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

The ACA Marketplace allows individuals and families to shop for and enroll in ACA-compliant health insurance plans. Subsidies may be available based on household income to help lower costs.¹

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Short-term health insurance

Short-term health insurance provides temporary coverage intended to fill a gap between health plans. These plans typically offer lower premiums but do not provide all of the essential health benefits offered by ACA Marketplace plans.¹

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Medicaid

Medicaid is a joint federal and state public health insurance program that provides coverage for low-income families and individuals. It covers a broad range of health care services, which varies by state.¹

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