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Open enrollment for 2023 health coverage has ended in most states, but you can still enroll if you experience a qualifying life event
Individual health insurance refers to coverage in the United States that’s purchased by individuals who don’t have coverage through an employer-sponsored health plan or through government health plan such as Medicare, Medicaid, CHIP or Tricare.
This medical insurance is also referred to as individual/family coverage, because the plans can also be used to cover family members.
Right now, more Americans than ever are finding ACA-compliant comprehensive coverage with low premiums – and in some cases no premiums – thanks to the American Rescue Plan (ARP). The ARP, signed into law in 2021, included subsidy enhancements that have allowed an unprecedented number of Americans to qualify for premium tax credits – subsidies that substantially lower the cost of insurance. And the Inflation Reduction Act, signed into law in 2022, extends the subsidy enhancements through 2025.
These premium tax credits are based on your household income. Use the subsidy calculator below to see how much money you could save through premium subsidies.
This ACA-compliant coverage is more affordable and it’s required under the Affordable Care Act (also known as Obamacare) to include a long list of essential health benefits – such as doctors’ services, inpatient and outpatient hospital care, pregnancy and childbirth, mental health services, preventative care and prescription drug coverage.
Learn more about the ACA and its affordability provisions and read frequently asked questions about health insurance.
An enrollee’s cost and coverage will vary depending on which insurer they use and which metal level they choose: Bronze, Silver, Gold, or Platinum. (You can compare plans benefits and premiums by getting a free quote at the top of this page.)
Outside of open enrollment, you can still enroll in a new ACA-compliant health plan if you have a qualifying event that triggers your own special open enrollment (SEP) window.
That means you can shop for plans in the exchange (or off-exchange, in most cases) with premium subsidies available in the exchange for eligible enrollees.
Read our guide to special enrollment periods.
Americans who purchase individual health plans that are ACA-compliant through the marketplace in each state can in many cases achieve substantial cost savings through the Affordable Care Act’s premium subsidies (premium tax credits) and cost-sharing reductions.
The premium subsidies have been enhanced by the American Rescue Plan, resulting in larger and more widely available subsidies. And the Inflation Reduction Act has extended these subsidy enhancements through 2025, ensuring that coverage will continue to be affordable for the next few years.
Consumers can also purchase ACA-compliant coverage outside the marketplace (ie, “off-exchange“) nationwide, except in the District of Columbia, where individual health insurance can only be purchased through the marketplace. However, the premium subsidies and cost-sharing reductions are only available if a plan is purchased through the marketplace (this includes enrollments completed via a direct enrollment or enhanced direct enrollment entity).
Regardless of whether you purchase coverage on-exchange or off-exchange, your enrollment in ACA-compliant coverage is limited to the annual open enrollment period or to a special enrollment period triggered by a qualifying event.
In most states, the annual open enrollment period runs from November 1 through January 15. But DC and 17 states run their own enrollment platforms, and some of them have different deadlines.
A common way to compare individual health insurance plans is by the total cost – the total annual premiums plus the maximum out-of-pocket – that you’d incur with each plan. If you qualify for a premium subsidy, be sure to use the after-subsidy premium for each plan when you’re calculating how much the coverage will cost.
You can determine your after-subsidy premium by using your exchange’s plan browsing tool. It only takes a minute or two and doesn’t require any identifying data. You can also use our subsidy calculator to get a close estimate of how much you’d save on ACA-compliant coverage.
Depending on your household income, it’s also wise to consider additional cost savings through cost-sharing reductions (CSR) that are built into Silver plans. If your household income does not exceed 250% of federal poverty guidelines, you’re eligible for cost-sharing subsidies in addition to premium subsidies. CSR benefits are particularly strong if your household income doesn’t exceed 200% of the poverty level. If you’re in that range, a Silver plan will likely provide you with the best value.
