Health Insurance

The Complete Guide to Individual and Family Health Insurance

The Complete Guide to Individual and Family Health Insurance

Find Cheap Health Insurance Quotes in Your Area

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Individual and family health insurance are two similar types of health insurance plan that can be purchased on health insurance exchanges during the annual open enrollment period. Also known as private health insurance, these policies can cover individuals and families who are not already covered by another type of health insurance. When compared to other health insurance policies, an individual plan can cost $200 more per month, but many people are eligible for subsidies through the government.

What are individual and family health insurance?

Individual health insurance policies are available to individuals who currently are not enrolled in either a government program — Medicare or Medicaid — or a job-based policy. A family policy is identical to an individual plan except that it will cover multiple individuals. Often this will increase the deductible, out-of-pocket maximums and monthly premiums.

Individual and family health insurance plans are both required by the Affordable Care Act (ACA) to cover the 10 essential health benefits:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse care
  • Prescription drugs
  • Rehabilitative services
  • Laboratory services
  • Preventative and wellness services
  • Pediatric services

By selecting individual health insurance, you are guaranteeing that you will be covered if you need one of the services above.

For example, if you become pregnant, then your health insurance policy is required by law to cover all things needed during your maternity. This includes pregnancy therapy, check-ins with a gynecologist, as well as the delivery in the hospital.

How do I enroll in family health insurance?

To enroll in a family health insurance policy, you must apply and select a policy during the open enrollment period. This occurs on a yearly basis, typically from the beginning of November until the middle of December, but this can change depending on the year and your state of residence. If you miss the open enrollment period, then you would be unable to purchase or change your health insurance unless you qualify for a special enrollment period (SEP).

Enrollment occurs in either your state or the federal health insurance marketplace. Most states utilize the federal exchange found on the Healthcare.gov website. However, some states have state-based exchanges (SBE) where private health insurance companies offer policies. Below you can find your state along with the type of exchange it utilizes:

StateType of exchange
AlabamaFederal
AlaskaFederal
ArizonaFederal
ArkansasFederal
CaliforniaCovered California
ColoradoConnect For Health Colorado
ConnecticutAccess Health CT
DelawareFederal
FloridaFederal
GeorgiaFederal
HawaiiFederal
IdahoYour Health Idaho
IllinoisFederal
IndianaFederal
IowaFederal
KansasFederal
KentuckyFederal
LouisianaFederal
MaineFederal
MarylandMaryland Health Connect
MassachusettsHealth Connector
MichiganFederal
MinnesotaMNsure
MississippiFederal
MissouriFederal
MontanaFederal
NebraskaFederal
NevadaNevada Health Link
New HampshireFederal
New JerseyFederal
New MexicoFederal
New YorkNew York State of Health
North CarolinaFederal
North DakotaFederal
OhioFederal
OklahomaFederal
OregonFederal
PennsylvaniaFederal
Rhode IslandHealthSource RI
South CarolinaFederal
South DakotaFederal
TennesseeFederal
TexasFederal
UtahFederal
VermontVermont Health Connect
VirginiaFederal
WashingtonWashington Health Plan Finder
West VirginiaFederal
WisconsinFederal
WyomingFederal

Metal tiers of individual health insurance

When visiting the health insurance marketplaces, you will notice that individual health insurance policies are broken down into five different metal tiers:

  • Catastrophic
  • Bronze
  • Silver
  • Gold
  • Platinum

The metal tier of the policy does not denote a policy that provides more or less coverage. Every plan, regardless of tier, will cover the same health services, but the higher-tier plans will generally cover a greater portion of the cost of care, for a higher monthly premium. Below we have broken down each metal tier of private health insurance into greater detail.

Catastrophic and Bronze

Catastrophic and Bronze tier individual health insurance plans are the cheapest health insurance policies by monthly premium. However, this means that the deductible and out-of-pocket maximums are significantly higher when compared with other policies. This can lead to significant medical bills if you were to have a major health issue or accident, such as a surgery. For this reason, Catastrophic and Bronze individual plans should only be considered if you are young and healthy. Additionally, you can only enroll in a catastrophic health insurance plan until you're 30 years old, unless you're eligible for an exemption (usually related to financial hardship).

Silver

Silver plans have average premiums, deductibles and out-of-pocket maximums. For this reason, a Silver plan will provide financial stability in the event that you or a family member experiences a serious medical problem, while not breaking the bank when you pay the monthly premium. Silver plans are also eligible for cost-sharing reductions. This is a discount that will lower the amount that you have to pay in deductibles, copays and coinsurance.

Gold and Platinum

Gold and Platinum individual health insurance have the highest monthly costs, but offer the lowest deductibles and out-of-pocket maximums. Due to the low deductible levels, a Gold or Platinum plan will best suit older individuals who may have health conditions that require monthly care or costly prescription drugs.

How much does private health insurance cost?

The average cost of individual health insurance will vary depending on the state you live in, your age and the metal tier of coverage that you select.

For example, if you are 60 years old, then you would expect to pay upwards of 2.5 times more for your health insurance compared to a 21-year-old with the same policy. On the other hand, a 60-year-old in Texas may pay slightly less for the same Silver health insurance policy compared to a 60-year-old in New York.

Sterling Price

Sterling Price is a research analyst at ValuePenguin specializing in health and life insurance. He graduated from Syracuse University with a bachelors degree in Finance and Accounting and has previous experience as a licensed life insurance representative.

Editorial Note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.