How to get help choosing an individual health insurance plan

Whether you’re enrolling in an individual health plan for the first time or looking to switch your current plan, selecting an individual health insurance policy on your own can be difficult. Many individual health insurance plans are available on the marketplaces, but how do you know which one is right for you?

Choosing a health insurance plan doesn't have to be complicated or time-consuming. Nowadays, several marketplaces and organizations exist to help individuals compare health insurance policies, review network providers, answer questions and concerns, and virtually sign up individuals for a new benefit plan.

To help you get started on the right foot, let’s review everything you need to know about individual health insurance plans and the resources available to help you choose the right one.

Takeaways from this blog post:

• Public health exchanges and their customer service teams offer free, valuable resources for individuals looking for help comparing and purchasing the right individual health insurance plan.
• Brokers on private exchanges provide personalized, white-glove assistance in selecting an individual health plan and have extensive knowledge of different health plan options.
• Healthcare shopping companies offer support in comparing and enrolling in health insurance plans and acting as advocates for customers in resolving issues with their health insurers.

What is an individual health insurance plan?

An individual health insurance plan is a policy that individuals or families purchase independently, not through an employer like traditional group health insurance. You can buy individual health plans directly from a health insurer, a broker, or a state or federal health insurance exchange, also known as a marketplace.

When buying an individual plan, you can choose a plan with the features and level of coverage you want. You can tailor your policy to meet your and your family’s healthcare needs to ensure you get exactly what you want. Compared to employer-sponsored group health plans, many individual policies tend to be more affordable.

In addition to health insurance, you can purchase supplemental health plans, such as dental, vision, and disability insurance, on an individual basis. An employer may not offer these plans, so individuals without employer-sponsored supplemental benefits are often responsible for choosing and paying for them. Lastly, individual plans aren’t tied to employment, so you can keep your policy as long as you like.

What are the four categories of individual health plans?

When understanding individual health insurance, it’s important to know your terminology. You probably know many plan types exist, but there are also four primary categories—or metal tiers—that help define the plans you see within the health insurance marketplaces.

The plan categories are bronze, silver, gold, and platinum. The higher the health plan category level, the more the insurance company pays on average toward medical expenses. The lower the level, the less the insurance company will pay. On the other hand, the higher the tier, the higher your monthly premium amount can be.

The following shows the approximate share of medical expenses a health plan will cover compared with what you can expect to cover with each type of plan:

• Bronze: You pay 40%, and the health insurance issuer pays 60%
• Silver: You pay 30%, and the health insurance issuer pays 70%
• Gold: You pay 20%, and the health insurance issuer pays 80%
• Platinum: You pay 10%, and the health insurance issuer pays 90%

According to the Affordable Care Act (ACA), all marketplace health plans will cover the ten essential health benefits. It’s also important to note that your chosen tier doesn’t impact your quality of care. Additionally, tiers can have plans in any type of network. For example, there are gold HMO plans and gold PPO plans.

If you qualify, you can also purchase other types of plans, like catastrophic plans. These plans provide those who meet specific criteria with more affordable premiums in exchange for much higher deductibles.

How much does individual health insurance cost?

According to KFF, the national average monthly premium for a benchmark ACA plan in 2024 was $477¹. A benchmark plan is the second-lowest-cost silver policy available on the public marketplaces.

Due to the ACA, a health insurer can no longer determine your price based on gender or a pre-existing medical condition. However, the average monthly cost of individual health insurance can vary depending on factors like age, location, family status, tobacco use, preferred doctors, and metal tier plan type.

Depending on your annual income level and other factors, you can qualify for premium tax credits and other federal government subsidies through the public marketplaces, which can help you purchase individual coverage.

Who should purchase individual health insurance?

You may think you don't need health insurance if you’re young and healthy. But that’s not a good guideline to follow. If you’re self-employed, a small business owner, coming off your parent’s policy, or your job doesn’t provide employer-sponsored health insurance, you should consider purchasing your own individual health insurance plan.

Healthcare costs can be expensive, especially if you need emergency care. For example, the average cost of an inpatient hospital stay to treat heart failure is about $13,418. If you don’t have the money to pay out-of-pocket for unexpected medical costs or a chronic condition, you can quickly find yourself in serious medical debt.

