work, is self-employed, retiring early, or who doesn’t qualify for Medicaid or Medicare.

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Short-term health insurance

Short-term health insurance may not offer all benefits of major medical but can offer temporary coverage during life transitions like job loss or missed enrollment. Find out if it’s right for you.

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Medicaid

Medicaid is a joint federal and state health insurance program for low-income individuals and families. Coverage is generally free or low-cost. Eligibility varies by state.

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Medicare

Medicare is federal health insurance for those 65 and older and younger people with certain disabilities, permanent kidney failure (ESRD), or amyotrophic lateral sclerosis (ALS). For added benefits like Rx coverage and help with out-of-pocket costs, many individuals buy Medicare Advantage, Medigap, Part D, and other supplemental plans.

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Dental insurance

Adult dental care isn’t typically covered by major medical insurance plans. Dental insurance can help with the cost of services such as cleanings, dentures, and costly procedures like fillings and crowns.

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Supplemental options

Supplemental insurance can help cover out-of-pocket medical costs and non-medical expenses that major medical insurance may not cover, helping with unexpected costs. Some plans offer cash benefits paid directly to the insured that can be used for medical bills, lost income, or daily living expenses during emergencies. Benefits may also be assigned directly to the provider.

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Proposed rule would bring sweeping changes to Marketplace enrollment, eligibility

A proposed federal rule issued this week would, if finalized, bring wide-ranging changes for the Affordable Care Act’s health insurance Marketplace, including a shorter open enrollment period in all states.

Is there still a penalty for being uninsured?

The ACA’s individual mandate penalty was assessed for the last time on tax returns filed in 2019; there’s no longer a federal penalty for being uninsured, but some states have their own mandates and penalties.

The most likely targets for Medicaid cuts

We look at likely ways the government might make cuts to federal Medicaid spending – and look at the populations that the cuts would likely affect.

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