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6 Questions to Ask When Selecting an Individual Health Insurance Plan

Written by: PeopleKeep Team
November 3, 2016 at 12:00 PM

As open enrollment for individual health insurance begins this week, many small business owners and their employees are eagerly awaiting final pricing and options. Some will be simply renewing their existing plan, while others will be shopping for a plan for the very first time.

If this is your maiden voyage into purchasing individual health insurance, you may find that understanding plan options can be a challenge. You may not even know which questions to ask.

To help, here are 6 important questions to keep in mind when selecting the best plan for you and your family.

FAQ: Questions to Ask When Selecting an Individual Health Insurance Plan

1. Do I need to shop for a new plan?

If your current individual health insurance policy is available next year, you should have received a letter detailing any changes being made to your plan and providing you instructions for renewal. Similarly, if your plan will not be available on January 1, you should have received a letter stating that the policy was being discontinued.

If you are satisfied with your current health plan, there is no need to shop for a new one. However, if you plan to renew your policy, it is very important that you file any and all paperwork requested from your insurance company by December 15 for coverage to continue on January 1.

2. What will my healthcare needs be in the coming year?

Are you aware of any planned medical expenses or issues? Are you pregnant? Do you hope to become pregnant? Are you managing any chronic illnesses? Do you need to have surgery? What prescriptions will you need? This is a good time to make a list of all of your known medical expenses so that you can choose a plan that best fits those requirements.

3. What type of plan will fit my budget and healthcare needs?

Typically high deductible health plans (HDHPs) are good options for people with little to no health issues. If you don’t go to the doctor often and aren’t on any prescriptions, this could be a good option for you because it offers lower premiums. The catch here is that you’ll pay everything out of pocket until you hit your deductible.

If you have chronic illnesses or know that you need monthly medications, you might find that selecting a higher tiered plan is a better option because it means lower out of pocket costs (Silver level being the most common). Only you know your budget, so be sure to take all expenses into account before making a decision.

4. Is my employer contributing?

Many small businesses contribute to employees’ individual health insurance premiums through a healthcare reimbursement plan (HRP) or health reimbursement arrangement (HRA). Knowing this information prior to shopping on the Marketplace will better prepare you because your budget will be more accurate. Perhaps a Gold plan would have been out of your price range prior to your employer’s contribution, but your HRP brings it within reach.

5. Can I keep my current doctors?

If you are currently managing a health issue and do not feel comfortable switching to a new doctor (or simply just don’t want to switch), then you’ll need to select a plan that allows you to do so — or gives you the option of seeing out-of-network doctors at a higher cost to you.

When searching for plans at Healthcare.gov, you’re able to enter your doctors’ names and any medications you are taking. The results page will be able to tell you if the qualifiers you entered are covered by each plan available to you. Remember that this isn’t always possible, as not all doctors accept Marketplace policies. Again, if this is the case, be sure to select a plan that gives you out-of-network options.

6. Would I qualify for the premium subsidies?

Some people qualify for premium tax credits for individual health insurance plans purchased on the Marketplace. The two major criteria are that 1) your employer cannot offer health insurance and 2) your income level must be below 400 percent of the poverty level, but be sure to check the Internal Revenue Services (IRS) website for a comprehensive list.

If you do not qualify for subsidies, you can sometimes find individual health insurance policies that are cheaper on the private market, but it is important to note that pre-existing conditions are not necessarily covered by non-Marketplace plans. Be sure to ask this question if you are interested in purchasing a plan on the private market.


Selecting an individual health insurance policy can be confusing, so it’s important to know which questions to ask when comparing plan options. Be sure to review all of your options carefully before choosing a policy. Remember that you must select a plan by December 15 in order to begin (or continue) coverage on January 1.

What questions do you still have about individual health insurance coverage through the Marketplace? Let us know in the comments below!

Topics: Individual Health Insurance, Health Insurance Marketplace