Individual & Family Health Insurance
Health Insurance Outside of Medicare
If you are not yet eligible for Medicare, individual and family health insurance can help protect you from the cost of unexpected medical care while providing coverage for services such as doctor visits, hospital care, prescriptions, and preventive care.
Coverage may be available through the Health Insurance Marketplace or directly from an insurance company. The options available to you can depend on where you live, your household, and when you are applying for coverage.
Choosing a plan involves more than comparing monthly premiums. Your doctors, prescriptions, deductible, provider network, and potential out-of-pocket costs can all affect which plan makes sense for you.
ACA Marketplace Plans and Financial Assistance
Marketplace plans are individual and family health insurance policies offered by private insurance companies. Depending on your household income and other factors, you may qualify for savings that reduce your monthly premium or other out-of-pocket costs.
Financial assistance is tied to Marketplace coverage. Plans purchased outside the Marketplace do not qualify for Marketplace premium tax credits or other income-based savings.
Because eligibility and savings depend on your household information, it is important to compare the actual options available to you rather than assume one type of plan will always cost less.
Open Enrollment and Special Enrollment Periods
Marketplace coverage has an annual Open Enrollment Period. Outside that period, you may still be able to enroll or change coverage if you qualify for a Special Enrollment Period.
Qualifying situations can include events such as losing other health coverage, moving, getting married, having a child, or experiencing certain other household changes.
Timing matters. If you recently lost coverage or experienced another major life change, it is worth reviewing your options promptly so you do not miss an enrollment window.
The Monthly Premium Is Only Part of the Cost
A lower premium does not always mean a lower overall cost. Deductibles, copayments, coinsurance, and the plan's out-of-pocket maximum can all affect what you may spend during the year.
Provider networks also matter. Before choosing a plan, it is important to check whether your doctors, hospitals, specialists, and pharmacies participate in the plan's network.
Prescription coverage can vary as well, so your current medications should be reviewed against the plan's drug coverage whenever possible.
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