In addition to costs, it’s also important to compare plans based on things like the covered drug list (formulary) and the medical provider network. These details can make some plans a better fit for your needs than others.
Plan availability and coverage options vary considerably from one area to another. Some parts of the country have only a single insurer that sells individual health insurance, while other areas have several different insurers and dozens or even hundreds of healthcare plans from which to choose.
The overall cost of a health policy includes premiums and cost sharing. Individual health insurance premiums vary greatly, depending on the applicant’s age, zip code, whether they use tobacco, the health insurance company they choose — and, most importantly, their household income (since premium subsidies are income-based). But unlike policies issued in most states pre-2014, premiums do not vary based on gender or an applicant’s medical history.
During the open enrollment period for 2022 coverage, more than 14.5 million people signed up for coverage through the marketplaces (or exchanges) nationwide. Most of those enrollees — more than 10.2 million — used the federally-run exchange (HealthCare.gov). Across those enrollees, total premiums averaged $594/month. But 92% of those enrollees were eligible for premium subsidies (premium tax credits) that averaged $524/month, covering the large majority of the total premium.
The American Rescue Plan has significantly boosted subsidies and made them available to more people, and the Inflation Reduction Act extends those provisions through 2025. So the subsidies available during the open enrollment period for 2022 coverage were larger than subsidies had been during previous fall open enrollment periods. And those larger subsidies will continue to be available for at least the next few years as well.
And the subsidies are also available to more Americans due to the elimination of the income cap for subsidy eligibility. If you haven’t shopped for medical insurance recently, you might be pleasantly surprised to see how affordable coverage can be.
Finding affordable health insurance has become easier in recent years. The Affordable Care Act was designed to improve the quality of health coverage but also put a heavy emphasis on affordability. As of early 2022, nearly 13 million Americans were receiving income-based premium subsidies that offset the cost of premiums.
The American Rescue Plan – passed in 2021 – provided further financial relief through several provisions that made coverage even cheaper than it was under the ACA alone. The ARP enhanced the ACA’s premium subsidies and eliminated the upper income cap for subsidy eligibility, making subsidies available to more enrollees. And those provisions will continue to be in effect through 2025, thanks to the Inflation Reduction Act.
Another form of coverage considered “cheap” is short-term health insurance, which can provide an affordable temporary safety net for consumers while they’re in transition from one life event to another without a comprehensive health plan.
These temporary medical insurance plans offer lower premiums and a wide range of deductibles – but also offer many buyers immediate enrollment, and a degree of flexibility when it comes to providers, services, and plan duration. However, they are not suitable to serve as a long-term replacement for ACA-compliant major medical coverage.
Find out how the American Rescue Plan has cut marketplace insurance costs for millions of Americans, and how the Inflation Reduction Act extends that assistance through 2025. Learn about $0-premium plans. Enroll now during open enrollment (through January 15 in most states).
Thirty-eight states and Washington, DC have expanded Medicaid under the ACA, and 21 million people are enrolled in expanded Medicaid (accounting for nearly a quarter of all Medicaid enrollees nationwide). See if your state expanded eligibility. Then, use our Federal Poverty Level Calculator to check your eligibility for enrollment.
Medicare’s open enrollment/annual election period (Oct. 15-Dec. 7) is an annual opportunity to reevaluate your coverage – whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage – and make changes or purchase new policies if they want to do so. Learn more in our 2023 Medicare Open Enrollment Guide.
Protect yourself from the soaring costs of dental procedures. Compare plan options to see premiums and deductibles that fit your budget.
I really appreciate you taking the time to help out and explain things to people who need it the most.
Thank you, Louise! This is extremely helpful and makes me feel better prepared to navigate my transition.
Louise, Thank you so much for the clear and very helpful response. I’ve learned a lot from you on the subject.
Thank you, Louise for your detailed answer. Your first paragraph is exactly what we were looking for!
Thank you so much … this is one of the clearest articles on the income limits and subsidy amounts.
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