If you have an employer who offers you a health reimbursement arrangement (HRA), you have access to a personalized health benefit. With an HRA, you have the power to choose your own individual health plan. Once you select a plan and pay the premium, your employer reimburses you, tax-free, for that premium.
The freedom to choose your own policy is great for your healthcare. But it can be daunting to shop for your own insurance plan if you've never done it before. While there are several ways to shop for individual health insurance, the most common way is through the federal Health Insurance Marketplace or state exchanges.
In this article, we'll walk you through the five-step process of shopping and applying for Marketplace coverage. That way, you can choose the right plan for you and your family.
In this blog post, you’ll learn:
- How the Affordable Care Act helps those seeking affordable health insurance coverage.
- How to apply for individual health insurance, and which basic personal and financial information you need to get started.
- How your employer can provide a tax-free reimbursement for your insurance premium with an HRA.
Individual health insurance is a health plan individuals purchase for themselves from a public or private exchange. It can refer to self-only coverage that a person purchases for themselves or a family plan that covers an entire household. Either way, it's not job-based or offered by an employer. It’s also not selected or sponsored by an employer, unlike a traditional group health plan.
Individuals can buy these policies on their own or through a health insurance agent or broker. Brokers can help individuals understand and navigate insurers, health plan choices, and health insurance premiums.
Since the Affordable Care Act (ACA) went into effect, many Americans have shopped for affordable health coverage through online Health Insurance Marketplaces, which include the federal Marketplace and state-based exchanges.
Terry Green is the President of eSports Insurance1. As an insurance broker with more than 20 years of experience in the industry, he assures you that purchasing your own plan isn't as tricky as it may seem.
"The application process itself is typically straightforward," Green said. "Come prepared with information like your income, family details, and any medical conditions. Check if your doctors, hospitals, and prescription drugs are in-network for the plans you're interested in."
With the creation of the ACA, insurers can no longer deny health insurance to individuals with preexisting medical conditions. Those shopping for individual coverage may also have access to federal premium tax credits. These credits are available to those who qualify based on their income. This health insurance subsidy helps Americans with their monthly premium costs.
Additionally, the Marketplace only offers qualified health plans. This means they cover the ten essential health benefits. You may also be able to enroll in ancillary policies like dental and vision coverage.
Usually, you can only sign up for a health plan during the open enrollment period at the end of the year. This generally runs from November 1 through January 15. States with their own exchanges can have longer open enrollment periods, but they cannot begin after November 1 or end before January 15, thanks to new final rules2 released by the Departments of the Treasury and Health and Human Services in 2024.
Special enrollment opportunities exist if you experience certain qualifying life events. These special enrollment periods allow you to shop for a plan outside of the regular open enrollment period. Some major life events that would qualify you for a special enrollment period include:
There's also a low-income special enrollment period that gives low-income people access to affordable health coverage outside of the normal open enrollment period.
You can buy your individual or family policy from a public or private exchange. Private insurance exchanges are online resources a health insurance company, a licensed broker, or an insurance agent sets up. Public exchanges include the federal and state marketplaces. In the steps below, we'll cover how to apply for individual health insurance on the public exchanges.
The ACA created the online Health Insurance Marketplaces, both the federal Marketplace and state-based exchanges, to help Americans sign up for their own individual and family health insurance coverage.
To compare health plan choices, you'll need to see if your state has its own health insurance exchange. You can check on our state-by-state guide. If your state doesn't have its own exchange, you can find a Marketplace health insurance plan at HealthCare.gov3.
When you visit the federal or state public exchange, you'll need to create an account to get started.
Whether you're applying for a policy for the first time or renewing your current health insurance plan, the Marketplace website will walk you through several questions via online forms to help determine your age, income level, and location.
You can expect to provide the following information during the application process:
*The exchanges only ask these questions if you apply for federal financial assistance (i.e., premium tax credits, cost-sharing, Medicaid, CHIP coverage, etc.).
Aside from your tobacco use, there won't be any questions about your medical history. The ACA mandated that no one should pay more for insurance because of their health. So there's no need to worry about having any medical records on hand.
Completing the form should take 15–30 minutes. After that, you'll receive email updates on your application status.
You can also enroll in coverage over the phone or by mailing in a paper application4.
Once you've completed your application, you're ready to choose a plan. The website will display all the available plan options within four metallic tiers: bronze, silver, gold, and platinum.
If you're generally healthy and want low-cost health coverage, a bronze plan may be your best choice. A bronze plan will generally have the lowest monthly premium. But you'll pay more out-of-pocket when you receive medical care. This could be a good option if you don't plan on needing a lot of medical services but want coverage if you're in an accident.
Conversely, a platinum plan will generally have the highest monthly premium costs. But you'll pay the least when you receive medical services. This could be a good option if you have many medical needs or visit your doctor often.
It's important to note that these metal tiers have nothing to do with the quality of care you'll receive. They simply determine how you and your health insurance company will split your healthcare costs.
Green recommends focusing on coverage that matches your needs and budget. He said you should also compare plans and quotes from reputable insurance companies. If you need a little extra help in your decision-making process, he recommends working with a broker.
"For most people, purchasing individual health insurance is easier than expected if you do your research and get guidance from a broker," Green said. "We work directly with clients to compare plans, explain coverage, and help you avoid confusion."
Additionally, HealthCare.gov has a number you can call5 to talk to one of their health benefits navigators who can offer enrollment assistance. If your employer administers your HRA with PeopleKeep, you can get even more help with one of our personalized benefits advisors. Depending on your state, you can shop for an individual health insurance plan right from your PeopleKeep dashboard.
All health plans are “guaranteed-issue.” This means insurers accept all eligible individuals no matter what. So you won't need to wait and see if the insurer accepts your application.
Once you select a plan, you'll make your first payment before your coverage starts. In most cases, you'll get redirected from the Marketplace to your health insurance company's website to enter your credit card information for your first payment. Or, the Marketplace will bill you for your premium and forward the payment to your insurance carrier.
Once purchased, you'll receive an insurance card and documents by mail. Even if you leave your current job, your plan will stay with you since it's not tied to your employment as it would be with a group health insurance plan.
If your employer offers you a qualified small employer HRA (QSEHRA) or an individual coverage HRA (ICHRA), they can reimburse you tax-free for your health insurance premiums.
Depending on how they customize the plan, they may also reimburse you for other qualifying medical expenses, such as:
All you need to do is submit documentation to your employer that shows the following:
After your employer reviews and approves the documentation, you'll automatically get reimbursed every month up to your allowance amount. If your premium exceeds your monthly allowance, you'll simply pay what's left out of pocket. If your employer uses PeopleKeep, we review your expense submissions. This keeps your medical needs private while your employer only sees the amount of the reimbursement request.
Note: If you enroll in a health plan through PeopleKeep's integrated shopping experience, you won't need to manually submit your premiums for reimbursement. Our software will take care of that for you.
It's easier than ever to find affordable health insurance coverage that meets your unique healthcare needs. Whether you’re shopping through the Health Insurance Marketplace or a private exchange, you can find a plan that works for you. If you want the support of an expert, you can work with a licensed broker to select the right plan for you and your family.
If your employer offers you an HRA, you can use your allowance to pay for your monthly premium and other healthcare expenses. This makes your individual health insurance policy even more affordable than you may think.
This article was originally published on July 8, 2021. It was last updated on August 20, 2024.