Find the right Individual and Family health care plan for you
Explore all the ACA marketplace health plans available in your area quick and easy on our partner site HealthPocket.com
Compare Individual and Family health care plans in your area on our partner site HealthPocket.com
For those who need a longer term plan, or may need more robust coverage, the Affordable Care Act (ACA) compliant Individual and Family plans, otherwise known as Obamacare, our partner site, HealthPocket.com, will show you options available.
ACA marketplace compliant individual and family plans offer major medical insurance which is a type of coverage that provides benefits for a broad range of health-care services, both inpatient and outpatient. This health insurance can help your budget to save you money on routine doctor's visits, prescription drug coverage, preventive care (no additional charge above the premium) and other medical services that are the other “10 essential health benefits.” The plan will typically come with costs such as a monthly premium, an annual deductible, copayments, and coinsurance.
What is an Individual and Family plan?
Individual and family plans have been around for decades. In recent years, the title has been given to health insurance plans that are compliant with the requirements of the Affordable Care Act.
These requirements include:
- Guaranteed issue regardless of pre-existing conditions
- Coverage for historically undercovered conditions such as maternity and mental health treatments
- Fixed premium/ age ratio
- Coverage for prescription drugs
Where and when can I enroll in an ACA health plan?
Those Affordable Care Act compliant health plans first became available to consumers on January 1st, 2014. These health insurance marketplace plans are available either through healthcare.gov, or through local state marketplaces depending on whether the state created their own or not. All available plans are available for comparison on our partner site HealthPocket.com. Plans are available to the general market during the Open Enrollment Period which lasts from November 1st to December 15th each year.
If you need to enroll in an ACA health plan outside of Open Enrollment, you may qualify for a Special Enrollment Period depending on your life circumstances.
Special Enrollment Periods
If you do not sign up for health insurance during the Open Enrollment Period that spans from November 1st to December 15th, you must wait until the next open enrollment period unless you have a qualifying event that makes you eligible for a Special Enrollment Period (SEP).
If you have a qualifying event, you can purchase health insurance or change your existing coverage without waiting until the next open enrollment. If you do not have a qualifying event, but do not qualify for a Special Enrollment Period than you should consider a Short Term Health Insurance Plan. In most states these Short Term Plans can help consumers span the gap to Open Enrollment.
What is a qualifying event for a Special Enrollment Period?
The standards of what determines a qualifying event are largely the same across the board. Special enrollment provisions are listed in detail on the HealthCare.gov website. There are two types of triggers for SEPs. Loss of eligibility for health coverage from either employer or public health insurance options, or certain life events.
Change in Family Size: Whether you get married, divorced, or have a child, you have the ability to add or remove family members for 60 days after the life event.
Change in Employment Status: If you lose your job, lose full time employment benefits, or begin employment with a company that does not offer health insurance you have 60 days to enroll in a new health insurance plan.
Change of Residence: If you move outside of your health insurance area, you can change plans but the premium and benefits for your plan may be different in your new area. You have 60 days from the time of move to enroll in a new plan.
There are many other factors that could allow for a Special Enrollment Period. If you believe you may need to change plans, AgileHealthInsurance highly recommends that you check out HealthCare.gov’s special enrollment tools.
Do I qualify for a subsidy for an ACA Individual and Family Plan?
If you make between 138% and 400% of the Federal Poverty Level and do not qualify for coverage through your employer, you could be eligible for a tax subsidy to make your health insurance more affordable.
For 2019 the Federal Poverty Level is:
- $12,140 for individuals
- $16,460 for a family of two
- $20,780 for a family of three
- $25,100 for a family of four
- $29,420 for a family of five
So: if you make under the figures below, you may qualify for a subsidy.*
- $48,560 for individuals
- $65,840 for a family of two
- $83,120 for a family of three
- $100,400 for a family of four
- $117,680 for a family of five
*These figures depend on the state you live. For more information, check the Healthcare.gov tool.