An individual health insurance policy can cushion the blow if you experience a medical crisis or need urgent care. And because some plans, like a high deductible plan (HDHP) or bronze plans, typically have cheaper monthly premiums, affording an individual plan may be more cost-effective than you think.

If your employer offers an alternative type of health benefit, you may also want to purchase an individual plan. If your employer offers you a stand-alone health reimbursement arrangement (HRA), like a qualified small employer HRA (QSEHRA) or individual coverage HRA (ICHRA), you’ll need a qualifying medical plan that meets minimum essential coverage (MEC) to participate in the benefit. An individual health insurance plan from the marketplaces will help you meet this requirement.

Ways you can get help shopping for individual health insurance

If you’re ready to shop for individual health insurance, you may be wary if it’s your first time. But finding the right policy that fits your needs doesn’t have to be complicated.

There are many cutting-edge technologies to help you browse, compare, and enroll in a plan in a short amount of time. Many health exchanges and companies act with your best interests in mind and offer support on your way to achieving your health insurance goals.

The following platforms and organizations offer assistance and resources to help you pick the perfect individual health coverage.

Public health exchanges

A public health exchange is a marketplace operated by the federal government, a state government, or a government-contracted entity. Common public exchanges are the federal Health Insurance Marketplace and state-based Marketplaces.

Public exchanges allow individuals to shop, compare, and enroll in a qualified health plan online or by phone with personalized help from a licensed agent through the website. These healthcare agents aren’t associated with a specific type of health insurance or carrier. Therefore, they’ll provide you with unbiased assistance. The exchanges also have free customer support options to answer any questions.

One advantage of using a public health exchange is that it’s convenient and accessible for individuals. Shoppers can find the right health plan for them by filtering by budget, provider network, ZIP code, covered services, and health insurance company. You can also find out if you’re eligible for premium tax credits and other subsidies on public marketplaces.

Private health exchanges

Private companies—like insurers, insurance agents, and brokers—run private health insurance exchanges. While public exchanges only offer ACA-compliant health plans, private exchanges can offer ACA-compliant and other types of plans, meaning individuals have more coverage options to choose from.

Off-exchange individual health plans might come with household income eligibility thresholds for participants. So, consider working with a broker to ensure you’re selecting the best plan possible. Brokers have a wealth of experience dealing with insurers and have extensive knowledge of a wide range of health plans. They work with you directly to find affordable health insurance coverage for you and your family.

Once you find the health plan you want, you can enroll through your agent or broker rather than the insurance provider. However, if you enroll in a plan on a private exchange, you will not be able to take advantage of any cost-sharing reductions—such as premium tax credits—that you may be eligible for if you shop on a public marketplace.

Healthcare shopping companies

The last way you can get assistance choosing an individual health plan is through a healthcare shopping company. These organizations are similar to health insurance marketplaces: they help individuals shop, compare, and enroll in affordable health and supplemental insurance. Their support staff is often available year-round to work with your health insurer to resolve issues.

Healthcare shopping companies design their platforms to recommend different types of health insurance to their customers, consolidate plan information for easy comparisons, and act as advocates when booking appointments and disputing bills. Whether online or over the phone, these companies provide personalized insurance solutions and advocacy to their customers seamlessly.

Some top healthcare shopping companies are:

• Stride Health
• KindHealth
• GetInsured
• HealthSherpa
• Oscar Health

If your employer offers a QSEHRA or ICHRA through PeopleKeep, you can shop for a policy right from your online dashboard. This makes it easy to find coverage that works with your HRA.

Conclusion

There’s no right or wrong answer when it comes to picking the perfect individual health insurance policy. The public or private health exchange can help you find an individual policy. However, a personalized healthcare shopping company can also help you compare plan options, optimize health savings, and guide you through the shopping and enrollment process.

Though health insurance can be confusing initially, it's essential for your overall health and well-being in the long run, especially if you have a medical emergency. Luckily, experts and organizations are waiting to help you get the type of health plan you need.

This article was originally published on June 1, 2022. It was last updated on May 3, 2024.

1. https://www.kff.org/affordable-care-act/state-indicator/average-marketplace-premiums-by-metal-tier/?currentTimeframe=0&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Average%20Benchmark%20Premium%22,%22sort%22:%22desc%22%7D